What is Premenstrual Dysphoric Disorder?

As a severe form of premenstrual syndrome, premenstrual dysphoric disorder (PMDD) involves physical and psychological symptoms around the time of menstruation. It’s common for women to experience distressing symptoms during the late luteal phase, including mood swings, breast tenderness, and fatigue. However, the symptoms of premenstrual syndrome (PMS) typically do not prevent women from functioning in daily life.

Unlike PMS symptoms, the symptoms of PMDD are more severe. PMDD causes somatic symptoms, like PMS, but PMDD often causes significant discomfort, extreme mood changes, and functional impairment.

According to the American Psychiatric Association, many women do not seek treatment for PMDD due to the stigma associated with premenstrual disorders. If you’re suffering from symptoms of PMDD, it’s important to remember that PMDD is recognized and that treatment options are available.

What causes PMDD?

The exact cause of PMDD is unknown. However, underlying depression and anxiety are common in both PMS and PMDD. Consequently, the cause of PMDD may be related to an abnormal reaction within the serotonin system to hormone changes during a woman’s menstrual cycle.

Studies have revealed a connection between PMDD and low serotonin levels, a neurotransmitter in the brain that transmits nerve signals. Brain cells use serotonin to control mood, attention, sleep, and pain. The same hormonal changes in estrogen and progesterone levels, which trigger a menstrual period, may also lead to a decrease in serotonin. This decrease in serotonin can cause PMDD symptoms and worsen the symptoms of mood disorders such as major depression.

PMDD is more prevalent among women with a history of mood disorders and anxiety disorders and a family history of premenstrual disorders. Stress during reproductive years is a significant risk factor for PMS and PMDD.

Symptoms of PMDD

Many women with PMDD experience a combination of the following symptoms during the luteal phase of the menstrual cycle (the week before the menstrual period begins):

• Mood swings, including irritability, anger, sadness, and depressed mood
• Increased anxiety or tension
• Reduced interest in usual activities
• Difficulty concentrating
• Fatigue or feeling tired
• Changes in appetite or sleeping patterns
• Feeling overwhelmed
• Physical symptoms, such as breast tenderness, nausea, a sense of weight gain (fluid retention), or vaginal dryness

In most cases, PMDD symptoms reduce or go away entirely in the week following menstruation.

How is PMDD diagnosed?

Under the Statistical Manual of Mental Disorders (DSM-5), PMDD is considered a depressive disorder. If you’re suffering from severe symptoms, reach out to your gynecologist or physician. Your doctor will perform a physical exam and evaluate your emotional and mental health.

During a diagnostic exam, clinicians must ensure that related mental illness, such as major depressive disorder, anxiety disorders, panic disorder, personality disorders, and bipolar disorder, are not the cause of symptoms. Other medical and gynecological conditions, including menopause and endometriosis, must also be ruled out for a diagnosis of PMDD.

Under the DSM-5, a PMDD diagnosis requires the following diagnostic criteria:

• You have at least five of the symptoms of PMDD.
• PMDD symptoms start 7–10 days before menstruation.
• PMDD symptoms subside shortly after menstruation begins.

If you’re dealing with mood-related symptoms daily and they don’t improve when menstruation begins, it’s unlikely that PMDD causes your symptoms.

Treatment Options for PMDD

The treatment of PMDD involves many of the same strategies used to treat PMS. If you’re experiencing discomfort due to premenstrual symptoms, consider one of the following treatment options:

• Therapy: Research suggests that talk therapy is an effective treatment to reduce the symptoms of PMDD and premenstrual depression. Relaxation therapy, meditation, and yoga may also provide relief from physical symptoms.

• Check-ups: Schedule a physical exam with your physician to rule out other medical conditions that may cause related symptoms.

• Selective serotonin reuptake inhibitors (SSRIs): Depending on your symptom severity, your physician may prescribe serotonin reuptake inhibitors, such as fluoxetine (Prozac), clomipramine (Anafranil), or sertraline (Zoloft). These medications can serve as a first-line treatment to reduce emotional symptoms, fatigue, and sleep problems. For some women, taking antidepressants during the interval between ovulation and the start of the menstrual period can reduce the symptoms of PMDD, while other women require continuous treatment.

• Oral contraceptives: In some cases, oral contraceptive pills (such as birth control pills or hormone therapy) are prescribed as a second-line treatment to reduce PMS and PMDD symptoms. If you’re concerned about side effects, consult your doctor to find a dose that works for you.

• Nutritional supplements: Consuming vitamin B6 and calcium supplements daily may reduce symptoms of PMS and PMDD in some women. Herbal remedies may also reduce irritability, mood swings, tenderness, and cramps associated with PMDD. Because the Food and Drug Administration (FDA) does not regulate herbal remedies or dietary supplements, ask your doctor before starting holistic treatment.

• Lifestyle changes: Exercising regularly, focusing on your diet, and maintaining a regular sleep schedule, especially around your menstrual period, can improve PMDD symptoms. Over-the-counter medications can help treat headaches, tenderness, and cramping, while diuretics can help relieve fluid retention and bloating. Naturally, you should ask your doctor before taking even over-the-counter medications. 

• Support groups: The International Association for Premenstrual Disorders (IAPMD) can help you find a support group in your community.

What should you look for in a therapist?

To improve mood symptoms, it’s helpful to find an experienced therapist who helps women with premenstrual disorders. Some women also find that they feel more comfortable working with a female therapist for PMDD.

If you’re seeking treatment for PMDD, consider reaching out to a mental health professional through WithTherapy. WithTherapy connects each patient to a personalized shortlist of mental health professionals and uses science and research to match preferences. We’ll match you with a therapist you feel comfortable with, regardless of your personal preferences and requirements. One of the qualified therapists on WithTherapy will help you cope with your diagnosis of PMDD and manage your PMDD symptoms.

Find a Therapist for Premenstrual Dysphoric Disorder