Symptoms of Premenstrual Dysphoric Disorder

Symptoms of Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder, also known as PMDD, is a severe form of premenstrual syndrome (PMS). Women with PMDD experience changes to how they respond to hormonal fluctuations. This can lead to frequent and more drastic mood swings, along with significantly worsened physiological symptoms associated with premenstrual syndrome. Women with a family history of PMDD or increasingly difficult PMS are at a higher risk of developing PMDD, along with women who have a family history of mood disorders.

While PMDD may appear as premenstrual syndrome (PMS) to others and some symptoms of each condition are similar in nature, those associated with PMDD are much more severe and debilitating than those of PMS.

It can be difficult to distinguish which symptoms are typical of PMS, however. This makes talking to others important. If you do not know any other women experiencing symptoms as extreme and debilitating as yours are, it will be helpful to speak to a healthcare provider, who can identify which symptoms are typical of a monthly cycle and which require further intervention.

Symptoms of Premenstrual Dysphoric Disorder
Verywell / Brianna Gilmartin

Frequent Symptoms

Symptoms of PMDD include both physical and psychological manifestations. They typically appear the week or so leading up to your period and may vanish soon after your period starts.

Physical symptoms of PMDD may include:

  • Muscle spasms
  • Changes in appetite
  • Changes in libido (sex drive)
  • Fluid retention
  • Food cravings and binge eating
  • Abdominal and pelvic pain
  • Acne
  • Breast fullness and pain
  • Temporary weight gain
  • Painful menstruation
  • Vision impairment
  • Headaches
  • Vertigo
  • Heart palpitations
  • Impaired coordination

In addition, someone with PMDD may experience psychological symptoms, such as:

  • Severe fatigue
  • Mood swings
  • Sleep issues and insomnia
  • Severe depression
  • Suicidal ideation
  • Anxiety
  • Irritability
  • Paranoia
  • Anger
  • Impaired memory and concentration

Rare Symptoms

While many symptoms associated with PMDD have a primary or secondary connection to hormonal imbalances, this can prove life-threatening in severe cases. Some symptoms, such as infections, can lead to respiratory failure and loss of limbs in extreme cases if not treated immediately. Severe heart palpitations can cause a heart attack (myocardial infarction). Severe depression and suicidal thoughts, vision changes, severe changes in sensation, and impaired coordination all pose safety risks.

Such risks of PMDD symptoms are especially of concern in those with impaired mobility and others who are already at risk for falls due to other medical conditions.

Mood changes and instability can be even more unstable and distressing in those diagnosed with a mood disorder or other psychiatric condition.

Sub-Group Indications

Those with a pre-existing mood disorder should seek medical advice for managing potential mood changes associated with PMDD. Concerns related specifically to mood disorders can be brought to a gynecologist and psychiatrist to effectively monitor both conditions.

If you have been diagnosed with PMDD and become pregnant, ask your healthcare provider about any potential impact of this condition on your pregnancy, as PMDD is a risk factor for depression in both pregnancy and postpartum. The absence of a menstrual cycle during the gestational period may temporarily lessen or eliminate symptoms of PMDD. However, a healthcare provider should be consulted to ensure lifestyle continues to support a healthy balance of hormone levels.

Women who are severely overweight may experience an increase in symptoms related to mobility, such as impaired coordination and heart palpitations. These, along with others, should be closely monitored by a healthcare provider.

When to See a Healthcare Provider or Go to the Hospital

Extreme cases of symptoms such as mood changes, severe depression, suicidal ideation, and heart palpitations should be addressed immediately by a healthcare provider. This will prevent further complications related to PMDD and keep hormone levels at an appropriate balance.

Treatment-related issues should also be immediately brought to the attention of a healthcare provider.

These include issues with vitamin supplements, selective serotonin reuptake inhibitors (SSRIs), nonsteroidal anti-inflammatory drugs (NSAIDs), or other anti-inflammatory medications, birth control pills, and drastic changes in diet.

A Word From Verywell

Treatment of PMDD typically includes stress management and lifestyle changes, as these are important factors in any hormonal condition. The medications mentioned above may also be indicated for more specific symptoms of PMDD. However, the most powerful recommendation is often a well-rounded lifestyle with good health education and maintenance of PMDD and all related health conditions. Being advised by a doctor, healthcare provider or other integrative health professional is the best way to keep PMDD under control and minimize the impact it has on your life’s activities.

Frequently Asked Questions

  • Can hormones cause depression in women?

    Yes. Hormonal fluctuations can cause depression and mood disorders. Menopause, pregnancy, giving birth, or having premenstrual syndrome or premenstrual dysphoric disorder can cause the condition, known as reproductive depression.

  • Can you get heart palpitations with PMS?

    Yes. Even normal estrogen and progesterone changes throughout the month can cause changes in heart rhythm. With more serious PMS, your heart may suddenly beat faster, known as supraventricular tachycardia (SVT), and you may have more serious symptoms related to SVT including chest pain and weakness.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Hantsoo L, Epperson CN. Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Curr Psychiatry Rep. 2015;17(11):87. doi:10.1007/s11920-015-0628-3

  3. Reid RL. Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome). In: Feingold KR, Anawalt B, Boyce A, et al, editors. Endotext. South Dartmouth (MA):, Inc.

  4. Perez-Lopez FR, Chedraui P, Perez-Roncero G, Lopez-Baena MT, Cuadros-Lopez JL. Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Symptoms and Cluster Influences. The Open Psychiatry Journal. 2009;3: 39-49. doi:10.2174/1874354400903010039

  5. Studd J, Nappi RE. Reproductive depression. Gynecological Endocrinology. 2012;28(sup1):42-45. doi:10.3109/09513590.2012.651932

  6. Cleveland Clinic. Women & abnormal heart beats.

Additional Reading

By Brittany Ferri
Brittany Ferri, MS, OTR-L, CCTP, is an occupational therapist, consultant, and author specializing in psychosocial rehab.