Premenstrual Dysphoric Disorder

What is premenstrual dysphoric disorder (PMDD)?

PMDD is a severe form of a common problem called premenstrual syndrome, or PMS. About 75% of women of childbearing age have some PMS problems. About 2% to 10% of women in this age group have PMDD.

Symptoms of PMDD

Many women may wonder if they have PMS or if it is PMDD because the symptoms are similar. The symptoms for both begin about 10-14 days before your period. But the symptoms of PMDD are more extreme and can spill over into other areas of your life. You may feel they are uncontrollable.

The symptoms of PMS and PMDD are:

  • Sadness and crying
  • Feeling nervous or anxious
  • Anger or irritability
  • Strong cravings for certain foods
  • Problems paying attention and concentrating
  • Fatigue
  • Physical problems such as breast tenderness, headaches, joint or muscle pain, and swelling or bloating
  • Trouble sleeping

It is largely the emotional symptoms that are more severe when you have PMDD. You may have more severe depression symptoms, irritability and tension, according to the National Institutes of Health (NIH).

These symptoms can affect your relationships and ability to do your job. If you have some of these symptoms a few weeks before your period and they improve when your period starts, you may have PMDD.


What causes PMDD?

The exact cause of PMDD is not known. Changes in hormones related to your period may cause PMDD.

How is PMDD diagnosed?

Your doctor will check your symptoms and the way they relate to your menstrual cycle. You might fill out a symptom chart for several weeks. There is no test that can diagnose PMDD.

To help diagnose PMDD, your family doctor may ask you to chart your symptoms (see sample chart below).

Daily Symptom Report

Severity scoring for each symptom:

0 = No symptom

1= Minimal or slightly apparent to you

2 = Moderate, awareness of symptom but does not affect your daily routine

3 = A lot, continuously bothered by the symptom and/or symptoms interferes with your daily routine

4 = Severe, symptom is overwhelming and/or unable to carry out your daily routine

Day 1 is first day of menses

Adapted with permission from Freeman EW, DeRubeis RJ, Rickels K. Reliability and validity of a daily diary for premenstrual syndrome. Psychiatry Res 1996; 65:97-106.

Can PMDD be prevented or avoided?

Stressful life events and a family history of PMS or PMDD may increase your chances of getting PMDD. Major depression is common in women who have PMDD. However, not all women who have PMDD have major depression.

PMDD treatment

Your doctor will ask you about your symptoms and will discuss different treatments with you. For mild to moderate symptoms, your doctor may suggest changes in your diet and lifestyle. You might talk to a counselor about your PMDD symptoms and life stresses. Medicines may help with severe symptoms.

What medicines are helpful?

Certain medicines used to treat depression also treat PMDD. Selective serotonin reuptake inhibitors (SSRIs) help by increasing the effect of a brain chemical called serotonin. Using these medicines can even help ease fatigue, food cravings, and sleep problems.

Does that mean I have depression?

No. SSRIs work for both conditions.

How often do I have to take these medicines?

Some of these medicines you take for 10 to 14 days before each period.

What if these medicines do not work?

Your doctor knows about other treatments. After talking with you, your doctor might have you try something else.

Living with PMDD

Trying to cope with the severe symptoms of PMDD without treatment can make you miserable. It can also make those around you miserable.

Do not feel as though it is up to you to manage PMDD by yourself. Your symptoms are real and you are not alone. If you believe you have PMDD, the best thing you can do is talk to your doctor.

Questions to ask your doctor

  • Do I have PMDD or PMS?
  • What is the difference between PMDD and PMS?
  • What treatment is best for me?
  • Will I have to take medicine until menopause?
  • Could I also have depression?
  • What are the side effects of my medicine?
  • How long will I have to take my medicine?
  • Is there anything I can do at home to help myself?