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Depression Before Period: What Is PMDD and How to Manage It?

For most women, an upcoming period usually brings a mix of symptoms collectively called premenstrual syndrome, or PMS. These can range from fatigue, backache, minor mood swings, and usually clear up a day or two into the period. However, about 5% of women experience far more severe condition called premenstrual dysphoric disorder, or PMDD. Let’s find out more about what PMDD is, how it differs from PMS, and how to manage its symptoms.

woman suffering from depression sitting on bed

Why does PMDD happen?

While the exact reason for PMDD is yet to be discovered, studies have pointed to certain potential causes.

A recent research conducted by the National Institute of Health (NIH) found that the cells from women suffering from PMDD react differently (and more sensitively) to fluctuations in reproductive hormone levels than in women without PMDD.

This heightened sensitivity affects the brain’s chemical and neurological pathways that regulate the mood and feeling of well-being, possibly leading to depression around period.

Since a woman’s reproductive hormone levels change from two weeks leading up to menstruation, this is the time period is when PMDD affected women experience their symptoms.

What are the symptoms of PMDD?

PMDD is a mix of severe physical, emotional and behavioral symptoms that can make daily life very difficult for those who suffer from it.

Typically, PMDD symptoms show up in the second half of the menstrual cycle (also called the luteal phase) - around 7 to 10 days before the period, and continue up till menstruation. PMDD has been included as a ‘depressive disorder not otherwise specified’ by the diagnostic and statistical manual of mental disorders, or DSM.

According to DSM-V manual, a person suffering from PMDD will show at least five of the following key symptoms:

  • frequent and extreme mood swings; feeling suddenly sad or tearful or increased sensitivity to rejection
  • increased irritability, anger or relationship conflicts
  • markedly depressed mood and feelings of hopelessness
  • severe anxiety, tension, feelings of being constantly ‘on edge’
  • decrease in interest in usual activities (e.g., hobbies, work, school, friends, hobbies)
  • difficulty in concentration
  • lethargy, feeling often and easily tired
  • marked change in appetite, overeating, or specific food cravings
  • excessive sleepiness or insomnia
  • feeling overwhelmed or out of control
  • other physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating, weight gain.

Since PMDD is tied to fluctuations in reproductive hormone levels, the above symptoms should be absent for at least a week after periods for PMDD to be diagnosed. If the above symptoms are not cyclical and do not seem to clear up at any time, it may point to another form of underlying depressive disorder.

Before diagnosis, it is also important to make sure that these symptoms are not the result of taking medication or oral contraceptives.

woman eating donut near refrigerator

Is it PMS?

While both PMS and PMDD symptoms share similarities and show up 7-10 days before periods. What differentiates the two is the severity of the symptoms experienced. 

PMDD is a more severe form of PMS, where the emotional and physical symptoms are so extreme that they make daily functioning nearly impossible. Here is a handy guide to compare the symptoms of each at a glance:

PMS PMDD
Affects 70-75% of women Affects 5% of women
A mix of emotional, physical symptoms that are mild in severity - mood swings, tension, sadness A far more severe form of PMS symptoms - extreme mood swings, severe anxiety, feeling out of control and hopeless about life
Emotional symptoms are not necessary for a PMS diagnosis. Monthly physical symptoms such as bloating, breast tenderness and fatigue can suffice Presence of at least five aggravated emotional symptoms are key for diagnosis, as per DSM-V
Physical tiredness but still able to perform routine tasks Sudden loss of interest in otherwise routine and easy tasks (hobbies, meeting friends, work etc.)
Symptoms not debilitating enough to hamper daily life Severity of emotional and physical symptoms hampers daily life
PMS symptoms have not been linked to an incidence or increase in suicidal thoughts PMDD has been linked to higher incidence of non-fatal suicidal thoughts and attempts

How can I beat depression?

