The week before is a dreaded week for anyone who experiences a period. For some, it’s a week filled with irritation, bloating, and the itching feeling that something is horribly, horribly wrong. Premenstrual Syndrome (PMS) is a group of emotional and physical changes that occur in a person right before their period. Some of these changes include irritability, anxiety, crying spells, bloating, and weight gain. 

For Dada*, 30, she first noticed that her ‘usual’ PMS symptoms were a little more than that at the age of 26. “I was in a car that was on Third Mainland Bridge, and I nearly jumped into the water. I was so scared because it felt so real; I could clearly see myself doing that. The only thing that stopped me was the fact that I thought about how cold the water would be.”

PMDD (Premenstrual Dysphoric Disorder) is a severe form of PMS, and suicidal thoughts are one of its symptoms. It causes intense physical and emotional symptoms every menstrual cycle in the week or two before your period. Symptoms often abate as soon as the period comes. We spoke to Clinical Psychology Researcher Juliet Obaniyi about PMDD and how it increases suicidal ideation in women.

What is PMDD?

PMDD affects roughly 5.5% of women of reproductive age; that is, 1 in every 18 women has PMDD. To get a diagnosis, at least five symptoms have to show up in the final week before a period, ease off within days of the period starting, and disappear in the week after the period starts. Because so many conditions can mimic it, doctors are meant to confirm the pattern with daily symptom tracking across at least two cycles before calling it PMDD. Most women never get that far.

The “just” in “it’s just PMS” is where the trouble starts. Women with PMDD have almost seven times the odds of attempting suicide, and almost four times the odds of experiencing suicidal ideation, compared to women without premenstrual disorders.

For Dada*, those two weeks before her period meant she was fighting her mind in addition to all the physical symptoms. “I would literally be in a fetal position, crying, and my mind would tell me how worthless and useless and stupid I was, and how I should kill myself because I wasn’t worth the time and space and nobody would love me for me,” she says. “It would stay for two weeks. I’d feel fatigued and exhausted, easily irritated and extremely emotional. It was like my nerves were exposed.” She would start fights with her sister and her partner at the time, and she believes the fog of it kept her in a toxic situationship far longer than she should have stayed. At work, she would lock herself in the toilet and cry for hours, “trying so hard not to die.” She cancelled plans because she felt drained and unworthy of being around people. “There have been times when I thought I was actually going to die. I’ve almost cut myself multiple times.”

For years, she didn’t have a name for any of it. “I didn’t think of PMDD until two years later, when I saw a post on X (fka Twitter). I thought it was just stress. I didn’t even track the frequency of my cycle until I was 27, and even then, I thought it was just usual period nonsense, because it would stop immediately when my period came.”

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The pattern of symptoms that build before a period and lift almost as soon as it arrives is one of the signature tells of PMDD, and one of the reasons it hides so well. Researchers now understand it as a sensitivity in the brain’s response to the normal hormonal changes of the menstrual cycle, not too much or too little of any hormone. The hormones of someone with PMDD would look perfectly ordinary on a test. What differs is how the brain reacts to them, and because the reaction is timed to her cycle, it is easy to mistake it for stress, a bad week, or a personality flaw.

Ibukun*, 23, an artist, spent years doing exactly that. She had always had depression, so when things got dramatically worse in the days before her period, she filed it under her existing diagnosis. “I just thought that was me being me,” she says. “I wasn’t very good at relationships, so I always thought it was a me problem. I just thought,” Oh, my depressive episodes get worse before my period. Cool.” 

In that week, she would stay in bed, struggle with basic hygiene, cry at everything, and pick fights with the idea of cutting people off entirely. “Every time I have an issue with a friend before my PMDD hits, I just consider cutting them off when I’m in a PMDD rut.” 

When she was younger and severely depressed, that same week came with self-harm. “A week before my period, I would constantly cut my arms. I’ve stopped that, thank God.” She only learned PMDD existed in 2021, when a friend posted about it, and she educated herself; she was formally diagnosed in therapy in 2023. Even now, she is unmedicated. “I’m not medicated or anything. I’m just aware that okay, yeah, it’s PMDD, and I rawdog it.”

Adesuwa*, 26, also had to find the word herself. The first time she noticed something was wrong was in 2020, and when she told a friend how she was feeling, the friend ‘jokingly’ told her to kill herself. She assumed it was the pressure of school. Her worst days bring body weakness that keeps her in bed, anger at the world and then at herself, and a depression deep enough that she thinks about dying. Her darkest moment came while cooking, when she caught herself wishing the gas would explode and kill her. Her period arrived less than an hour later. Like many Nigerians, she read about PMDD online and immediately recognised herself in it. Naming the feeling was her first step to coping. She sees a therapist now, and while she has no formal diagnosis, her therapist gives her techniques that help.

