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Understanding Premenstrual Dysphoric Disorder (PMDD): Symptoms, Causes, and Treatment

Premenstrual Dysphoric Disorder (PMDD) is a condition that affects millions of women worldwide, causing significant physical, emotional, and psychological distress. Unlike the typical mood swings and physical discomfort experienced during premenstrual syndrome (PMS), PMDD presents as a more severe and disabling form of premenstrual symptoms.

Women with PMDD often find themselves grappling with intense mood disturbances, irritability, depression, anxiety, and other distressing symptoms in the days leading up to menstruation. These symptoms can be so severe that they disrupt daily activities, strain relationships, and negatively impact overall well-being.

Despite the significant impact of PMDD on women’s lives, it is often overlooked or dismissed as mere PMS. Recognizing and understanding PMDD as a distinct and valid medical condition is crucial for providing appropriate support and treatment options to those affected.

This article outlines the causes, symptoms, and available treatment options for PMDD, shedding light on this often misunderstood condition.

What is Premenstrual Dysphoric Disorder (PMDD)?

PMDD is a complex disorder characterized by a constellation of symptoms that occur cyclically during the luteal phase of the menstrual cycle. Compared to milder premenstrual syndrome (PMS), PMDD has more severe and disruptive symptoms. These symptoms can significantly impact a person’s daily life, relationships, and well-being. Approximately 3–8% of women experience PMDD, with symptoms severe enough to interfere with daily functioning.

What are the symptoms of PMDD?

Symptoms associated with PMDD include a range of physical, emotional, and behavioral symptoms that occur one or two weeks before menstruation and significantly improve or disappear once menstruation begins. The most common symptoms include:

  • Emotional Symptoms: Women with PMDD usually experience intense emotional symptoms, such as persistent feelings of sadness, hopelessness, or worthlessness. Irritability, anger, and mood swings are common symptoms that often lead to relationship difficulties. Anxiety, tension, and being overwhelmed may also be present.
  • Physical Symptoms: Besides the emotional symptoms, PMDD can also manifest as physical discomfort. Common complaints include fatigue, bloating, breast tenderness, and headaches. Changes in appetite, including food cravings or overeating, may occur. Patients may also experience sleep disturbances and difficulty concentrating.
  • Behavioral Symptoms: PMDD can impact a woman’s daily life and functioning. Social withdrawal, decreased interest in usual activities, and reduced productivity are typical behavioral symptoms. At the same time, PMDD can also cause concentration problems and poor decision-making skills, altering work or school performance.

What causes PMDD?

While the exact causes of PMDD remain unclear, experts believe that hormonal fluctuations during the menstrual cycle and individual vulnerability factors play a significant role in its development. Fluctuating levels of estrogen and progesterone can disrupt serotonin’s regulation, leading to mood dysregulation and other emotional symptoms. Diagnosing PMDD requires assessing symptoms thoroughly, ruling out other conditions, and documenting symptom patterns over several menstrual cycles.

Meanwhile, certain risk factors may increase the likelihood of developing PMDD. A personal or family history of mood disorders, such as depression or anxiety, can make women more susceptible to PMDD. Additionally, women with heightened sensitivity to hormonal changes and those experiencing high-stress levels may be at greater risk of developing PMDD symptoms.

1. Hormonal Imbalance

Researchers believe that the interplay between hormonal changes and neurotransmitters, particularly serotonin, plays a pivotal role in the emergence of PMDD symptoms. Although the exact mechanism is not fully understood, studies suggest it affects brain chemistry and neurotransmitter activity, influencing mood and cognitive functioning. 

Related: Menopause: Symptoms and How to Manage It

2. Serotonin Deficiency

When estrogen levels drop after ovulation, women with PMDD may also experience an exaggerated drop in serotonin levels. Serotonin is a neurotransmitter responsible for regulating mood, sleep, and appetite. Studies have shown a correlation between serotonin deficiency and PMDD symptoms like depressed mood, food cravings, and poor cognitive function.

