Premenstrual dysphoric disorder (PMDD): Causes and treatment

You’ve probably heard of premenstrual syndrome (PMS), but how about premenstrual dysphoric disorder (PMDD)? Here’s everything you need to know about the condition, from the symptoms to look out for to the treatment options available.

Key takeaways

• Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome (PMS).
• PMDD causes debilitating emotional symptoms that begin before your period and go away shortly after it starts.
• Your health care provider might ask you to track your symptoms for a few months to diagnose you with PMDD.
• There’s no one-size-fits-all treatment for PMDD, but some options include antidepressants, therapy, or hormonal medications.

PMDD: What is it?

Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome (PMS). While both PMDD and PMS can cause physical and emotional symptoms, such as headaches, bloating, and disruption to sleep, PMDD has a bigger impact on someone’s mood. This can understandably get in the way of your daily life, like work, school, or relationships, and lead to extreme anxiety or depression. For this reason, the DSM-5 — the manual used to categorize and diagnose mental health disorders — lists PMDD as a “depressive disorder.”

This might sound scary, but rest assured that help and treatment are available. We’ve got more information below.

What causes PMDD? How common is it?

PMDD affects around 3% to 8% of women. While we don’t know exactly what causes it, experts think PMDD might be related to an increased sensitivity to fluctuating hormones during the menstrual cycle. 

Some research also suggests that there could be a genetic component.

PMDD symptoms

Symptoms of PMDD usually show up in the week before your period before going away a few days after it begins. As we’ve seen, the symptoms of PMDD can be so disruptive that they make working, socializing, and having healthy relationships difficult. It’s also important to note that while PMDD is characterized by emotional symptoms, people may also experience some of the physical symptoms of PMS alongside these.

Emotional symptoms

Severe emotional symptoms are usually what marks PMDD as being different from PMS. These include at least one of the following:

• Tension or anxiety
• A feeling of hopelessness or sadness
• Extreme mood swings
• Noticeable irritability or anger

Physical symptoms

The physical symptoms of PMDD can sometimes mirror those of PMS and include things like:

• Bloating
• Cramping
• Headaches
• Breast tenderness

This isn’t an exhaustive list; for more information on the physical symptoms of PMS that could also be present with PMDD, click here.

Disorders that look like PMDD

Identifying PMDD can be tricky, as it shares similar symptoms with other conditions, such as depression, anxiety, and thyroid disorders. So, it’s important to speak with your health care provider for an official diagnosis.

PMDD risk factors 

PMDD is still fairly misunderstood and under researched, but some things that have been shown to increase the risk of developing PMDD include:

• Having experienced traumatic events in the past, as well as preexisting anxiety disorders
• Smoking cigarettes
• Having a BMI of 27.5 or higher

That being said, it’s important to remember that while these factors could be connected to PMDD, researchers are still working to understand this condition better.

PMDD complications 

Dealing with PMDD can be incredibly challenging, and without treatment, it can lead to depression. In some very severe cases, it could also lead to suicidal thoughts.

With this in mind, it’s important to reach out to your health care provider for advice, assessment, and treatment if you think you might be living with the condition. And don’t be afraid to ask your loved ones for all the support you need, too. 

There are also some national helplines you can contact for support, advice, or just a chat. They’re available 24/7, every day of the week. If you’re experiencing suicidal thoughts and you live in the United States, you can text or call the Suicide and Crisis Lifeline at 988. If you live in the United Kingdom, you can call The Samaritans at 116 123. You can also see more options for support here.

PMDD Diagnosis

As with PMS, there’s no single test that providers use to diagnose PMDD. However, don’t let that discourage you from seeking help. If your symptoms are having an impact on your daily life, schedule a visit with your health care provider for help and support.

Potential criteria for diagnosis

To be diagnosed with PMDD, a doctor will be looking for you to fit a number of criteria. 

First, you must have experienced five or more of the following symptoms during most menstrual cycles over the course of a year (and the emotional symptoms must have resolved when your period began):

• Anger or irritability
• Depression
• Problems concentrating
• Either needing more sleep or struggling to sleep
• Mood swings
• Increased appetite
• Loss of interest in your usual activities
• A feeling of being overwhelmed 
• Physical symptoms such as bloating, headaches, and breast tenderness

In addition, your doctor will be looking for symptoms that disrupt your normal work or social life and are not related to (or enhanced by) any other medical conditions.

There’s no doubt that getting a PMDD diagnosis can be time-consuming and frustrating, but one thing that helps is tracking your symptoms. Keeping a detailed record of your symptoms each month can make it easier to advocate for yourself and be diagnosed. You can use an app like Flo to do this.

PMDD treatments options and therapies

There is no one-size-fits-all treatment for PMDD, so your health care provider might recommend targeting the symptoms that affect you the most. Currently, management for PMDD includes:

• Lifestyle changes, such as decreasing the amount of sugar, salt, caffeine, and alcohol in your diet and getting regular exercise
• Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and/or therapy to manage PMDD symptoms like depression, anxiety, and mood swings
• Hormonal birth control or gonadotropin-releasing hormone (GnRH) injections to suppress hormonal fluctuations caused by your cycle
• Pain relief medication for physical symptoms like cramps and sore breasts

Can you prevent PMDD? 

If you already have anxiety or depression, then treating these conditions could help to prevent the symptoms of PMS from becoming more severe. If you don’t already have these conditions and your PMDD is caused by hormones or genetics, then it might not be possible to prevent it. But that doesn’t mean you have to suffer in silence. You can make the condition easier to live with by making some lifestyle tweaks (more on those in a minute) or receiving treatment as described above.

Tips for living with and managing PMDD 

PMDD can be a challenging condition to manage, but there are some things you can try that might help reduce the impact PMDD has on your daily life. As we saw above, your doctor may suggest some lifestyle changes, particularly in the weeks leading up to your period. These changes can include:

• Exercising regularly 
• Eating a balanced diet (with plenty of protein and carbohydrates)
• Cutting back on caffeine, alcohol, sugar, and salt 
• Managing stress, for example, with meditation or yoga

Making these changes isn’t going to cure PMDD, but practicing self-care could make a positive difference and make your symptoms more manageable.

Taking care of your emotional well-being when dealing with PMDD is equally important. You might find it helpful to reach out to a therapist or an organization that provides peer support and advice tailored to PMDD.

When should you see a doctor?

It’s totally normal to experience some emotional and physical discomfort in the days leading up to your period. However, if these symptoms are impacting your work, family, or relationships or if you feel depressed or have suicidal thoughts, you should always reach out to your health care provider.

What can you expect from your appointment?

If you’re concerned that you might have PMDD, your health care provider will want to understand your overall health. This might include asking you about your mental and physical health history and doing a pelvic exam to rule out any other medical conditions. 

To help with the diagnosis, your doctor might also ask you to record your mood and physical symptoms daily for a number of months. 

It’s completely normal to feel nervous during appointments. If you ever feel uneasy, you have the right to bring along someone you trust to support you and help you speak up for yourself.