How Premenstrual Dysphoria Disorder (PMDD) Is Diagnosed

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Premenstrual dysphoric disorder (PMDD) diagnosis is complex. There is no blood or imaging test for it, so doctors must rely on patients' self-reported symptoms, such as depression, anxiety, and other mood swings. The timing of these symptoms is a key indicator: They must occur seven to 14 days before the start of menstruation and resolve shortly after one's period arrives.

Though similar to premenstrual syndrome (PMS), PMDD symptoms are extreme, can impact daily life and relationships, and even lead to thoughts of suicide. If you think you may have PMDD, it is important to get a proper diagnosis so you can start treatment.

Self-Checks

If you suspect you have PMDD, you can take an online screening assessment offered by the International Association for Premenstrual Disorders (IAPMD). This self-screen goes over various symptoms that occur following ovulation during the luteal phase of your cycle, which is typically a week or two prior to your period. This is not enough to formally diagnose you, but it can tell you if what you are experiencing could be PMDD.

Since PMDD is diagnosed based on recurring symptoms, it is important to track your symptoms for at least two full menstrual cycles. You can use a blank calendar, notebook, or journal to keep a paper record of your symptoms. IAPMD offers tools to help with this, including a printable symptom tracker and a tracking app.

The timing of your symptoms is necessary to differentiate between PMDD or a premenstrual exacerbation of an underlying condition, such as bipolar disorder. An accurate symptom log will help your doctor to make the correct diagnosis of PMDD.

Medical History

In an effort to make a PMDD diagnosis, your doctor will ask you a lot of questions related to your symptoms: their severity, frequency, impact on your daily life, and so on.

This is to piece together enough information to see if you meet the diagnostic criteria for PMDD as outlined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

  • You must have five or more severe symptoms that occur during the time between ovulation and your period (see below).
  • These symptoms must go away during your period and not return for at least another couple of weeks when your next luteal phase starts.
  • These symptoms must also interfere with your work or school, your relationships with family, friends, and/or coworkers and your usual social activities.

You have to have at least one of the following symptoms to have the diagnosis of PMDD:

  • Very labile moods like mood swings, increased sensitivity to rejection, and/or sudden sadness or tearfulness
  • Marked irritability or anger
  • Depressed mood
  • Marked anxiety and tension

In addition, you may also have any of the following symptoms to make a total of five or more symptoms: 

  • Decreased interest in your usual activities
  • Difficulty concentrating
  • Lack of energy
  • Overeating or food cravings
  • Changes in your sleep habits
  • Feeling overwhelmed or out of control
  • Physical symptoms like breast tenderness or swelling, joint pain, muscle aches, bloat, or weight gain

Labs and Tests

Since PMDD is a mood disorder, it cannot be diagnosed through blood tests or imaging. However, your doctor may order blood tests to rule out other potential causes of your symptoms, such as altered hormone levels or thyroid problems.

Differential Diagnoses

PMDD presents with a combination of physical and psychological symptoms. Though you may suspect your symptoms are due to PMDD, there are other health conditions your doctor may consider:

  • Premenstrual syndrome: The timing of PMS and PMDD are the same, however, PMS tends to include more physical symptoms, while the emotional symptoms of PMDD are more severe and debilitating.
  • Hormonal imbalance: Mood swings, bloating, irritability, and difficulty concentrating can be due to a hormonal imbalance unrelated to PMDD. Your doctor can test blood levels of hormones to differentiate between hormonal imbalances and this disorder.
  • Premenstrual exacerbation of another disorder: Some conditions, such as anxiety, can worsen before your period and may appear related to PMS or PMDD. The difference between a premenstrual exacerbation and PMDD is the symptoms are still present, although at lower levels, at other times of the month.
  • Thyroid problems: Having high or low levels of thyroid hormones can cause physical and emotions symptoms that are similar to PMS and PMDD, including fatigue, weight gain, and anxiety. What's more, thyroid disorders may exacerbate PMS and PMDD symptoms. Your doctor will likely test blood levels of thyroid hormones to rule a thyroid-related issue in or out.
  • Depression: PMDD may present with symptoms similar to clinical depression. However, PMDD symptoms are limited to the two weeks before your period. If your symptoms occur at other times during the month, you may be diagnosed with depression.
  • Generalized anxiety disorder (GAD): Anxiety is a common symptom of PMDD, however, with PMDD, the symptoms are limited to the two weeks before your period. If your symptom diary shows high levels of anxiety at other times of the month, you may be diagnosed with generalized anxiety disorder.
  • Bipolar disorder: The extreme mood swings of PMDD can mimic bipolar disorder in some women. While symptoms of PMDD only occur in the week to two prior to menstruation, some women with bipolar experience cyclical episodes that may coincide with the menstrual cycle.

Note: PMDD is more likely in women with a personal or family history of mental health disorders. While PMDD can cause depression, it's also possible for it (or another psychological concern) to co-occur with and independent of PMDD.

A Word From Verywell

Getting the proper diagnosis of PMDD is the first step to feeling better. If you think you might have PMDD and you and your doctor don't seem to be on the same page about this possibility and the severity of your symptoms, seek a second opinion. Unfortunately, many women with PMDD report that they don't feel they are taken seriously when describing how they feel. The National Association for Premenstrual Dysphoria Disorder provides many resources to help women connect and learn more about the condition and treatment options.

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