Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisReliefTreatmentHolistic ApproachNext in Premenstrual dysphoric disorder GuideCauses and Risk Factors of Premenstrual Dysphoric Disorder (PMDD)

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Table of Contents

Symptoms

Causes

Diagnosis

Relief

Treatment

Holistic Approach

Next in Premenstrual dysphoric disorder Guide

Hormonal fluctuations causing minor physical discomfort or emotional disturbances are common throughout the menstrual cycle. However, if you experience symptoms leading up to and during your period (menstruation) that are so severe they adversely impact your work, academic, and social life, then you might havepremenstrual dysphoric disorder(PMDD).

Between 1.3% and 5.3% of menstruating people meet the rigorous diagnostic criteria for PMDD.

This article will discuss PMDD symptoms, diagnosis, risk factors, self-care options, and medical treatment.

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Woman holding a phone with a menstrual calendar app beside a cup of espresso.

Symptoms of Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder begins during ovulation (the luteal phase) and resolves shortly after your period ends. It can occur at any age, from your first period until menopause.PMDD symptoms include the following:

Talk to a healthcare provider, such as a gynecologist, if you experience such symptoms the week before and during your period.

PMS vs. PMDDPremenstrual syndrome (PMS)and PMDD occur during ovulation through the end of menstruation.PMS is a constellation of physical and emotional symptoms, such as bloating, breast tenderness, or moodiness, which tends to beless severe than those of PMDDand does not interfere with your overall quality of life. In contrast, PMDD affects fewer people but causes more physical and mental symptoms, often requiring medication management. PMDD is classified as a mood disorder, whereas PMS is not.

PMS vs. PMDD

Premenstrual syndrome (PMS)and PMDD occur during ovulation through the end of menstruation.PMS is a constellation of physical and emotional symptoms, such as bloating, breast tenderness, or moodiness, which tends to beless severe than those of PMDDand does not interfere with your overall quality of life. In contrast, PMDD affects fewer people but causes more physical and mental symptoms, often requiring medication management. PMDD is classified as a mood disorder, whereas PMS is not.

Why Do Some People Experience PMDD?

The exact cause of PMDD is unknown. Some researchers theorize that fluctuations inestrogenandprogesterone(sex hormones that play a crucial role in menstruation) cause an adverse reaction in the brain, generating the physical and emotional symptoms associated with PMDD.

However, studies have not shown higher levels of estrogen or progesterone in people with PMDD compared to the general population.There is also a lack of scientific evidence that people with PMDD are more sensitive to the cyclical changes of estrogen and progesterone.

Science has shown PMDD can becausedor worsened in the following ways:

PMDD can mimic symptoms of other diseases but does not cause or worsen any of the following conditions:

PMDD and Mental HealthPMDD does not cause but can exacerbate underlying mental health conditions such asmajor depressive disorder,panic disorder,persistent depressive disorder, orgeneralized anxiety disorder.If you have a mental health condition, it is important to see a healthcare provider to determine whether your symptoms result from an underlying health condition or PMDD. No reliable scientific evidence supports PMDD’s impacts on bipolar disorders, post-traumatic stress disorder, social phobias, eating disorders, or substance use disorders.

PMDD and Mental Health

PMDD does not cause but can exacerbate underlying mental health conditions such asmajor depressive disorder,panic disorder,persistent depressive disorder, orgeneralized anxiety disorder.If you have a mental health condition, it is important to see a healthcare provider to determine whether your symptoms result from an underlying health condition or PMDD. No reliable scientific evidence supports PMDD’s impacts on bipolar disorders, post-traumatic stress disorder, social phobias, eating disorders, or substance use disorders.

Listening to the Signs Your Period Is on the Way

Diagnostic Criteria for PMDD

There are no laboratory or imaging tests fordiagnosing PMDD. However, depending on your symptoms, a healthcare provider may order lab testing to rule out any underlying medical issues.

A provider may instruct you to track your daily symptoms over two menstrual cycles. The diagnosis is made based on the symptoms persisting over three prior menstrual cycles.

The timing of the symptoms is as important as the symptoms themselves. A provider will want to know whether they are present during the week before your period, improve within the first few days, and decline or resolve in the week after your period.

The criteria for a PMDD diagnosis include at least five baseline symptoms or additional symptoms that are hurting your social, academic, or work performance or interpersonal relationships.

Baseline SymptomsMood swings, heightened sensitivity to rejection, or sadness or tearfulnessIncreased irritability or anger or interpersonal conflictsIncreased depressed mood, feelings of hopelessness or self-criticismIncreased feelings of being hyped up or on edge, anxiety, or tensionAdditional SymptomsLess interest in usual activities such as school, work, hobbies, or friendsDifficulty concentratingDecreased energy and increased fatigue or lethargySignificant changes in appetite (e.g., overeating or cravings)Insomnia or hypersomniaFeeling overwhelmed or out of controlPhysical symptoms, including joint or muscle pain, feeling bloated, weight gain, and breast tenderness or swelling

Baseline SymptomsMood swings, heightened sensitivity to rejection, or sadness or tearfulnessIncreased irritability or anger or interpersonal conflictsIncreased depressed mood, feelings of hopelessness or self-criticismIncreased feelings of being hyped up or on edge, anxiety, or tension

Mood swings, heightened sensitivity to rejection, or sadness or tearfulness

Increased irritability or anger or interpersonal conflicts

Increased depressed mood, feelings of hopelessness or self-criticism

Increased feelings of being hyped up or on edge, anxiety, or tension

Additional SymptomsLess interest in usual activities such as school, work, hobbies, or friendsDifficulty concentratingDecreased energy and increased fatigue or lethargySignificant changes in appetite (e.g., overeating or cravings)Insomnia or hypersomniaFeeling overwhelmed or out of controlPhysical symptoms, including joint or muscle pain, feeling bloated, weight gain, and breast tenderness or swelling