Some women never get that close to an answer. Funmi*, 23, started experiencing worsening anxiety and feelings of low self-worth about two weeks before her period, around the age of 20, and she dismissed it herself. “I really just thought this was what everyone experienced when they said they experienced PMS,” she says. She has no official diagnosis and had never spoken to anyone about it until last year. Her lowest point came during her medical board exams, when worsening premenstrual symptoms collided with exam anxiety. “It was such a haze, honestly, and I can’t even say how I got through it. It’s a blank space in my memory.”

The women who did seek medical help often came back with nothing useful. Dada* was repeatedly told it was stress and that she should improve her diet and exercise more. “The gynaecologists kept saying it was normal, which is crazy,” she says. She was only diagnosed in the end because her therapist was working carefully to rule out ADHD and autism. “I wish women weren’t always dismissed with ‘that’s how it is’,” she says. “It irks my soul every time I hear it.”

Why is Getting a PMDD Diagnosis Hard?

Like most mental disorders, PMDD doesn’t come alone, and that is one reason it hides for so long. Between 42% and 49% of people with premenstrual disorders also live with a mood disorder such as depression or bipolar disorder. An existing diagnosis can become a hiding place. Ibukun spent years filing her worst weeks under the depression she already knew she had, because a worsening of what you already have does not look like a new condition.

The overlap with ADHD is even sharper. Provisional PMDD appeared in 31.4% of women with an ADHD diagnosis, against 9.8% of women without ADHD. Women carrying ADHD together with depression or anxiety were the most at risk in the entire sample, with more than four times the risk of women without ADHD. Dada*’s experience sits inside this pattern: her PMDD was only named because her therapist was carefully ruling out ADHD and autism first.

PMDD is also genetic. Women with mothers and sisters who experience PMDD are more at risk of developing the disorder. 

PMDD rearranges lives, especially in Nigeria, a country where women’s diagnosis is a Herculean task. Funmi missed classes for days at a time, absences she couldn’t afford and had to scramble to make up for. Adesuwa* can’t do meaningful work in her bad week and now plans her workload around her cycle. Ibukun*’s executive dysfunction deepens. And because Nigeria’s mental health support is largely private and largely unaffordable, therapy, the thing that moved three of these four women forward, stays out of reach for most. “I just wish everyone could afford mental health support services, because they go a long way,” Adesuwa says.

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So what actually helps? 

The women have answers they built themselves. For Funmi*, she optimises her life around her cycle, and keeps her closest circle to people she doesn’t have to apologise to, reminds herself that some of what she feels in that week isn’t real, and protects her school attendance so that the days she truly can’t show up don’t cost her. 

Adesuwa* tracks her cycle to plan and leans on music. She goes to therapy, watches comfort shows, and surrounds herself with friends and family who make things feel lighter. 

Dada* tracks her period with an app and her calendar so she can catch the shift early, and finds that exercise, eating well, and sleeping well all help. “Having a safe community of people who can listen without judgment, and who can care for you in the aftermath of an episode, is extremely important,” she says.

Modern medicine has answers, too. The American College of Obstetricians and Gynaecologists strongly recommends SSRIs, a class of antidepressants, for the mood symptoms of premenstrual disorders, and lists hormonal treatments, counselling, exercise, nutritional therapies, and self-help strategies among the options. Many patients do best with a combination. A diagnosis matters because the treatment for PMDD is specific, and because a woman who knows her calendar can prepare for her hardest week instead of being ambushed by it.

The week before a period should be uncomfortable at worst. It should not be a week a woman has to survive. For the roughly 1 in 18 women living with PMDD, “it’s just PMS” is not reassurance, and for some women, the distance between that dismissal and a bridge, a blade, or a kitchen is one bad cycle. As Funmi puts it: “People make a lot of jokes about ‘oh, it’s that time of the month’, but it’s not normal to feel like you want to jump off a bridge because of your period.”

It’s more than mood swings. It always was.

If you or someone you know is struggling with thoughts of suicide or self-harm, you can reach out to someone:

• Mentally Aware Nigeria Initiative (MANI): 08091116264 or 08111680686

• International Association for Premenstrual Disorders (IAPMD): iapmd.org

• Find a Helpline: findahelpline.com