Warning: This article contains discussion of suicide
The morning after she tried to end her life, Annika Waheed's period started. The feelings of despair left her and the "weight of the world", as she describes it, lifted.
"Did I really do that?" she asked her sister, who had hugged Annika close to keep her safe as she slept off an attempted overdose.
"Yes, you did."
Annika would spend two weeks of every month haunted by suicidal thoughts, and then, like the flick of a switch, the darkness would dissipate as soon as she started her period and she would "be able to see and function again".
"How can my hormones do this to me?" she asks.
The 42-year-old has had premenstrual dysphoric disorder (PMDD) for more than eight years.
PMDD is a mental health disorder which causes severe psychological and sometimes physical symptoms.
It can affect women at any point in their lives but often coincides with moments of significant hormonal changes - including puberty, having a baby, or going through the menopause.
Similar to premenstrual syndrome (PMS), it occurs in the one to two weeks leading up to a period, the luteal phase, but it is far more severe.
While PMS might leave you feeling tired, irritable and bloated, PMDD can trigger severe anxiety, depression and intense psychological distress.
Women can also experience physical symptoms such as fatigue, headaches and joint pain, but to be diagnosed with PMDD you must also have a mood-related symptom.
The International Association for Premenstrual Disorders (IAPMD) - a global research charity - estimates more than a million women in the UK may be affected by PMDD, but only a fraction have received a diagnosis.
Suicide is a complex issue, but some studies suggest those with PMDD are more likely to have suicidal thoughts and attempt to take their own life than the general population.
"PMS can be really hard," says Annika, who also experiences physical symptoms such as heart palpitations, severe backache and bloating. "But this? This is something else.
"It is like the Grim Reaper coming for us every month. You can feel it, and there is nothing you can do about it."
It's believed women affected by PMDD have a severe and negative reaction to the natural hormonal fluctuations happening in their bodies before a period. That reaction is mainly driven by changes in progesterone levels, which peak, and oestrogen, which fluctuates, triggering strong feelings of despair, loss and a lack of control.
And while there is still very little scientific understanding about why PMDD is triggered in some individuals, researchers in Scotland have devised a groundbreaking suicide prevention tool aimed at helping clinicians identify signs of women displaying PMDD symptoms.
"For so long, women have lived with this condition and not had any idea what could be causing it," says Dr Lynsay Matthews, from the University of the West of Scotland, who has led the research. "Even though the menstrual cycle plays such a huge part in a woman's health, it is often not brought up in doctors' consultation rooms."
Matthews says that asking women questions about their menstrual cycle should help doctors and patients pick up on patterns and understand if their mental health is connected to their cycle.
The model, which is available for clinicians to use now, gives crucial information about how women with PMDD might react differently from the rest of the population when it comes to suicide.
The next stage, Matthews explains, is to measure how effective it is in helping women, with the hope it will be rolled out across the NHS.
If you have been affected by the issues raised in this article, the BBC's Action Line contains a list of organisations which can provide support
Dr Helen Wall, a GP based in Bolton who specialises in women's health, says doctors "still struggle to relate things to a woman's periods".
"We have to listen to women's stories and understand what is happening in the context of their hormones."
But she says the healthcare system can make it difficult to do that: "We get 10 minutes, 15 minutes maximum with a patient.
"Many women with PMDD will present when they are in crisis, and they have nowhere else to turn. It is difficult to get a full history and understand the complexities in such little time."
More women are documenting their experiences with PMDD on social media - #PMDD posts have been viewed more than 230m times on TikTok.
One of those is Katie Cook, who was diagnosed with PMDD in 2025 at the age of 21 - after a decade struggling with her physical and mental health.
She believes PMDD kicked in when she started her periods aged 12. It was then, she says, the "battle in my mind began".
"It's like I'm Jekyll and Hyde," she explains.
When Katie is in her luteal phase, in the run-up to her period, she says life is dark. Her body aches, she's sensitive to light and sound, and everything feels too much.
But Katie's GP would tell her her severe mood swings were part of growing up.
Katie began to note down her fluctuating moods and other symptoms throughout the month and began to see patterns.
Then in her first year of university, a GP asked if Katie had heard of PMDD, and "everything started to make sense".
Getting a diagnosis can unlock different treatment options, but Annika says that just "being understood" is a "validating experience in itself".
Could the work carried out by Matthews to help clinicians spot the signs of PMDD earlier have helped her - perhaps even prevented her from reaching such a desperate point in her life?
"Absolutely," Annika says, "I wouldn't have been gaslit by doctors.
"If doctors understand, then patients understand. I could have explained these suicidal thoughts to my friends and family and I might have been able to safeguard me from myself."
There are several treatments which can be tailored to PMDD but, for many, including Annika, finding the one that works can be a matter of trial and error.
As well as anti-depressants, women can be offered the contraceptive pill and other contraceptives like the Mirena coil, which helps to regulate hormones.
There are also more extreme options, such as the chemical menopause and, in some cases, having ovaries removed to stop the natural hormone cycle.
Annika is having hormone-blocking injections to stop her menstrual cycle, in order to treat her PMDD. But within minutes of the medication wearing off, she says she can feel anger, fury or despair rising inside her depending on what stage she is at in her cycle.
Living with the impact of PMDD has made it impossible for Annika to consider pregnancy and parenthood - and being in chemical menopause has eliminated any chance of her getting pregnant.
There are times she imagines an alternative life, where she could have become a mum, but she says: "PMDD has snatched that from me."
At 31 years old, Lily Rose Winter, who is part of the growing PMDD community online, is considering undergoing a chemical menopause.
It's taken years for Lily to get a PMDD diagnosis and she's tried numerous treatments - but as yet none has had a significant impact on the symptoms she suffers each month.
"I am learning to reframe it. Instead of trying to be positive and saying I should be feeling OK, I tell myself it's OK that I don't feel grateful to be alive today, and it will pass. I have to be patient."
The government acknowledges that women with PMDD "have been failed for far too long". In a statement, a spokesperson for the Department of Health and Social Care, said, "Too often their symptoms are dismissed or normalised, and that has to change."
They said the renewed Women's Health Strategy will "ensure women are listened to and taken seriously from their very first appointment" and are referred to the right healthcare professional "first time".
