Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome. Although it is similar to premenstrual syndrome (PMS), it comparatively leads to more serious symptoms. PMDD causes severe anxiety, depression and irritability, followed by sudden mood swings almost a week prior to the start of the menstrual period. Symptoms usually disappear within two to three days after menstruation starts. 


Mild PMS is common. It affects nearly 75 percent of women having regular menstrual cycles; however, PMDD affects only 3 to 8 percent of women. This condition can occur in women of any cultural, socioeconomic, or ethnic background. PMDD is usually seen as a chronic condition and can have a disturbing and severe impact on the quality of a woman’s life.

Luckily with the help of treatment, most women having PMDD get relief from the symptoms and are able to enjoy life more fully. Talking to a mental health professional or joining a support group might also help in relieving the psychological symptoms of PMDD. 

Premenstrual Dysphoric Disorder

Who gets Premenstrual Dysphoric Disorder ?

PMDD occurs in around 5 percent of women of childbearing age. Many women with PMDD may suffer from depression or anxiety.

Studies have shown an association between PMDD and low levels of serotonin which is a chemical in the brain that helps in the transmission of nerve signals. Many brain cells that use serotonin also control attention, mood, pain, and sleep. Hormonal changes may become a cause of decline in the level of serotonin, leading to PMDD symptoms.

Signs and symptoms of Premenstrual Dysphoric Disorder (PMDD?)

The symptoms of PMDD usually appear a week before you start your period and last for a few days following the beginning of it. Most of the time they are severe and distressing, and they can keep you from regular activities.

Symptoms of PMDD include:

  • Anxiety, depression or feelings of hopelessness
  • Mood swings
  • Intense aggression and conflicts with others
  • Tension and irritability
  •  Loss of interest in your usual activities
  • Concentration issues
  • Fatigue
  • Sudden changes in appetite
  • Feeling overwhelmed or out of control
  • Sleeping problems
  • Cramps and abdominal bloating
  • Breast soreness
  • Migraines and headaches
  • Hot flashes 
  • Joint or muscle pain

What causes Premenstrual Dysphoric Disorder (PMDD)?

The exact cause of PMDD and PMS is still unknown.

It is believed that PMDD occurs due to the abnormal response of brain to a woman’s fluctuation of hormones during the menstrual cycle.  Consequently this could lead to an insufficiency in the neurotransmitter serotonin.

However some women are more likely than others to experience PMDD, involving those who have had a personal or family history of depression, postpartum depression or mood disorders.

How is Premenstrual Dysphoric Disorder (PMDD) diagnosed?

The symptoms of PMDD can be similar to those of the other psychological conditions, so health care providers will possibly perform a physical exam, ask for a complete medical history, and ask for specific tests to find out other conditions while making a diagnosis.

A symptom chart is also used in the process of diagnosis to determine any association between the symptoms and the menstrual cycle.

Guidelines from the Diagnostic and Statistical Manual 5th Edition (DSM-V) and American Psychiatric Association (APA) require that the symptoms of PMDD should be there for a minimum of two consecutive menstrual cycles before making a diagnosis of PMDD.

According to the given guidelines, symptoms must:

  • be there for a week before the onset of periods
  • resolve after the start and within the first few days of periods
  • disturb normal daily living

For a PMDD diagnosis, a patient must experience at least five symptoms, including at least one of the following:

  • feelings of hopelessness or sadness
  • feelings of tension or anxiety
  • increased sensitivity or mood swings
  • feelings of irritability or aggression

Other symptoms of PMDD can involve:

  • lethargy to routine activities, which may be linked with social withdrawal
  • concentration issues
  • exhaustion
  • changes in appetite
  • sleep problems, (insomnia or hypersomnia)  
  • feeling as being overwhelmed or having a sense of a lack of control

Other physical symptoms of PMDD involve:

  • Breast tenderness or swelling.
  • Headaches or muscular pain,
  • Bloating, and weight gain.

How Premenstrual Dysphoric Disorder (PMDD) is treated?

Two types of medications to deal with PMDD impact the central nervous system (CNS) and those that affect ovulation, for example:
• SSRI(s) / anti-depressants such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa)
• Oral contraceptives containing drospirenone and Ethinyl estradiol
• Gonadotropin-releasing hormone analogs such as leuprolide (Lupron), nafarelin (Synarel), and goserelin (Zoladex)

Psychological treatment for PMDD that may be helpful is cognitive behavioral therapy (CBT). 

Dietary changes include:

  • limiting your alcohol, salt, caffeine, and sugar intake
  • Increasing protein and the intake of complex carbs

Exercising and stress management techniques might help in viewing the menstrual cycle in a positive way.