Premenstrual Dysphoric Disorder (PMDD) – Symptoms, Effects, and Treatment

Premenstrual dysphoric disorder (PMDD) is a condition in which a woman experiences severe depression symptoms, irritability, and tension before the menstrual cycle. It causes severe mood swings, which can disrupt daily life and damage relationships.

Premenstrual Dysphoric Disorder is a severe form of PMS
Premenstrual Dysphoric Disorder is a severe form of PMS

What PMDD is?

The premenstrual dysphoric disorder is a severe form of PMS that causes psychological distress and socioeconomic dysfunction. Symptoms of PMDD appear in menstruating women during the luteal phase (between ovulation and menstruation) of the menstrual cycle, improve within a few days after the onset of menstruation, and are minimal or absent in the week after menstruation. PMDD has a profound impact on a woman’s quality of life and dramatically increases the risk of suicidal thoughts and even suicide attempts.

In 2013, the Diagnostic and Statistical Manual of Mental Disorders added PMDD to the list of depressive disorders.

PMDD Symptoms

PMDD has been reported by menstruating women all over the world, implying a biological cause that is not geographically specific.

PMDD is a mood disorder characterized by emotional, cognitive, and physical symptoms that cause significant distress or aggravation. The majority of females experience only mild discomfort, and their symptoms have no impact on their personal, social, or professional lives. However, 5% to 8% of women experience moderate-to-severe symptoms, which can cause significant distress and functional impairment. It is most common in women between the ages of 25 and 35, but it can occur at any time during their reproductive years. 

Symptoms last six days on average, but typically appear a week or two before menstruation and last for a few days. PMDD has 11 main symptoms, and a woman must exhibit at least five of them to be diagnosed:

  • Affective lability is noticeable (eg, mood swings, sudden sadness or crying, or increased sensitivity to rejection)
  • Significant irritability or anger, as well as an increase in interpersonal conflicts
  • Significantly depressed mood, feelings of hopelessness, sadness, or thoughts of self-deprecation
  • Significant anxiety, tension, and/or tenseness or irritability
PMDD Symptoms
PMDD symptoms typically appear a week before menstruation and last for a few days after it begins.
  • Loss of interest in normal activities (eg work, school, friends, hobbies).
  • Subjective difficulty focusing.
  • Lethargy, easily fatigued, or a significant lack of energy.
  • A significant change in appetite; overeating; or specific food preferences.
  • Sleep problems (Hypersomnia or insomnia)
  • Feeling overwhelmed or out of control.
  • Physical symptoms such as breast tenderness (pain) or swelling, joint or muscle pain, feeling bloated (belly feels full and tight), or weight gain

Severe symptoms can begin and worsen until menstruation begins, with many people experiencing relief only a few days after menstruation ends. The most severe symptoms occur in the week and days preceding the first day of menstruation.


The exact cause of PMDD is currently unknown. However, because the symptoms appear only during ovulatory cycles and disappear after menstruation, they are thought to be caused by fluctuations in gonadal hormone levels or changes in sensitivity to sex hormones.

According to research, women with PMDD have genetic changes that make their emotional regulatory pathways more sensitive to estrogen and progesterone, as well as their chemical derivatives. Researchers believe that this increased sensitivity is responsible for the said symptoms of PMDD.

Premenstrual Dysphoric Disorder Treatment

PMDD is a serious disorder that can be treated with medication if necessary. Some women of childbearing age suffer from severe premenstrual symptoms that cause significant mental distress and interfere with work, school, or relationships.


Women suffering from PMDD can be prescribed a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). To help alleviate symptoms, the FDA-approved antidepressants sertraline, fluoxetine, or paroxetine hydrochloride may be prescribed.

Serotonin reuptake inhibitor side effects are typically mild and transient. For example, nausea typically subsides after several days of taking a drug for the first time — and the problem does not reoccur even if the drug is taken intermittently.

Lifestyle changes

For some, a few adjustments to daily habits can make a big difference in PMDD symptoms.

These include:

  • Frequent exercise. It doesn’t have to be an intense workout in the gym. A daily 30-minute walk around your neighborhood can help improve your mood.
  • Keep your stress under control. It’s hard to avoid stress completely, but try to stay on top of your major stressors. This can include reaching out to a co-worker for help, using a relaxation technique like yoga or meditation, or investing in a good daily planner.
  • Indulge in moderation. Try to cut back on sweets and high-sodium snacks. You may also find some relief by cutting back on caffeine and alcohol.
  • Eat according to mood. Focus on foods containing lean protein and complex carbohydrates. Think fish, nuts, chicken, and whole grains. These types of foods can increase levels of tryptophan, a chemical your body uses to make serotonin. Remember that hormonal changes can cause serotonin levels to drop.


Working with a therapist can help you navigate the emotional challenges that come with PMDD. A specific type of therapy called cognitive behavioral therapy (CBT) can be especially helpful. CBT has been proven to be a successful treatment for anxiety and mood disorders, as well as for improving how well people handle physical symptoms like pain.

Premenstrual Dysphoric Disorder Treatment
Premenstrual Dysphoric Disorder Treatment

This approach will help you develop new behaviors and thought patterns that will help you better navigate difficult situations. Using CBT, your therapist can help you develop new tools to use when your mood starts to drop before your period.