What is premenstrual dysphoric disorder?

Odds are you’ve heard plenty about premenstrual syndrome, or PMS. Many people experience PMS symptoms that affect both body and mood each month for a few days before getting your period each month. 

Premenstrual dysphoric disorder (PMDD) is similar to PMS but more severe. PMDD can have a huge impact on day-to-day life and can last for a week or two every month. 

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Researchers aren’t entirely sure what brings on PMDD, but studies exploring the role of reproductive hormones and brain chemicals are ongoing. 

One theory is that people with PMDD don’t necessarily have higher levels of hormones causing their symptoms but a higher sensitivity to the regular monthly fluctuations that people who menstruate experience (Reid, 2018; Lanza, 2019).

As mentioned, the symptoms of PMDD are similar to those you might have during PMS but more extreme. 

Signs of PMDD typically start one to two weeks before your period begins and stop a few days after. Symptoms tend to be the most severe two days before menstruation and manifest as physical problems, mood changes, or behavioral shifts.

Common indicators of PMDD include: 

• Anxiety

• Tenderness and swelling in the breasts 

• Muscles and joint aches 

• Headaches 

• Lack of energy and focus

• Bloating or weight gain

• Feeling sad, depressed, or hopeless

Another sign of PMDD is sudden shifts in mood. You may feel anxious, angry, or on edge. You may find yourself crying more often or feeling more irritable than usual. 

You may notice changes in your day-to-day habits, too. Overeating, feeling lethargic, and having issues sleeping are all things you may experience with PMDD. You also might feel easily overwhelmed or disinterested in daily activities (Mishra, 2020).

This long list of symptoms means that having PMDD can seriously impact your relationships, work, education, and daily life. Speak to a healthcare provider if you see signs of PMDD to help get a proper diagnosis and learn about treatment options.

PMDD can be difficult to diagnose as symptoms may be similar to other disorders like depression. 

The difference is that PMDD symptoms come and go with your cycle each month, so your healthcare provider will want to make sure your symptoms are related to your period before diagnosing PMDD (Mishra, 2020; Reid, 2018).

As part of the diagnostic process, you may be asked to record how you feel physically and mentally to see if any patterns emerge (Hofmeister, 2016). There are also questionnaires to learn more about your specific symptoms and how they affect your life. 

If you experience at least five of the following—including one of the first four symptoms—you may be dealing with PMDD (Mishra, 2020):

1. Noticeably depressed mood

2. Noticeable anxiety or tension

3. Intense mood swings

4. Increased anger, irritability, or conflict with others

5. Decreased interest in everyday activities like school, work, or time with friends

6. Difficulty focusing

7. Lack of energy or feeling tired

8. Changes in appetite, including eating or craving certain foods more than usual 

9. Not being able to fall asleep at night or feeling sleepy during the day

10. Feeling overwhelmed or not in control of yourself

11. Physical discomfort including breast tenderness, bloating, headaches, and joint or muscle pain

PMDD is most commonly treated with hormonal medications or antidepressants.

Birth control can be used as a first-line treatment for PMDD for those who want to take it. Combination oral contraceptives containing estrogen and progestin can help alleviate symptoms (Reid, 2018; Marr, 2011). 

Antidepressants, specifically selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors, are used to treat PMDD symptoms in those who don’t want to or can't take hormonal birth control. Both effectively treat PMDD and can be taken daily or in the two weeks before your period (Reid, 2018; Carlini, 2020).

Ovulation suppressants, such as danazol, are also sometimes used to treat PMDD (Lanza, 2019; Carlini, 2020). As researchers learn more about the exact causes of PMDD, new drugs are being developed and studied (Bixo, 2017; Carlini, 2020).

Dietary supplements like calcium and vitamin B6 have been found to be effective at reducing PMS symptoms, but their effect on PMDD is still being studied (Retallick-Brown, 2020).

Mental health treatments such as cognitive behavioral therapy (CBT) can also help. CBT encourages behavioral changes by developing through new ways of thinking and understanding emotions. Used in combination with other treatments, therapy is a useful tool for finding relief (Lanza, 2019).

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Current version

June 11, 2021

Written by

Danielle Oaks

Fact checked by

Yael Cooperman, MD

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About the medical reviewer

Yael Cooperman, MD, Ro

Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.