Premenstrual Dysphoric Disorder

Written by BetterHelp Editorial Team
Medically reviewed by Dr. Jennie Stanford, MD, FAAFP, DipABOM, Andrea Brant, LMHC, and Dr. April Brewer, DBH, LPC

Overview

Premenstrual dysphoric disorder (PMDD), a very severe form of premenstrual syndrome, is categorized as a depressive disorder that affects people with a gynecological reproductive system who are of childbearing age. A severe form of premenstrual syndrome (PMS), premenstrual dysphoric disorder is characterized by intense emotional and physical symptoms that often begin up to two weeks before a menstrual period and resolve within a few days after the period begins.

Individuals with PMDD may experience extreme irritability, depression, anxiety, mood swings, and physical symptoms like bloating and headaches. PMDD is believed to arise due to hormonal changes or chemical imbalances in the brain. The symptoms of PMDD can be so severe that they affect all facets of life, including one’s ability to work, maintain personal relationships, and perform daily activities at home. 

There are some misconceptions about PMDD, as some people may confuse it as typical “PMS.” However, differentiating between the two can be key, as PMDD is a more serious and chronic1 condition that requires appropriate treatment, and PMS is not a recognized medical condition. PMDD is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation. Managing PMDD often involves lifestyle changes and, in some cases, medications to treat symptoms.

Symptoms

Premenstrual dysphoric disorder (PMDD) symptoms can vary in severity but often include physical, emotional, and behavioral symptoms. These symptoms typically occur during the luteal phase of the menstrual cycle and can cause distress2 and interfere with relationships, work, or school. The physical symptoms of PMDD are like those of premenstrual syndrome (PMS) but a more severe version. These may include:

  • Bloating and fluid retention
  • Cramps
  • Breast tenderness
  • Headaches or migraines
  • Joint or muscle pain
  • Fatigue
  • Appetite changes and food cravings

What differentiates PMDD from typical PMS are the emotional symptoms. These emotional symptoms are often unique to PMDD and can be severe. Some common emotional symptoms of this severe, sometimes disabling extension of premenstrual syndrome  are:

  • Depressed mood 
  • Anxiety or tension
  • Mood swings or rapid or intense changes in mood 
  • Severe irritability or anger
  • Difficulty concentrating
  • Decreased interest in previously enjoyed activities
  • Fatigue or lethargy
  • Changes in eating habits
  • Changes in sleep patterns
  • A sense of being overwhelmed

To be diagnosed with PMDD, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), an individual must show at least five of the above symptoms. These symptoms must be severe enough to affect daily life and not be caused by another mental health disorder. 

In addition to the physical and emotional symptoms, individuals with PMDD might also experience behavioral symptoms. These might include:

  • Social withdrawal or isolation
  • Difficulty at work or school due to lack of focus or emotional outbursts

Symptoms of PMDD may resemble other conditions or medical problems, such as thyroid disorders, depression, or anxiety disorders. Therefore, it may be valuable to consult a healthcare provider for an accurate diagnosis and appropriate support.

Causes

The exact cause of premenstrual dysphoric disorder (PMDD) is unknown. However, researchers have found several factors that may contribute to its development, such as the following: 

  • Hormonal changes: PMDD may be incited by an abnormal reaction to normal hormonal changes that occur with each menstrual cycle. The hormonal fluctuations like estrogen and progesterone may lead to various physical and emotional symptoms.
  • Neurochemical imbalances: Disturbances in the brain's neurochemistry and communication pathways are thought to play a role in the development of PMDD. These changes may cause a deficiency in serotonin, a neurotransmitter that helps regulate mood, sleep, and appetite. Low levels of serotonin may contribute to mood swings and other symptoms associated with PMDD.
  • Genetic factors: Genetic factors may also influence the development of PMDD. A family history of PMDD or other mood disorders could put an individual at a higher risk for experiencing PMDD.

Some common risk factors associated with PMDD include:

  • A history of depression, anxiety, or other mood disorders
  • A history of traumatic or stressful life events
  • A family history of PMDD or mood disorders
  • Lifestyle factors, such as poor diet, lack of exercise, and insufficient sleep
  • Cigarette smoking
  • Obesity

Treatments

A PMDD diagnosis used to indicate serious premenstrual distress with associated deterioration in functioning necessitates treatment. The goal of treatment for PMDD is often to reduce symptoms, improve daily functioning, and reduce the effects of the disorder on a person's quality of life. Various treatment options are available, including therapy, medication, and self-care strategies.

Therapy 

Cognitive-behavioral therapy (CBT) is a common form of therapy used to treat PMDD. CBT focuses on recognizing maladaptive thoughts and behaviors and creating healthy ways to cope with them. This type of therapy may help individuals with PMDD better understand their emotions and behaviors, which may allow them to manage some of their symptoms.

