Diagnosis - Why It Takes So Long, and Who Can Actually Help

Why does it so often take years to get a PMDD diagnosis — and once you suspect it, who should you actually go and see? In this episode, Dr Georgina Standen explains why this condition falls through the gaps in the healthcare system, and how to find a clinician who can actually help.

In this episode:

• Why PMDD diagnosis is genuinely complex — hormone tests are usually normal, and treatment has to be individualised
• Why so many women aren't believed the first time they raise their symptoms
• How PMDD sits between gynaecology, psychiatry and general practice — and why that gap slows diagnosis down
• What GPs, gynaecologists and psychiatrists are each trained to spot, and where the gaps are
• What actually matters most when choosing who to see — and why it's rarely about job title

A full transcript of this episode is available above.

Sirona Health Podcast is hosted by Dr Georgina Standen, GP and founder of Sirona Health (sironahealth.co.uk), a specialist women's health practice covering menopause, PMS/PMDD and teen health. Book a consultation at sironahealth.co.uk.

This podcast is for general information only and doesn't replace individual medical advice — please speak to your GP or a specialist about your own symptoms. If you're struggling, please reach out for support.

Transcript

0:04

Hormones don't just run your cycle. They run your mood, your mind, your whole sense of self. I'm Dr. Georgina Standen, GP and founder of Sirona Health, and this is the Sirona Health Podcast, where we talk about the relationship between female hormones and mental health properly without the mystique and without the dismissal. Over the last few episodes, I've talked about what PMS and PMDD actually are, how common they are, and how diagnosis actually works. And I think if you've been listening along and recognizing some of this in yourself, the obvious next question is, "Okay, so why haven't I been diagnosed already? And who do I actually need to see?" That's what I want to cover today, why this so often takes years rather than months, and then practically who's actually best placed to help you. I think it's worth being honest here, because this is something I hear constantly. Women who've had symptoms for years, sometimes decades, before anyone properly connects them to their cycle, and I don't think that's because anyone's being careless. I think there's a genuine set of reasons this happens, and I want to go through them. The first is just scientific uncertainty. We now understand that PMDD isn't caused by abnormal hormone levels. It's caused by an increased sensitivity to completely normal hormonal fluctuations, which means standard blood tests usually come back normal, and treatment has to be individualized rather than following one clear pathway. Some women respond well to estrogen-based approaches, others to SSRIs, others to ovulation suppression, and there isn't one single route that works for everyone. That complexity, I think, genuinely slows down clinical decision-making, because it's not like treating a straightforward infection where there's one obvious next step. The second thing, and I think this one matters enormously, is that many women simply aren't believed or aren't taken seriously the first time they raise it. Being told your symptoms are just PMS or just normal can lead to years of self-doubt before someone finally investigates it properly, and I think that delay compounds itself, because if you've been dismissed once or twice, you're less likely to keep pushing the third time, even though you probably should. The third reason is more structural, and it's really what I want to spend the rest of today on. PMDD sits right at the boundary between gynecology and mental health, and most clinical training is built around one specialty or the other, not both at once. Think about it from a training perspective. A GP's curriculum does include gynecology and mental health, but not in the depth needed for something as nuanced as PMDD. A gynecologist training covers menstrual disorders and hormone physiology really well, but only some gynecologists specialize specifically in PMS or PMDD. It's not universal. And a psychiatrist training is excellent for diagnosing and treating complex mood disorders, but it isn't built around menstrual cycle physiology. So you've got a condition that genuinely needs both halves of the picture, hormonal understanding and mental health expertise, and most of the system is set up to deliver one half or the other. I think that's really the core of why this so often takes years rather than months. It's not incompetence anywhere in the system. It's more that PMDD doesn't sit neatly inside any one specialty's normal remit. So given all of that, who's actually best placed to help? Your GP is usually the right first point of contact, and honestly, many are excellent, particularly if they've got a specific interest in women's health. But I think it's worth knowing going in that PMDD is genuinely complex to diagnose and manage well, and it isn't something that tends to get sorted in a single ten-minute appointment. It's a process. It involves pattern recognition, tracking, sometimes a bit of trial and adjustment, and that takes time and continuity, seeing the same clinician who already knows your history rather than a different person each time I think what actually matters more than the specific job title on someone's door is whether that clinician can hold both halves of the picture at once, the hormonal side and the mental health side together, rather than treating PMDD as purely a gynecological issue or purely a psychiatric one. That's really why I think a generalist with specific expertise in this area, so a GP who's built up a real depth in women's hormonal health and mental health together, is often so well-placed to help. GP training is actually built around exactly this kind of complexity, seeing the whole person rather than one system in isolation, and then layering specific expertise on top of that generalist foundation. To manage PMDD well, I think a clinician needs to be comfortable using hormonal treatments, so things like ovulation suppression, alongside psychiatric treatments like SSRIs, sometimes in combination, and needs to understand that this isn't a single appointment diagnosis. It's a process of tracking, trying something, reviewing, and refining. I think the honest message here is PMDD isn't just hormones, and it isn't just mental health. It's both, genuinely both, and it needs to be treated as both. So if you suspect this is what you're dealing with, I'd say the most useful thing you can do is look for someone who's comfortable working across that boundary rather than assuming you need to see a gynecologist specifically or a psychiatrist specifically, or that your GP can't help at all because your care really shouldn't have to sit in one box when the condition itself doesn't. So to bring today together, this takes a long time to diagnose properly, often because of genuine scientific complexity, sometimes because women aren't believed the first time they raise it, and quite often because of how our healthcare system is structured around single specialties rather than the conditions that cross boundaries. And I think the way through that is finding someone who's comfortable working across that gynecology and mental health divide rather than assuming you need a specific specialist and being prepared for this to be a process rather than a single appointment. Next time, I want to go a bit deeper into the actual biology behind all of this, why some brains respond so differently to completely normal hormonal changes, and what the current research tells us about that That's it for today. I'm Georgina. Thanks for listening. A quick note before you go. This podcast is for general information, not individual medical advice. It doesn't replace seeing your own GP or a specialist, so if anything you've heard today feels relevant to you, please do talk to someone. And if you're struggling, please reach out to your GP, to someone you trust, or to a crisis line if you need one right now. You can find Sirona Health and book your appointment at sironahealth.co.uk. See you next time