Norman Swan: Premenstrual dysphoric disorder, PMDD, has been called premenstrual syndrome on steroids. It can badly affected some women in the second half of their menstrual cycle, and it goes away as quickly as it started. PMDD is real and research is closing in on its causes. Jo Lauder prepared this for the Health Report.

Julia: A bad month is like two weeks, two weeks of symptoms. So when it's bad month after month, it's essentially 50% of your life is taken over by this thing.

Jo Lauder: This is 30-year-old Julia, telling me about her experiences with PMDD or premenstrual dysphoric disorder. Although it's often described as severe PMS, or PMS on steroids, Julia says it's quite different.

Julia: PMDD is essentially symptoms of depression, anxiety, an inability to stop crying, basically an inability to function.

Jo Lauder: Think of it like a depression that comes for up to a couple of weeks and then disappears suddenly, usually on the day that you get your period.

Julia: It's very easy to get amnesia each month about just how bad it gets, and it's very disorientating because of the way that it fluctuates.

Jo Lauder: In terms of the amnesia, how do you feel when it goes away, or is it just one day that it's just lifted?

Julia: Yeah, it's a really, really surreal experience. PMDD is like having a dark cloud descend over you out of nowhere, and once you get your period it lifts. While one day you were feeling like everything in your life is wrong and the next day you feel joy and gratitude and you have perspective on your life. You know what it is? I just feel relieved.

Rosie Worsley: Severe PMDD occurs in about 5% of women.

Jo Lauder: Dr Rosie Worsley is an endocrinologist at Jean Hailes for Women's Health. The symptoms of PMDD are similar to those of depression, and for the women Dr Worsley treats, PMDD is having a significant impact on their lives.

Rosie Worsley: What distinguishes PMDD from, say, PMS or common PMS things like having some cravings or things like that, is that it has very severe mood symptoms as part of it. There might not be working at all in that time. I've had people that won't travel because they don't want to risk having PMDD when they are overseas and therefore wasting all their money. I've had women that have been wanting to have children but reluctant to do it because they are very severely affected and how would that impact on a baby, et cetera. So it can have really widespread consequences.

Jayashri Kulkarni: The whole issue of this is that it's a cyclical depression. It occurs every month and is a full-on awful, horrible depression, not just slightly feeling sad.

Jo Lauder: Jayashri Kulkarni is a Professor of Psychiatry and the director of the Monash Alfred Psychiatry Research Centre, and she studies PMDD, women's hormones and mental health. Professor Kulkarni says the key to diagnosis of PMDD is the switching on and off of the symptoms.

Jayashri Kulkarni: When we hear that, we need to think about things that are biological causing this depression, such as hormone shifts.

Jo Lauder: PMDD is caused by the fluctuation of hormones that all reproductive age women experience. For most women with PMDD, the symptoms kick in during the luteal phase, after ovulation, it's when the ovaries start producing progesterone in the lead up to the period.

Jayashri Kulkarni: So this is where it gets complicated because the brain hormones, like oestrogen, progesterone, testosterone, all of these hormones that are in charge of reproduction actually are very important brain hormones. So they have a separate set of effects in the brain and we can't see that of course and we can't measure it.

Jo Lauder: Professor Kulkarni says her team is working to develop a progesterone biomarker test for PMDD.

Jayashri Kulkarni: The fluctuations are there in all reproductive age women, but for some reason some women have a greater vulnerability and respond worse to the fluctuations than other women. So we are trying to work on a test to see if we can measure which women are going to be more at risk. We haven't got there yet but we are working on it.

Jo Lauder: I was going to ask you about what your research is focusing on in this area and what are the real unknowns here.

Jayashri Kulkarni: Our work is on hormones and cognition, which is the higher intellectual thinking, mood and behaviour. Also we are looking at it from a biological marker point of view to see if we can develop a test to actually go, yep, you are more vulnerable. Because it's not just PMDD, we also have to remember that the women who get PMDD are more likely to get postnatal depression once they have their baby, and the same women are more likely to get perimenopausal.

Jo Lauder: As it is driven by these progesterone changes, PMDD can be treated with some types of contraceptive pills as they stop hormonal fluctuations. Antidepressants are also a treatment option and they can be effective if you just take them part-time. Dr Rosie Worsley again:

Rosie Worsley: Unfortunately a lot of the pills contain synthetic progesterones that can also mimic these types of symptoms in susceptible women. So the pill and antidepressants are hit and miss type treatments, they won't work for everybody. In a very severe cases, in rare cases we are able to use things like a medical menopause, so we actually just turn people's ovaries off.

Jo Lauder: PMDD was formally recognised as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, the DSM, in 2013, but women still report trouble finding a doctor who understands the condition. Professor Kulkarni believes that reflects a broader issue with women's mental health.

Jayashri Kulkarni: For a long, long time there was quite a sharp delineation between what have hormones got to do with mental health? You know, the hormones are all about the reproduction, having babies and so on, it's got nothing to do with the way you feel, or the mental state. And that was really bad because it is all connected and we are learning more about that. There's a kind of weird conflict here because there's a sense of, hang on, are you saying that all women are moody, unreliable creatures that are just kind of at the mercy of their hormones? No, not at all. But there are some women who really, really suffer and struggle.

Norman Swan: Professor Jayashri Kulkarni ending that report from Jo Lauder.