Medication

Certain birth control pills can alleviate the symptoms of PMDD. Oral contraceptives that contain drospirenone—a progestin medication—have been shown to reduce the negative effects of PMDD. These forms of birth control, however, may cause adverse effects, including increased breast tenderness and nausea.  

Medication may be beneficial in a treatment plan when combined with other approaches, like therapy or nutritional counseling. Note that the decision to use medication as treatment can be made with a healthcare provider who is familiar with the individual’s specific symptoms, health, and medical history in mind. Do not start, change, or stop a medication without consulting your doctor. 

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Other treatment options

Other treatment options for premenstrual dysphoric disorder include the following: 

  • Nutritional supplements: Certain supplements, such as calcium, magnesium, and vitamin B6, may reduce PMDD symptoms. These supplements can be taken daily to regulate mood and alleviate physical symptoms.
  • Alternative therapies: Acupuncture, yoga, and herbal remedies like chasteberry and black cohosh have been used to treat premenstrual syndrome. While these methods may show potential, more research is needed to confirm their effectiveness.

Self-care

Practicing self-care can be helpful in managing PMDD symptoms. Some potential self-care practices include:

  • Regular exercise: Regular physical activity may improve mood, reduce stress and anxiety, and boost energy levels. Aerobic exercises like swimming, biking, or walking are often recommended. 
  • Healthy diet: A balanced diet rich in whole foods, lean proteins, fruits, and vegetables may promote overall health. However, there is no conclusive evidence regarding the impact of diet on PMDD symptoms. 
  • Stress management: Learning to manage stress through techniques like deep breathing, meditation, and mindfulness may reduce the effects of PMDD on daily life.
  • Sleep: Maintaining a consistent sleep schedule with high-quality sleep may reduce fatigue and promote mental and physical health.
  • Support network: Having a strong support system of friends, family, and mental health professionals may provide support and encouragement to individuals with PMDD to manage their symptoms.

Resources

Several resources are available to offer support to individuals experiencing PMDD. Therapy is a potential method for coping with PMDD. An online therapy platform like BetterHelp may be a helpful way to connect with a professional therapist to address symptoms and the effects of the condition, as you can meet with a provider from home. 

Additional resources for PMDD include mental health organizations and support groups. The International Association for Premenstrual Disorders (IAPMD) offers valuable tools and resources to help individuals manage the condition. In addition to connecting users with valuable resources, they also provide a mobile app called Me v. PMDD, which is available on Apple and Android devices and can help users track the symptoms and treatment of PMDD.

Another organization, the Office on Women's Health, offers information about PMDD, its symptoms, and potential treatment options. They also provide a convenient way to find local health centers that may be able to support and treat individuals with PMDD. With these resources and support options, individuals with PMDD may find guidance on managing their unique experiences with the condition.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. Please also see our Get Help Now page for more immediate resources.

Research

Recent research evaluated the potential causes and treatments of PMDD. One key finding involves the role of certain hormones3 produced by the ovaries, particularly allopregnanolone, as these hormones may influence mood symptoms in some women with PMDD.

One study examined how a sharp rise in ovarian hormones may incite the negative mood symptoms of PMDD in vulnerable individuals. The research further suggests that allopregnanolone's action on specific receptors in the central nervous system could play a role in the development and treatment of PMDD. 

SSRI medications have been commonly used to manage PMDD, but they may not be suitable for all individuals. A recent study explored the use of a selective progesterone receptor modulator (SPRM), ulipristal acetate, as a potential treatment for PMDD. 

The study showed promising results, with a significant reduction in the severity of mental symptoms of PMDD. These findings may offer insight into a new way of managing the condition. However, more research is needed to explore the long-term effectiveness and safety of SPRMs in managing PMDD.

Statistics

Below are several critical statistics on premenstrual dysphoric disorder (PMDD):

  • PMDD affects around 3% to 8% of women worldwide, based on data from a survey-based study that compiled prevalence rates from various analyses.
  • Studies reveal a strong link between disorders like premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) and the risk of suicide. Women with PMDD are almost seven times more likely to try suicide and four times more likely to have suicidal thoughts.
  • A diagnosis of PMDD is associated with an increased risk of several co-existing conditions, such as panic disorder without agoraphobia (74% increased odds), panic disorder with agoraphobia (92% increased odds), post-traumatic stress disorder4 (79% increased odds), and generalized anxiety disorder5 (79% increased odds).
  • SSRIs have been proven to be effective in treating PMS and PMDD symptoms with a success rate of 60% to 90%, significantly higher than the 30% to 40% seen with placebos. These medications may alleviate mood-related and physical symptoms.
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Updated on September 6, 2024.
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