3. History of Mood Disorders

Research shows that women with generalized anxiety disorder (GAD) are more likely to experience PMDD. More than half (53%) of women diagnosed with PMDD also have an anxiety disorder. This is because of their biological markers of anxiety vulnerability and cognitive anxiety sensitivity. 

The data also show that women with PMDD and GAD have higher anxiety symptoms than those without GAD. Furthermore, their depression and irritability did not subside even during the follicular phase.  

4. Genetic Factors

There may be a genetic predisposition to developing PMDD, as it often runs in families. Research has identified certain gene variations, particularly those that control how they respond to estrogen and progesterone, that may contribute to the development of the disorder.

5. Environmental Factors

Stress, trauma, and other environmental factors can exacerbate PMDD symptoms. Emotional and physical stressors can worsen the condition and make it more challenging to manage. 

In addition, researchers are examining the connection between allopregnanolone (ALLO) and the stress response in PMDD-affected women. Experimental studies suggest that chronic stress causes ALLO to decrease significantly. ALLO typically helps control agitation, anxiety, and irritability by interacting with GABA receptors in the brain. However, women with PMDD appear to have abnormal reactions to it.

How is PMDD diagnosed?

Diagnosing Premenstrual Dysphoric Disorder (PMDD) involves a comprehensive evaluation of a woman’s symptoms, medical history, and menstrual cycle patterns. Here are the typical steps involved in the diagnostic process:

Symptom Tracking

The first step in diagnosing PMDD is to track and document the presence and severity of symptoms over several menstrual cycles. It is essential to record both physical and emotional symptoms, their duration, and their impact on daily functioning. You can use a symptom diary or a specialized tracking app.

Medical History Review

A healthcare provider will review the woman’s medical history to rule out other conditions that may mimic or contribute to PMDD symptoms. Conditions such as depression, anxiety disorders, thyroid disorders, and hormonal imbalances can have overlapping symptoms with PMDD.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for diagnosing PMDD. Here are the following:

  • Presence of at least five physical and emotional symptoms that began in the final week before menstruation;
  • Symptoms must significantly interfere with daily functioning or relationships;
  • Symptoms must resolve within a few days after menstruation begins;
  • Symptoms are not attributable to another underlying condition.

Physical Examination 

You might undergo a physical examination to rule out any underlying medical conditions and assess your general health. It can include blood pressure measurements, body mass index (BMI), and an examination of the breast and pelvic organs.

Psychological Evaluation

In some cases, your healthcare provider may recommend a psychological evaluation. This test will help assess any coexisting mental health conditions or evaluate the impact of PMDD symptoms on the woman’s overall well-being and functioning.

Laboratory Tests

Although there are no specific laboratory tests to diagnose PMDD, doctors may order blood tests to rule out other conditions, such as hormonal imbalances or thyroid dysfunction, which can contribute to similar symptoms.

It is important to note that a PMDD diagnosis requires a careful and thorough assessment by a qualified healthcare professional. Open and honest communication about symptoms and their impact is crucial for an accurate diagnosis and developing an effective treatment plan.

If you suspect you have PMDD, you may need to speak with a qualified healthcare professional, such as a gynecologist or a psychiatrist. They will be able to evaluate your symptoms, provide a diagnosis, and guide you through appropriate treatment options.

5 Treatment Options for PMDD

The treatment of PMDD aims to alleviate symptoms, improve overall functioning, and enhance the quality of life for affected individuals. Treatment options vary depending on the severity of symptoms and the individual’s specific needs. Here are some commonly recommended approaches:

1. Lifestyle Modifications

Implementing specific lifestyle changes can be an essential component of the treatment plan for PMDD. While they may not eliminate all symptoms, lifestyle changes can significantly improve overall well-being and reduce the severity of symptoms. Here are some lifestyle modifications that may help manage PMDD:

  • Regular exercise: Engaging in regular physical activity, such as walking, jogging, cycling, or yoga, can be beneficial for managing PMDD symptoms. Exercise releases endorphins, which are natural mood lifters and can help reduce stress and anxiety.

