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Premenstrual Dysphoric Disorder (PMDD)

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. It’s a severe and chronic medical condition that needs attention and treatment. Lifestyle changes and sometimes medicines can help manage symptoms.

What causes PMDD?

The exact cause of PMDD is not known. It may be an abnormal reaction to normal hormone changes that happen with each menstrual cycle. The hormone changes can cause a serotonin deficiency. Serotonin is a substance found naturally in the brain and intestines that narrows blood vessels and can affect mood and cause physical symptoms.

Who is at risk for PMDD?

While any woman can develop PMDD, the following may be at an increased risk:

  • Women with a family history of PMS or PMDD  

  • Women with a personal or family history of depression, postpartum depression, or other mood disorders

Other possible risk factors include lower education and cigarette smoking.

Talk with your healthcare provider for more information.

What are the symptoms of PMDD?

Symptoms of PMDD start during the week before menstruation and end within a few days after your period starts. These symptoms disrupt daily living tasks. Symptoms of PMDD are so severe that women have trouble functioning at home, at work, and in relationships during this time. This is markedly different than other times during the month.

The following are the most common symptoms of PMDD: 

Psychological symptoms

  • Irritability

  • Nervousness

  • Lack of control

  • Agitation

  • Anger

  • Insomnia

  • Trouble concentrating

  • Depression

  • Severe fatigue

  • Anxiety

  • Confusion

  • Forgetfulness

  • Poor self-image

  • Paranoia

  • Emotional sensitivity

  • Crying spells

  • Moodiness

  • Trouble sleeping

Fluid retention

  • Swelling of the ankles, hands, and feet

  • Periodic weight gain

  • Diminished urine output

  • Breast fullness and pain

Respiratory problems

  • Allergies

  • Infections

Eye complaints

  • Vision changes

  • Eye infection


Gastrointestinal symptoms

  • Abdominal cramps

  • Bloating

  • Constipation

  • Nausea

  • Vomiting

  • Pelvic heaviness or pressure

  • Backache

Skin problems

  • Acne

  • Skin inflammation with itching

  • Aggravation of other skin disorders, including cold sores

Neurologic and vascular symptoms

  • Headache

  • Dizziness

  • Fainting

  • Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs

  • Easy bruising

  • Heart palpitations

  • Muscle spasms


  • Decreased coordination

  • Painful menstruation

  • Diminished sex drive

  • Appetite changes

  • Food cravings

  • Hot flashes


The symptoms of PMDD may look like other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Always see a healthcare provider for a diagnosis.

How is PMDD diagnosed?

Aside from a complete medical history and physical and pelvic exam, there are very few diagnostic tests. Because there are mental health symptoms, your healthcare provider may want you to be evaluated for mental health concerns. In addition, your healthcare provider may ask that you keep a journal or diary of your symptoms for several months. In general, to diagnose PMDD the following symptoms must be present:

  • Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:

    • Depressed mood

    • Anger or irritability

    • Trouble concentrating

    • Lack of interest in activities once enjoyed

    • Moodiness

    • Increased appetite

    • Insomnia or the need for more sleep

    • Feeling overwhelmed or out of control

    • Other physical symptoms, the most common being belly bloating, breast tenderness, and headache


  • Symptoms that disturb your ability to function in social, work, or other situations

  • Symptoms that are not related to, or exaggerated by, another medical condition

How is PMDD treated?

PMDD is a serious, chronic condition that does need treatment. Several of the following treatment approaches may help relieve or decrease the severity of PMDD symptoms:

  • Changes in diet to increase protein and carbohydrates and decrease sugar, salt, caffeine, and alcohol

  • Regular exercise

  • Stress management

  • Vitamin supplements (such as vitamin B6, calcium, and magnesium)

  • Anti-inflammatory medicines

  • Selective serotonin reuptake inhibitors (SSRIs)


For some women, the severity of symptoms increases over time and lasts until menopause. For this reason, a woman may need treatment for an extended time. Medicine dosage may change throughout the course of treatment.

Key points about PMDD

  • PMDD is a much more severe form of premenstrual syndrome (PMS).

  • The exact cause of PMDD is not known.

  • PMDD is different from other mood disorders or menstrual conditions because of when symptoms start and how long they last.

  • Symptoms of PMDD are so severe that it affects your ability to function at home, work and in relationships.

  • Treatment that may include lifestyle changes and sometimes medicines.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

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