What Is Premenstrual Dysphoric Disorder (PMDD)?
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Medically reviewed by Renita White, MD
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:
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
Looking for support?
If you are experiencing a crisis, or know someone who is, call or text the National Suicide Prevention Lifeline at 988 for free and confidential support 24/7. You can also visit SpeakingOfSuicide.com/resources for a list of additional resources or call the number below to reach Substance Abuse and Mental Health Services Administration (SAMHSA) hotline.
Physical Symptoms
The physical symptoms of PMDD may include:
Weight gain or bloating
Fluid retention, especially in the ankles
Joint or muscle pain
Hot flashes or sweating
Cramps and body aches
Feeling low energy
Causes
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
Treatment
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
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.
Frequently Asked Questions
What age does PMDD usually start?
Most people with PMDD start to notice symptoms during their early-to-mid 20s. However, anyone who menstruates can develop PMDD at any time.
Does PMDD get worse with age?
The symptoms of PMDD often get worse as you get closer to menopause, as your body is undergoing hormonal changes.
Does PMDD qualify for disability?
PMDD is a depressive disorder, which may qualify as a disability according to the Social Security Administration (SSA) and the Americans with Disabilities Act (ADA). Talk to your healthcare provider if applying for disability is right for you.
Does PMDD ever go away?
For some people, PMDD gets more severe with age. However, the symptoms should stop once you enter menopause and stop menstruating. Receiving proper treatment for PMDD can also reduce symptoms significantly.
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