Related: Movement: The Key to Health and Longevity

  • Balanced diet: Adopting a balanced and nutritious diet is crucial for overall health and well-being. Focus on consuming a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats. Limiting caffeine, sugar, and processed foods may also help regulate mood and energy levels.

Related: Going Vegan: Benefits of a Plant-Based Diet

  • Adequate sleep: Ensure you get enough restful sleep each night. Establish a regular sleep schedule, create a calming bedtime routine, and avoid stimulants or heavy meals close to bedtime.

Related: Insomnia: Why Getting Poor Sleep Is Cause for Alarm

  • Avoiding Smoking and Alcohol: Smoking and excessive alcohol consumption can worsen PMDD symptoms. Avoiding these substances can improve your overall health and potentially reduce the severity of premenstrual symptoms.

Related: Alcohol: The World’s Most Harmful Drug

2. Medications

Healthcare professionals may prescribe various medications to alleviate PMDD symptoms. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and sertraline, are commonly used to regulate serotonin levels and improve mood. Hormonal contraceptives, including birth control or progestin-only pills, can help regulate hormone levels and alleviate symptoms in some women. 

In some cases, patients may benefit from OTC pain relievers for relieving physical symptoms, such as joint pain, cramps, headaches, backaches, and breast tenderness.

3. Cognitive-Behavioral Therapy (CBT)

CBT is a widely recognized and evidence-based form of psychotherapy (talk therapy) that identifies and changes negative thought patterns and behaviors. It can help individuals with PMDD develop coping strategies and improve their well-being. CBT may be used in conjunction with medication or as a standalone treatment.

4. Alternative Therapies

Some women find relief from PMDD symptoms through alternative therapies such as acupuncture, herbal supplements (e.g., chaste berry), or dietary changes (e.g., increasing omega-3 fatty acids). However, before trying any alternative treatments, be sure to consult a healthcare professional first.

5. Stress Management

Stress management plays a vital role in the treatment of PMDD because stress can exacerbate the symptoms of PMDD and negatively impact a woman’s overall well-being. By adopting effective stress management techniques, women with PMDD can reduce the severity of their symptoms and improve their quality of life.

Examples of Stress Management Techniques for PMDD:

  • Relaxation Techniques: Deep breathing exercises, progressive muscle relaxation, and guided imagery can help reduce stress and induce relaxation.
  • Mindfulness and Meditation: Mindfulness practices, such as meditation or yoga, can improve self-awareness, reduce anxiety, and promote emotional balance.
  • Supportive Therapies: Engaging in counseling, therapy, or support groups can provide a safe space to discuss PMDD-related stressors and explore coping strategies.
  • Time Management: Organizing and prioritizing tasks can reduce feelings of overwhelm and create a sense of control over daily responsibilities.
  • Self-Care: Making time for self-care activities, such as taking a warm bath, reading a book, or spending time in nature, can reduce stress and promote well-being.

Remember that stress management is not a one-size-fits-all approach, and it may take time to find the techniques that work best for each individual. Women with PMDD are encouraged to explore various stress management strategies and incorporate them into their daily routines to experience the maximum benefits of managing their condition. 

Related: Stress Management: How to Overcome Stress and Turn It Into Healthy Practices


Premenstrual Dysphoric Disorder is a complex condition that significantly impacts the lives of those affected. Understanding the causes, symptoms, and available treatment options is crucial for managing PMDD effectively. By combining lifestyle modifications, medication, therapy, and support networks, women with PMDD can find relief and regain control over their lives. It is essential to seek professional help and maintain open communication with healthcare providers to tailor the treatment approach to individual needs. With proper care and support, women with PMDD can lead fulfilling lives and be burden free from severe premenstrual symptoms.

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