Premenstrual Dysphoric Disorder- Causes, Symptoms And Treatment

Premenstrual dysphoric disorder(PMDD), is a type of hormonal induced mood disorder that occurs around the time of menstruation. Learn about its causes, symptoms and possible treatments.

Premenstrual Dysphoric Disorder And the Menstrual Cycle

Premenstrual Dysphoric Disorder
Photo by Andrea Piacquadio 

Premenstrual dysphoric disorder(PMDD), is a cyclic, hormone-based mood disorder. It might look similar to premenstrual syndrome (PMS) but it has more severe and disabling symptoms. While up to 85% of women experience PMS, only around 5% of women are diagnosed with PMDD, according to a study in the American Journal of Psychiatry. PMDD can arise at any time during a woman’s reproductive years although the average age of onset is 26 years.

Premenstrual Dysphoric Disorder and Premenstrual Syndrome(PMS)

Both Premenstrual Dysphoric Disorder(PMDD) and Premenstrual syndrome(PMS) present symptoms which begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins. 

Difference Between PMS and PMDD

The difference is that while most women have PMS from time to time in the days leading up to their period, the symptoms do not cause any clinically significant distress or impact their ability to continue with their daily activities unlike PMDD which disrupts daily functioning.

For women with Premenstrual Dysphoric Disorder(PMDD), the symptoms are more severe and particularly psychological problems which prevent them from going about their everyday lives. Such psychological symptoms include depression and suicidal thoughts, anxiety, irritability and tension. These symptoms do not necessarily occur every cycle, but they are present in the majority of the cycles. Some months may be worse than others.

Unlike in PMDD, women with PMS may experience some fluctuation in mood in the days before their period, the psychological symptoms of PMDD such as severe depression, anxiety, and suicidal thoughts are not associated with PMS. For a diagnosis of PMDD to be made, a minimum of five symptoms are required to be present.

PMDD, Pregnancy, Menopause And Postpartum Depression

The onset of PMDD may begin at any time after a woman’s first period, although many individuals report a worsening of symptoms as they approach menopause. After menopause and during pregnancy, symptoms do not occur, though it is important to note that women with PMDD have a high risk of experiencing postpartum depression following the birth of a child.

Causes of Premenstrual Dysphoric Disorder

Researchers are still working to determine the exact cause of PMDD, though it has been suggested that women with the disorder are more sensitive to normal levels of estrogen and progesterone fluctuation that cause premenstrual symptoms.

Risk Factors

  • Environmental: Stress, history of interpersonal trauma, and seasonal changes are all environmental factors associated with the presence of premenstrual dysphoric disorder.
  • Genetic: While the heritability of premenstrual dysphoric disorder is unknown, it is estimated that premenstrual symptoms generally are 50% heritable.
  • Menstrual Cycle Modifiers: According to the DSM-5, women who use oral contraceptives may have fewer premenstrual complaints than do women who do not use oral contraceptives.

Symptoms Of Premenstrual Dysphoric Disorder

To receive a diagnosis of PMDD, a woman must have experienced symptoms during most of the menstrual cycles of the past year and these symptoms must have had an adverse effect on work or social functioning.

While the core symptoms relate to mood and anxiety, behavioral and physical symptoms commonly occur also. It is crucial to note that the presence of behavioral or physical symptoms in the absence of mood and/or anxious symptoms is not sufficient for a diagnosis.

In the majority of cases, at least five of the following symptoms must be present in the week before the period, start to improve within a few days after the onset, and become minimal in the week following:

  • Mood swings
  • Irritability or anger or increased interpersonal conflicts
  • Depressed mood, feelings of hopelessness, or self-deprecating thoughts
  • Anxiety, tension, and/or feelings of being on edge
  • Decreased interest in usual activities
  • Difficulty concentrating
  • Marked lack of energy
  • Changes in appetite
  • Hypersomnia or insomnia
  • A sense of being overwhelmed or out of control
  • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating, or weight gain

Diagnosing Premenstrual Dysphoric Disorder

A clinician must determine that the patient’s symptoms are not merely an exacerbation of another disorder, such as depression or panic disorder, and cannot be attributed to the effects of substance abuse.

The symptoms should also be confirmed by prospective daily ratings of at least two symptomatic cycles.


Although a woman would not receive a diagnosis of PMDD if she only experiences a worsening in symptoms of another mental disorder around the time of menses, PMDD can be considered in addition to the diagnosis of another mental disorder if the individual experiences PMDD symptoms that are markedly different to those experienced as part of the ongoing disorder.

Premenstrual Dysphoric Disorder- Treatment Options


A group of antidepressants named selective serotonin reuptake inhibitors (SSRIs) can be prescribed to women suffering from PMDD. The FDA approved sertraline, fluoxetine, or paroxetine hydrochloride may be prescribed to help alleviate symptoms.

Moreover, over-the-counter pain relievers may help with breast tenderness, muscle aches and pains, cramps, and headaches. Your doctor may suggest you try ibuprofen, naproxen, or aspirin to help relieve these physical symptoms.

Birth Control

In 2010, the FDA approved the birth control pill containing drospirenone and ethinyl estradiol to treat PMDD. It may be worth talking to your doctor or gynecologist to determine whether or not this birth control pill (brand name Beyaz) is right for your body and could help with your PMDD symptoms.


Living with severe depression and anxiety shouldn’t be something you have to face alone. Cognitive behavioral therapy (CBT) is a structured, action-oriented type of psychological treatment that focuses on the interaction between thoughts, feelings, and behaviors. CBT has been shown to be an effective treatment for mood and anxiety disorders and has also been shown to help people cope better with physical symptoms, such as pain


When drug-based treatments are ineffective, surgical removal of the ovaries, known as an oophorectomy, may be considered. Ovary removal has been shown to relieve the symptoms of PMDD. This treatment causes women to stop ovulating and become menopausal, butalso comes with a variety of symptoms. This form of treatment is a serious decision that should be the last resort for PMDD treatment.

Natural Remedies

If medication or surgery isn’t a viable treatment path, you may want to try natural remedies for PMDD symptoms. Research shows that mindfulness meditation can reduce anxiety, depression, and pain–all common symptoms of PMDD. To relieve menstrual cramps, take a warm bath and try different menstrual products during menstruation. In some women, tampons can increase cramping, so pads may be a better option.

Here is what a health professional says about how women can help properly diagnose PMDD and treatment options available.

Seeking Professional Help

If you think you may be suffering from PMDD, we encourage you to seek diagnosis and treatment from your doctor and a mental health professional. Although PMDD can feel like a debilitating and lonely condition, it is important to remember that you aren’t alone.

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