Less interest in usual activities such as school, work, hobbies, or friends

Difficulty concentrating

Decreased energy and increased fatigue or lethargy

Significant changes in appetite (e.g., overeating or cravings)

Insomnia or hypersomnia

Feeling overwhelmed or out of control

Physical symptoms, including joint or muscle pain, feeling bloated, weight gain, and breast tenderness or swelling

PMDD Relief: Self-Care at Home

PMDD can cause physical and emotional symptoms. You can manage some of the symptoms through self-care techniques, including the following:

Other supportive measures are not as well studied but are lower-risk and worth considering, including the following:

PMDD Medical Treatment

The severity of physical and emotional symptoms, which often requires medication management, differentiates PMDD from PMS.If you have PMDD, a healthcare provider may prescribe medication to relieve the physical and emotional symptoms associated with the disorder.

How does menopause affect PMDD?

Thinking About PMDD Holistically

Holistic approaches to managing PMDD physical and emotional symptoms are available:

Summary

PMDD affects between 1.3% and 5.3% of people with periods and causes significant physical and emotional disturbances, impacting their quality of life. There are different treatment options for managing PMDD, but the most common therapy is medication management with SSRIs. If you struggle with PMDD, work closely with a healthcare provider or specialist, such as a gynecologist, to determine the best treatment for managing your symptoms.

6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hofmeister S, Bodden S.Premenstrual syndrome and premenstrual dysphoric disorder.American Family Physicians. 2016;94(3):236-240.Royal College of Obstetricians and Gynaecologists (RCOG).Premenstrual dysphoric disorder.International Association for Premenstrual Disorders.Evidence-based management of premenstrual disorders (PMDs).Hantsoo L, Epperson CN.Allopregnanolone in premenstrual dysphoric disorder (PMDD): evidence for dysregulated sensitivity to GABA-A receptor modulating neuroactive steroids across the menstrual cycle.Neurobiol Stress. 2020;12:100213. 2020. doi:10.1016/j.ynstr.2020.100213Sepede G, Sarchione F, Matarazzo I, et al.Premenstrual dysphoric disorder without comorbid psychiatric conditions: a systematic review of therapeutic options.Clin Neuropharmacol. 2016;39(5):241-261. doi:10.1097/WNF.0000000000000173U.S. Food and Drug Administration.Information about drospirenone.

6 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hofmeister S, Bodden S.Premenstrual syndrome and premenstrual dysphoric disorder.American Family Physicians. 2016;94(3):236-240.Royal College of Obstetricians and Gynaecologists (RCOG).Premenstrual dysphoric disorder.International Association for Premenstrual Disorders.Evidence-based management of premenstrual disorders (PMDs).Hantsoo L, Epperson CN.Allopregnanolone in premenstrual dysphoric disorder (PMDD): evidence for dysregulated sensitivity to GABA-A receptor modulating neuroactive steroids across the menstrual cycle.Neurobiol Stress. 2020;12:100213. 2020. doi:10.1016/j.ynstr.2020.100213Sepede G, Sarchione F, Matarazzo I, et al.Premenstrual dysphoric disorder without comorbid psychiatric conditions: a systematic review of therapeutic options.Clin Neuropharmacol. 2016;39(5):241-261. doi:10.1097/WNF.0000000000000173U.S. Food and Drug Administration.Information about drospirenone.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Hofmeister S, Bodden S.Premenstrual syndrome and premenstrual dysphoric disorder.American Family Physicians. 2016;94(3):236-240.Royal College of Obstetricians and Gynaecologists (RCOG).Premenstrual dysphoric disorder.International Association for Premenstrual Disorders.Evidence-based management of premenstrual disorders (PMDs).Hantsoo L, Epperson CN.Allopregnanolone in premenstrual dysphoric disorder (PMDD): evidence for dysregulated sensitivity to GABA-A receptor modulating neuroactive steroids across the menstrual cycle.Neurobiol Stress. 2020;12:100213. 2020. doi:10.1016/j.ynstr.2020.100213Sepede G, Sarchione F, Matarazzo I, et al.Premenstrual dysphoric disorder without comorbid psychiatric conditions: a systematic review of therapeutic options.Clin Neuropharmacol. 2016;39(5):241-261. doi:10.1097/WNF.0000000000000173U.S. Food and Drug Administration.Information about drospirenone.

Hofmeister S, Bodden S.Premenstrual syndrome and premenstrual dysphoric disorder.American Family Physicians. 2016;94(3):236-240.

Royal College of Obstetricians and Gynaecologists (RCOG).Premenstrual dysphoric disorder.

International Association for Premenstrual Disorders.Evidence-based management of premenstrual disorders (PMDs).

Hantsoo L, Epperson CN.Allopregnanolone in premenstrual dysphoric disorder (PMDD): evidence for dysregulated sensitivity to GABA-A receptor modulating neuroactive steroids across the menstrual cycle.Neurobiol Stress. 2020;12:100213. 2020. doi:10.1016/j.ynstr.2020.100213

Sepede G, Sarchione F, Matarazzo I, et al.Premenstrual dysphoric disorder without comorbid psychiatric conditions: a systematic review of therapeutic options.Clin Neuropharmacol. 2016;39(5):241-261. doi:10.1097/WNF.0000000000000173

U.S. Food and Drug Administration.Information about drospirenone.

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