Breaking the Cycle: A Case of Delayed Diagnosis and Sustained Remission Following Definitive Surgical Treatment of Premenstrual Dysphoric Disorder (PMDD).

Premenstrual dysphoric disorder (PMDD) is a hormone-sensitive mood disorder characterized by cyclical psychiatric and physical symptoms that impair functioning. Despite inclusion in DSM-5 and ICD-11, PMDD is frequently misdiagnosed or overlooked due to clinical unfamiliarity, lack of structured assessment, and systemic minimization of hormone-linked distress. Women routinely face delays in diagnosis and often only receive definitive treatment through self-advocacy. This report describes a 35-year-old cisgender female with treatment-resistant PMDD, whose symptoms began after menarche and worsened over two decades. Despite multiple psychiatric and medical encounters, her condition was misattributed to obesity, mood disorders, or trauma. After a diagnostic delay and multiple first and second-line treatment failures, a trial of leuprolide acetate confirmed a hormonal etiology of her symptoms, and she subsequently underwent total hysterectomy with bilateral salpingo-oophorectomy. Although she experienced a severe depressive episode in the immediate postoperative period, she has since remained in sustained symptom remission on an SSRI and estrogen replacement. This case demonstrates the need to recognize cyclic symptom patterns and potential hormonal etiology in treatment-resistant mood disorders.