What Is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS), causing symptoms such as anxiety, depression, and irritability one to two weeks before your menstrual period. Research suggests that as many as 75% of people who have periods experience PMS. However, PMDD is less common—with 3% to 8% of people developing symptoms that can disrupt daily life.

Knowing the symptoms, understanding when to reach out for medical support, and learning about your treatment options can help you reduce PMDD episodes and improve your quality of life.

Symptoms

PMDD symptoms generally start one to weeks before you begin your period. Your symptoms should tend to go away within the first few days of your period. It's common to experience a combination of psychological and physical symptoms when you have PMDD.

Psychological Symptoms

PMDD may cause one or more of the following psychological (or, emotional) symptoms:

• Anxiety
• Sadness, hopelessness, or depression
• Irritability or anger
• Loss of interest in daily activities
• Mood swings
• Crying spells
• Difficulty concentrating on tasks
• Brain fog or trouble thinking
• Thoughts of self-harm or suicide

Physical Symptoms

The physical symptoms of PMDD may include:

• Weight gain or bloating
• Fluid retention, especially in the ankles
• Breast tenderness
• Migraine or headaches
• Joint or muscle pain
• Changes in sex drive
• Difficulty sleeping
• Appetite changes
• Hot flashes or sweating
• Cramps and body aches
• Fatigue
• Feeling low energy
• Acne
• Nausea
  

What Causes PMDD?

The exact cause of PMDD (and PMS) is currently unknown. Some researchers have found evidence that hormonal changes during your period may play a role in the development of PMDD symptoms. Generally, PMDD symptoms begin shortly after ovulation—the part of your menstrual cycle when your ovaries release an egg. As this process happens, you might experience a drop in key hormone levels that regulate your menstrual cycle, including estrogen and progesterone.

Experts also believe that changes in hormone levels can affect your brain chemistry and serotonin levels. Serotonin is a neurotransmitter (brain chemical) that helps manage brain-related functions such as mood, memory, thinking, and sleep.

Risk Factors

The following factors may also increase your risk of developing PMDD symptoms:

• Having a family history of PMDD
• Living with thyroid disease or obesity
  
• Using substances or drinking excessive amounts of alcohol
• Engaging in a lack of physical activity or living a sedentary lifestyle

Diagnosis

In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), PMDD is listed as a depressive disorder. The DSM-5 is a reference book that healthcare providers use to identify and diagnose mental health and brain-related conditions.

While there is no single test to diagnose PMDD, your healthcare provider should ask you about your medical history and symptoms, conduct a physical exam, perform a psychological evaluation, and test you for thyroid disease. This helps your provider rule out other conditions before giving you a diagnosis for PMDD.

According to the DSM-5, a PMDD diagnosis requires that you experience at least five symptoms in the week before your period. These symptoms can’t be due to another mental health condition and they must only be present around the time of your menstrual cycle. Your symptoms must also be disruptive and interfere with your ability to go to work or school, complete daily tasks, and engage in social activities.

There are two categories of criteria that you must meet before your healthcare provider can diagnose you with PMDD.

In the first category, you must have at least one of the following symptoms:

• Affective lability (or, emotional instability) such as mood swings or being sensitive to rejection
• Irritability or anger
• Depressed mood or hopelessness
• Anxiety, tension, or feeling on edge

In the second category, you must experience one of the following symptoms:

• Decreased interest in daily activities
• Difficulty concentrating
• Fatigue, lethargy, or lack of energy
• Appetite changes such as overeating or having food cravings
• Difficulty sleeping
• Feeling overwhelmed
• Physical symptoms like weight gain, joint pain, muscle pain, bloating, or swollen and tender breasts
  

Treatments for PMDD

If you receive a diagnosis for PMDD, your healthcare provider can help you develop a treatment plan that is right for you. This may include taking medication, going to therapy, and practicing lifestyle changes, among others.

Your treatment options may include one or more of the following:

• Taking an antidepressant medication such as a selective serotonin reuptake inhibitor (SSRI)
• Seeing a mental health professional for talk therapy, such as cognitive behavioral therapy (CBT)
• Using birth control pills to reduce the severity of PMDD symptoms
• Trying diuretics (water pills) to relieve bloating
• Getting an over-the-counter pain medication such as Advil (ibuprofen) to treat physical symptoms

How to Prevent PMDD Episodes

Unfortunately, there's no surefire way to prevent PMDD. However, you may try the following lifestyle modification to help you reduce the severity of your symptoms:

• Avoiding alcohol and caffeine
• Lowering your salt and sugar intake
• Eating plenty of whole grains, fruits, and vegetables
• Practicing healthy sleep habits, such as turning off your phone an hour before bed and keeping your bedroom cool and dark
• Exercising regularly 

Related Conditions

Many people with PMDD experience symptoms of or receive a diagnosis for at least one other mental health condition. These related conditions may include:

• Anxiety disorders, such as generalized anxiety disorder (GAD)
• Major depressive disorder (MDD)
• Somatic symptom disorder (SSD)
• Mood disorders, such as bipolar disorder
• Seasonal affective disorder (SAD)

Living With PMDD

Living with PMDD can feel difficult and tiring. Many people with PMDD may think they have typical symptoms of PMS. This often prevents people from receiving the treatment they need to reduce symptoms.

If your symptoms are disrupting your daily life, making it difficult to go to school or work, or causing extreme mood changes, it's best to see your healthcare provider for support. Treatment for PMDD is available and effective in improving your quality of life before and during your menstrual period.