What is PMDD, and what should I do if I think I have it?

Mental Health Reproductive Health

A: PMDD (premenstrual dysphoric disorder) is a serious mood condition. Symptoms often appear in the time between ovulation and menstruation. If you think you have PMDD, speak to your clinician about medicine and lifestyle changes.

What is PMDD and what are the main symptoms?

PMDD (premenstrual dysphoric disorder) is a condition that results in severe mood and physical disruptions around the time of menstruation. It affects up to 5% of people who have periods. It is similar to premenstrual syndrome (PMS). Both PMDD and PMS occur around menstruation and cause unwanted mood and physical symptoms. The mood symptoms of PMDD are often much more severe than those of PMS.

Generally, clinicians diagnose someone with PMDD if they have five or more of the following symptoms over the course of a year for most of their cycles:

-Depressed mood
-Anger or irritability
-Trouble concentrating
-Lack of interest in activities once enjoyed
-Increased appetite
-Insomnia or need for more sleep
-Feeling overwhelmed or out of control
-Physical symptoms like bloating, headache, breast tenderness

Some of the symptoms of PMDD are similar to those of major depressive disorder (MDD), such as trouble concentrating. These types of symptoms are not common in PMS. In general, PMDD symptoms are severe enough to disrupt someone’s daily life, be it in the home, school, or workplace.

What causes PMDD?

As with most mood disorders, experts do not know exactly what causes PMDD, but it is most likely due to several factors and not just one. We do know that people with anxiety and depression are at higher risk for severe PMS and PMDD. It’s thought that the hormonal changes that occur around menstruation can make existing mood problems worse. Because estrogen is needed to make serotonin, which improves mood, these hormonal changes may also be related to a deficiency of serotonin. People with a family history of severe PMS or PMDD or even people with a family history of depression and other mood disorders may be most at risk.

What kinds of treatments work?

Even if we are not clear on the causes of PMDD, there are treatments that can help. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) can be very effective for severe mood issues associated with PMDD. Birth control pills with no pill-free or a shortened pill-free interval are another effective treatment for PMDD.

Outside of medication, changes to diet, exercise, and lifestyle can also be effective at helping to maintain a more positive mood and fighting the physical symptoms associated with PMDD. For significant physical symptoms such as bloating, reducing salt and sugar intake can be helpful. Regular exercise has been shown to have a positive effect on mood overall and the same is likely true for people dealing with PMDD. Relaxation techniques, such as mindfulness and meditation, can also quell the significant anxiety symptoms associated with PMDD.

If you are struggling with severe mood symptoms surrounding menstruation, you might suffer from PMDD. Some people also experience premenstrual exacerbation of an existing mood disorder, so make sure you and your clinician are in close contact about this as well. Talk to your clinician about any concerns you have about your mood and well-being at any time of the month.

Stay well,
The Nerdy Girls

Mayo Clinic

Johns Hopkins

HHS Office on Women’s Health

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