Tola is a 29-year-old banker in Lagos. For most of the month, she is calm, efficient, and well-liked at work. But about a week before her period, everything changes. She becomes intensely irritable. Small things like a delayed email or traffic can trigger disproportionate anger. She snaps at her colleagues, avoids calls from friends, and withdraws from her fiancé.
Last month, she almost resigned from her job after a disagreement with her Manager. Three days later, after her period started, she couldn’t understand why she had reacted so strongly. She felt embarrassed and ashamed, apologizing repeatedly to everyone she had hurt. This pattern has repeated itself for years. Tola has been told she is “overreacting,”
“too emotional,” or simply being difficult. She has tried to “be stronger,” to pray more, to ignore it, but every month, the same overwhelming emotional storm returns.
Amina is a 35-year-old mother of three in Kano. About 10 days before her menstrual cycle, she begins to feel a deep sadness she cannot explain. She loses interest in everything: her children, her business, even food. She cries easily and sometimes feels hopeless about her life. Her husband thinks she is being “moody,” and her mother-in-law believes she is lazy.
No one understands why she is “fine one moment and completely different the next.” Amina herself is confused. She has even had thoughts that scare her. Thoughts of not wanting to exist anymore. Yet, within a few days of her period starting, those feelings disappear, and she goes back to her usual self.
Both women have never heard of Premenstrual Dysphoric Disorder (PMDD) or Premenstrual Syndrome (PMS).
Discussion
Premenstrual Dysphoric Disorder (PMDD) is a severe and disabling form of premenstrual syndrome (PMS). While many women experience mild physical or emotional symptoms before their period, PMDD goes far beyond this. It is a recognized mental health condition characterized by intense emotional and physical symptoms that significantly interfere with daily functioning. Studies suggest that PMDD affects about 3 - 8% of women of reproductive
age worldwide. Though this may seem small, the impact on quality of life, relationships, and productivity can be profound. If females make up about half of Nigeria’s population, that will translate into 100 million females, with as high as 8 million of them potentially experiencing PMDD. These are not numbers to be dismissed lightly.
PMDD is not simply “being emotional” or “having mood swings.” It is linked to the body’s abnormal response to normal hormonal changes during the menstrual cycle, particularly fluctuations in estrogen and progesterone. These changes affect brain chemicals such as serotonin, which regulate mood. Unfortunately, PMDD is often misunderstood, dismissed,
or misdiagnosed, especially in settings where menstrual health is not openly discussed.
Many women suffer in silence for years without appropriate support or treatment. Or even worse, they are blamed for being lazy, like Amina above.
Common Symptoms of PMDD
Symptoms typically occur in the luteal phase (about 1–2 weeks before menstruation) and improve shortly after the period begins.

Emotional and Psychological Symptoms:

• Severe mood swings
• Intense irritability or anger
• Depression or feelings of hopelessness
• Heightened anxiety or tension
• Crying spells
• Feelings of being overwhelmed or out of control

Behavioural Symptoms:

• Social withdrawal
• Conflict in relationships
• Reduced interest in usual activities
• Difficulty functioning at work or home

Cognitive Symptoms:

• Difficulty concentrating
• Memory problems
• Indecisiveness

Physical Symptoms:

• Fatigue or low energy
• Sleep problems (insomnia or excessive sleep)
• Changes in appetite or cravings
• Breast tenderness, bloating, or headaches
• Menstrual cramps (which may be severe in some women, especially when other conditions are present)

Why PMDD Matters
PMDD is not just a “women’s issue”. It is a public health concern. It affects workplace productivity, family relationships, and overall wellbeing. Women with PMDD are at higher risk of major depressive disorder, anxiety disorders, substance use, relationship breakdown and poor work performance or job loss. This is because symptoms come and go with the menstrual cycle, many women are misunderstood or labelled as “difficult,” “unstable,” or “overly sensitive.” This stigma is not helpful.
How to Manage PMDD
The good news is that PMDD is treatable. With the right support, women can regain stability and improve their quality of life.
1. Track Symptoms: Keeping a daily record of mood and physical symptoms over at least two menstrual cycles can help confirm patterns and support diagnosis.
2. Lifestyle Adjustments: Regular exercise, eating balanced diet with reduced caffeine, sugar, and alcohol, and getting adequate sleep can help regulate mood and reduce stress.
3. Psychological Support: Cognitive Behavioural Therapy (CBT) can help women manage negative thoughts, emotional reactions, and stress.
4. Medications: Antidepressants are commonly used and effective. Hormonal
treatments (such as certain contraceptives) may also help regulate symptoms. These should always be prescribed by a qualified healthcare professional.
5. Stress Management: Relaxation techniques such as mindfulness, breathing exercises, or prayer can help reduce emotional intensity.
6. Community support and empathy: We all have a duty to promote public awareness, provide emotional support and avoid shaming and stigmatizing affected individuals.