An Overview of Premenstrual Dysphoric Disorder (PMDD)

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Premenstrual dysphoric disorder (PMDD) is the most severe form of premenstrual syndrome (PMS). The diagnostic criteria for PMDD were first included in the American Psychiatric Association's fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) in 1994.


Women with PMDD experience extreme PMS in the week before starting her period. In addition to the physical and emotional symptoms required for a diagnosis of PMS, at least five of the following symptoms must occur for most of the time during the seven days before menstruation, and go away within a few days of the start of the menstrual period:

  • Feeling sad, hopeless, or suicidal
  • Severe feelings of stress, tension, or anxiety
  • Panic attacks
  • Mood swings that include bouts of crying
  • Constant irritability or anger that affects other people
  • Loss of interest in usual daily activities and relationships
  • Inability to concentrate or focus
  • Fatigue or loss of normal energy
  • Food cravings or binging


The cause of PMDD is still not understood. It is believed to be an abnormal reaction to hormonal fluctuations. According to recent research, there is a correlation between PMDD and low levels of serotonin, and it is suspected that changes in estrogen levels in the week prior to menstruation may alter serotonin levels.

Brain cells that use serotonin as a messenger are involved in controlling mood, attention, sleep, and pain. Therefore, chronic changes in serotonin levels can lead to PMDD symptoms.


The diagnosis of PMDD begins with the information that you provide to your doctor. It is helpful to track your symptoms for at least two months before your appointment. You can use a notebook, calendar, or period tracker app such as Clue or Glow. Keeping track of your symptoms will help your doctor make an accurate diagnosis.

Other mood disorders, such as depression or generalized anxiety disorder, will also have to be ruled out. In addition, underlying medical or gynecological conditions such as endometriosis, fibroids, menopause, or hormonal problems also must be ruled out.


Your doctor will decide on the right course of treatment for your PMDD symptoms.

Many women with PMDD take antidepressants known as Selective Serotonin Reuptake Inhibitors (SSRIs), with either a steady dose throughout the month or with an increased dose for two weeks before their periods.

Hormones are also used to treat PMDD. Many women find taking medication to stop ovulation can eliminate the hormone fluctuations that lead to PMDD. Your doctor may also recommend medications or creams containing progesterone or estrogen to relieve symptoms. 


Living with PMDD can be challenging. Women with PMDD may be more likely to have suicidal thoughts. If you feel you are in danger of hurting yourself, call the Suicide Prevention Hotline at 1-800-273-8255 or instant message with Lifeline Chat.

In addition to medication, women with PMDD may find some relief using holistic techniques, relaxation exercises, stress relief, and diet in the week before their period. Here are some methods that are also suggested for easing PMS symptoms:

  • Eat right. Follow the rules of good nutrition. Health experts recommend that women with PMDD limit their intake of salt, caffeine, refined sugar, and alcohol.
  • Take supplements. Calcium, vitamin B6, vitamin E, and magnesium are recommended for easing PMS and PMDD. 
  • Reduce stress. PMDD is cyclical, so you have a good idea of when it will resurface. When possible, lower your expectations for productivity or social commitments for the week before your period, and try to incorporate stress relieving techniques, such as deep breathing or meditation. Book yourself a massage, pedicure, reflexology, or other types of pampering session during this time.
  • Get exercise. Even light exercises, like walking, yoga, or tai chi, can help to relieve symptoms.
  • Try OTC meds. Over-the-counter (OTC) pain relievers may help with some symptoms, such as headaches, breast tenderness, backaches, and cramping. Diuretics can help with fluid retention and bloating.
  • Seek professional mental health care. Some women suffering from the symptoms of PMDD also seek out counseling. Therapy can help you to develop effective coping strategies.

A Word From Verywell

PMDD can cause emotional, physical, and professional difficulty for many women. If you think you are affected by PMDD, make an appointment to speak with your doctor to seek out treatment and support. Your doctor can help you to find the right medication and treatment plan for you.

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