Premenstrual Dysphoric Disorder (PMDD)

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Premenstrual Dysphoric Disorder (PMDD)

THC Editorial Team January 20, 2021
Image of a woman in contemplation
Photo by Zulmaury Saavedra on Unsplash


What Is Premenstrual Dysphoric Disorder?

Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome. Symptoms are much more intense and often interfere with a woman’s ability to work, attend school, or socialize regularly. Symptoms begin after ovulation as hormone levels begin to decrease and may occur as early as 1 to 2 weeks before menstruation begins. Symptoms typically subside a few days after a woman’s period starts.

Many women experience pronounced physical and psychological changes in the days before menstruation. Although as many as one third of premenopausal women undergo noticeable premenstrual symptoms,1 only about 3%–8% of women have symptoms that are severe enough to be diagnosed as PMDD.2

As of 2013, PMDD is a new category in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (5th edition; DSM-5). It was previously included under depressive disorders; however, research has determined that this condition is actually unrelated to depression and presents with unique symptoms that warrant an independent diagnosis.3

What Are the Symptoms of Premenstrual Dysphoric Disorder?

Many women experience mild to moderate changes in physicality and mood with premenstrual syndrome, but women with PMDD have more severe symptoms that cause significant daily disruption and affect overall quality of life.

Symptoms usually begin 7 to 10 days before menstruation.4 Although women with PMDD experience a wide range of symptoms, the most common are classified as psychological or physical.

Psychological symptoms include the following:

  • moodiness
  • sadness or crying spells
  • irritability or agitation
  • anger
  • extreme fatigue
  • forgetfulness or confusion
  • difficulty sleeping
  • anxiety or nervousness
  • trouble concentrating or focusing
  • paranoia
  • depression

Physical symptoms include the following:4

  • fluid retention
  • breast tenderness
  • vision changes
  • bloating
  • abdominal or back cramps
  • nausea or vomiting
  • constipation
  • acne
  • headache
  • dizziness or fainting
  • painful menstruation
  • hot flashes
  • changes in appetite
  • decreased sex drive

Complications of Premenstrual Dysphoric Disorder

Women who suffer from both depression and PMDD may notice that depressive symptoms worsen during the latter half of the menstrual cycle. Because suicidal thoughts may occur, medications or dosages may need to be changed during this time period.

Causes and Risk Factors for Premenstrual Dysphoric Disorder

Although researchers have identified no one specific reason why some women are more likely to experience PMDD than others, fluctuating hormone levels play a significant role in PMDD.1 Recent research has found that a certain gene complex, the ESC/E(Z) gene complex, may increase a woman’s sensitivity to normal levels of monthly fluctuation in the reproductive hormones estrogen and progesterone—which also affect levels of serotonin in the brain and are involved in mood regulation.5 This increased sensitivity may explain the severity of symptoms that some women experience with PMDD.5

Risk factors that may make a woman more susceptible to PMDD include the following:

  • presence of a mood disorder (e.g., anxiety, depression, or seasonal affective disorder)
  • family history of PMDD
  • obesity
  • lack of exercise
  • substance abuse
  • smoking cigarettes6
  • presence of an eating disorder6

How Is Premenstrual Dysphoric Disorder Diagnosed?

A physician will perform a physical examination and interview a patient regarding the timing of symptoms. Although there are no tests to check for PMDD, the physician may perform diagnostic testing to rule out other conditions.

In order to be diagnosed with PMDD, a woman must be of childbearing age and have at least five symptoms that begin 1 to 2 weeks before menses. These symptoms must start to improve within a few days of the onset of menstruation and should cease once the cycle is complete. Additionally, the symptoms must interfere with the woman’s daily activities or with her social relationships and must not be related to another mood or personality disorder.7

Treatments for Premenstrual Dysphoric Disorder

No one specific treatment exists for PMDD; rather, a combination of treatment methods may be effective for most women who suffer from this condition.


Antidepressants and birth control pills have shown to be effective PMDD treatments for many women.8 However, women who already take antidepressants may need to change their dosage or add another medication during the second half of their menstrual cycle. Anti-inflammatory medicines can help with the physical symptoms associated with PMDD.


Certain vitamins and herbal remedies may help reduce disabling symptoms in some women. Vitamin B6, vitamin E, calcium, magnesium, and chasteberry show promise; however, it is important to check with a healthcare provider before taking any supplements or herbs.1

Therapy and Stress Reduction

Cognitive behavioral therapy (CBT) or stress reduction techniques, such as meditation or yoga, have reduced symptoms associated with PMDD for many women.8

Lifestyle Changes

Diet and exercise may have a large impact on the severity of PMDD symptoms.8 Increasing protein and complex carbohydrates while reducing salty and sugary foods may help.4 Increasing physical activity and getting enough sleep can also relieve many symptoms.5

With the right treatments, most women find that they can alleviate their PMDD symptoms completely or at least reduce them to levels that improve their quality of life.


  1. Biggs, W. S., & Demuth, R.H. (2011). Premenstrual syndrome and premenstrual dysphoric disorder. American Family Physician, 84(8), 918–924.
  2. Halbreich, U., Borenstein, J., Pearlstein, T., & Kahn, L. S. (2003). The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology, 28(Suppl. 3), 1–23.
  3. Epperson, C. N., Steiner, M., Hartlage, S. A., Eriksson, E., Schmidt, P. J., Jones, I., & Yonkers, K. A. (2012). Premenstrual dysphoric disorder: Evidence for a new category for DSM-5. American Journal of Psychiatry, 169(5), 465–475.
  4. Johns Hopkins Medicine. (n.d.). Premenstrual dysphoric disorder (PMDD). Retrieved September 3, 2020, from
  5. National Institutes of Health. (2017, January 3). Sex hormone-sensitive gene complex linked to premenstrual mood disorder
  6. MedlinePlus. (2018). Premenstrual dysphoric disorder. Retrieved September 3, 2020, from
  7. Reid, R. L. (2017). Table 1, Diagnostic criteria for premenstrual dysphoric disorder (PMDD).
  8. Rapkin, A. J., & Lewis, E. I. (2013). Treatment of premenstrual dysphoric disorder. Women’s Health, 9(6), 537–556.

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