If you experience anxiety and severe depression before period, know that you are not alone and that there is a biological basis for your condition. Often, women are told that their PMDD symptoms are imaginary, whereas numerous studies and research has clearly proved otherwise. A combination of the following suggested treatments can potentially help manage and ease the severity of your symptoms:

Track your monthly symptoms

Keep a track of each of your symptoms each month, their severity (on a scale of 1-10) and on which days they occur via a daily log.

This exercise is very helpful in helping your doctor diagnose PMDD, and will also help you predict the days on which you are most likely to experience symptoms. This will make sure you are not caught off guard, and can help prepare for them.

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woman practices yoga and meditates in the lotus position on the beach

Resort to natural remedies

In a study conducted amongst 118 women with PMDD, having chasteberry and calcium supplements was shown to significantly improve premenstrual symptoms. Being natural and not chemical based is a clear benefit, and can be added as a natural treatment to your diet to alleviate symptoms.

Hormonal birth control forms

Use of certain hormonal birth control methods is a possible way to treat PMDD symptoms. Hormonal birth control pills release a steady dose of reproductive hormones in the body throughout the cycle, which makes your hormone levels more predictable and less prone to the fluctuations that trigger PMDD symptoms. It is advisable to consult your doctor before deciding whether to and which hormonal birth control to use for treatment.

Change your lifestyle

Small lifestyle changes can go a long way in easing your PMDD symptoms. Regular exercise, getting enough sleep, reducing caffeine and avoiding alcohol and smoking have all been shown to reduce the severity of symptoms. It is also a good idea to avoid stressful and emotional triggers that you’ve known to cause anxiety.

Practicing yoga, meditation and other relaxation techniques can also contribute to alleviating your symptoms.

Make an appointment with your doctor

Fix an appointment with your doctor to discuss your symptoms at length. Taking at least a two month log of your daily symptoms will also help in understanding the symptoms, their severity and help draw up an accurate diagnosis.

Find support

Living with PMDD can often feel like a lone struggle, which is why joining a local peer support group or consulting a counsellor can greatly help. Sharing your experiences with those that have gone through the same can be a great source of emotional and mental support.

Apart from peer support, reaching out to your loved ones and having them involved goes a long way in reducing relationship strain. If they know what you’re going through, there is a much greater scope of understanding and diffuse potential conflict.

Conclusion

Affecting around 2 - 8% of women, PMDD is a mix of severe premenstrual symptoms that are physical, emotional and behavioral in nature. Those suffering from the condition have a much higher sensitivity to the normal monthly fluctuations in reproductive hormone levels. The symptoms range from extreme mood swings, pre-period depression, and sudden disinterest in routine tasks and can make simple daily tasks a struggle.

Suggested treatment is a combination of lifestyle changes such as regular exercise, yoga, avoiding alcohol and smoking, and cutting caffeine. Taking chasteberry and calcium supplements, and joining a peer support group or counselling have also been shown alleviate symptoms.

It is a good idea to keep a daily track of your symptoms and consult your doctor to discuss your symptoms at length, and decide on the best way to treat and manage the disorder.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890701/
https://www.nih.gov/news-events/news-releases/sex-hormone-sensitive-gene-complex-linked-premenstrual-mood-disorder
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5024711/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440788/
https://www.webmd.com/women/pms/premenstrual-dysphoric-disorder#1
https://www.psychologytoday.com/us/blog/millennial-media/201202/the-inclusion-pmdd-in-dsm-5
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3774023/
https://www.health.harvard.edu/womens-health/treating-premenstrual-dysphoric-disorder
https://web.archive.org/web/20150226050453/http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf
https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440788/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3774023/
https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd
https://www.webmd.com/women/pms/pms-and-the-pill#2
https://www.health.harvard.edu/blog/premenstrual-dysphoria-disorder-its-biology-not-a-behavior-choice-2017053011768
https://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder
https://www.webmd.com/women/pms/pms-vs-pmdd

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