Premenstrual Dysphoric Disorder (PMDD) Symptoms, Causes & Treatment Options

Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome (PMS) that affects some menstruating women.

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  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Premenstrual Dysphoric Disorder (PMDD)?


Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). PMDD affects 1-5% of women who are menstruating. It consists of the usual premenstrual syndrome symptoms such as cramping and irritability plus additional symptoms, such as depression, deep mood swings, and anxiety attacks. If you have five or more PMDD symptoms sometime during the two weeks prior to menstruation (but feel normal at other times), then you may be diagnosed with the condition. The cause is not well known. It is treated with antidepressant medication, birth control pills, and anti-inflammatory medication. There is no cure for PMDD and no way to prevent it.

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Premenstrual Dysphoric Disorder (PMDD) Symptoms

Main symptoms

The following symptoms are shared by both PMS and by PMDD:

  • Cramping
  • Breast tenderness
  • Joint/muscle pain
  • Headaches
  • Irritability

Other symptoms

The following more severe symptoms are typical of PMDD:

  • Anger
  • Sadness/depression
  • Anxiety
  • Panic attacks
  • Mood swings
  • Difficulty concentrating
  • Difficulty sleeping or always feeling sleepy
  • Low or high appetite
  • Low energy
  • Crying
  • Swelling of legs
  • Gaining or losing weight
  • Acne

Premenstrual Dysphoric Disorder (PMDD) Causes

The cause of PMDD is unknown. It affects roughly 1 to 5% of women, which means that it is much rarer than It is thought that there is some hormonal component to PMDD because the symptoms only occur at certain phases of the menstrual cycle. It is thought that women with PMDD are more sensitive to variations in their hormone levels than other people. Women typically gave a genetic predisposition to having PMDD. There may also be some connection between emotional trauma and developing PMDD. People with depression are also more likely to get PMDD.

Premenstrual Dysphoric Disorder (PMDD) Symptom Checker

Take a quiz to find out if your symptoms point to premenstrual dysphoric disorder (PMDD)

Treatment Options, Relief, and Prevention for Premenstrual Dysphoric Disorder (PMDD)


Diagnosing PMDD requires that at least 5 of the symptoms listed in the Symptoms section are present. One of the symptoms must be a mood-related symptom. In addition, these symptoms must be present only during the two weeks before menstruation. In other words, if they are present all the time, then other diagnoses are more likely, such as major depressive disorder or generalized anxiety disorder. During pregnancy, the symptoms should be absent. The symptoms must be recurrent cycle after cycle. It is best if you keep track of your symptoms in a diary where you indicate the dates of the symptoms, as this will help distinguish PMDD from psychiatric illness.

Other tests that assist in diagnosis include:

  • Thyroid-stimulating hormone level
  • Folic acid level
  • Vitamin B12 level
  • FSH level
  • Blood count

There are a number of treatments for PMDD:

  • Antidepressants: such as escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), and venlafaxine (Effexor)
  • Hormone replacement (birth control): This stabilizes your levels of estrogen and progesterone at one, high level. This means your hormones will not fluctuate and you should not develop the symptoms of PMDD.
  • Nonsteroidal anti-inflammatory drugs: such as ibuprofen (Advil) and naproxen (Aleve) Calcium supplements

Lifestyle changes may also improve PMDD:

  • Get plenty of exercise
  • Eat healthfully
  • Avoid alcohol
  • Don’t smoke
  • Cut back on caffeine
  • Engage in mindfulness meditation and/or yoga
  • Treat sources of emotional distress
  • Get enough sleep
  • Get cognitive behavioral therapy from a psychologist or therapist


There is no way to prevent getting PMDD. However, if you have PMDD, you can prevent getting the symptoms by taking your medications as prescribed and not missing doses. You should also adhere to your healthy lifestyle goals as defined in the previous section.

When to Seek Further Consultation for Premenstrual Dysphoric Disorder (PMDD)

You should seek the advice of a healthcare professional if you experience recurrent PMS symptoms plus mood symptoms each month before your period. To make lifestyle changes, you may wish to seek the assistance of a nutritionist or psychologist, for example.