How Premenstrual Dysphoria Disorder (PMDD) Is Diagnosed

In This Article

Premenstrual dysphoric disorder (PMDD) is a mood disorder that affects 3 to 8 percent of women in the second half of their menstrual cycle. It presents as severe mood changes occurring seven to 14 days before the start of your period and resolves shortly after your period arrives.

Though similar to premenstrual syndrome (PMS) that many women experience, women with PMDD can have extreme symptoms that impact personal and professional relationships and can lead to thoughts of suicide.

There are no blood tests or imaging tests that are helpful to diagnose PMDD. The diagnosis is made based solely on your symptoms.

According to the diagnostic criteria for PMDD as outlined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM):

  • You must have five or more severe symptoms that occur during the time between ovulation and your period. 
  • 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 one or more 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 or muscle aches, feeling bloated, and or weight gain

At-Home Testing

If you suspect you have PMDD, you can take an online screening assessment through the International Association for Premenstrual Disorders website iapmd.org.

This self-screen goes over various symptoms that occur following ovulation during the luteal phase of your cycle, which is typically seven to 14 days prior to your period. It is not intended to diagnose the condition or replace the care of a medical practitioner but rather serves as an indicator for further investigation.

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, such as altered hormone levels or thyroid problems.

Preparing For Your Appointment

PMDD is diagnosed based on symptoms, so it is important to track your symptoms for two months prior to your appointment.

 You can use a blank calendar, notebook, or journal to keep a paper record of your symptoms, or use an online symptom tracker or app. Keep a detailed account of how you are feeling emotionally and physically every day for two complete menstrual cycles starting with the first day of your period.

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 allow your doctor to make the correct diagnosis of PMDD.

While the exact cause of PMDD is unknown, normal cyclic changes in the menstrual cycle can trigger changes in your neurotransmitters or brain chemicals. These changes result in the symptoms of PMDD. Once you have been properly diagnosed with PMDD you can work with your doctor to determine what treatment options are best for you.

A Word From Verywell

Getting the proper diagnosis of PMDD is the first step to feeling better. Because the condition can be isolating and can create big disruptions in your personal relationships it is a good idea to connect with other women who have PMDD. The National Association for Premenstrual Dysphoria Disorder provides many resources to help women connect and learn more about the condition and treatment options. Making healthy lifestyle changes, gettingproper treatment, and support will help you to live well with PMDD.

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Article Sources

  • Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Table 1, Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD). https://www.ncbi.nlm.nih.gov/books/NBK279045/table/premenstrual-syndrom.table1diag/

  • Hantsoo L, Epperson C. Premenstrual Dysphoria Disorder: Epidemiology and Treatment. Current Psychiatry Reports. 2015;17(11)86-94