What Is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual dysphoric disorder is a mood disorder that occurs during the premenstrual phase of the menstrual cycle. While similar to that of premenstrual syndrome (PMS), the symptoms of PMDD are much more severe and can lead to extreme mood changes that can disrupt daily life and functioning.

Research indicates that women with premenstrual dysphoric disorder may have alterations in the genes that influence how the body processes stress and sex hormones. These differences mean that women with PMDD have a greater sensitivity to the hormones that influence both mood and general well-being.

While PMS can have an impact on a woman's life and functioning, it is not classified as a disorder and the symptoms can usually be self-managed. Premenstrual dysphoric disorder is classified as a mental disorder by the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition" (DSM-5).

Symptoms of Premenstrual Dysphoric Disorder

Some of the major symptoms of PMDD include:

• Feelings of sadness
• Food cravings and binges
• Irritability and anger that is directed toward others
• Lack of interest in activities
• Lack of energy and fatigue
• Physical symptoms, including breast tenderness, bloating, and headaches
• Severe mood swings
• Sleep disturbances
  
• Trouble concentrating or thinking

Symptoms begin during the luteal phase, or after ovulation, and end shortly after menstruation starts. 

Causes of Premenstrual Dysphoric Disorder

Research on the causes and treatments of PMDD is emerging, but the evidence has shown that the condition is heavily influenced by a genetic sensitivity to sex hormones. While PMDD is believed to have biological causes, research has shown that environmental variables such as perceived stress can also increase the risk and severity of the condition. 

The condition is estimated to be about 50% heritable. 

Diagnosis of Premenstrual Dysphoric Disorder

The diagnosis of premenstrual dysphoric disorder usually begins with your doctor taking a health history and doing a physical exam. In most cases, you will need to keep a calendar to track your symptoms over at least two menstrual cycles. 

In order to be diagnosed with PMDD, people must:

• Experience at least five symptoms across two domains, one involving mood and the other physical symptoms
• Experience these symptoms during the premenstrual phase and symptoms must be mostly absent within the week following menses

These symptoms must also interfere with functioning in work, school, relationships, and other important life areas and must not be related to an existing condition or caused by substance use.

Treatment for Premenstrual Dysphoric Disorder

Treatments for PMDD are focused on minimizing and managing the symptoms of the condition. Some of the treatment options include:

• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), have been shown to be effective in treating PMDD symptoms
• Oral contraceptives
• Lifestyle adaptations including changes in diet, exercise, and stress management techniques
• Medications to treat physical symptoms including diuretics for fluid retention and anti-inflammatory drugs for pain
• Changes in menstrual products, particularly if these tend to cause discomfort or irritation

Medications that have been FDA-approved to treat PMDD include the SSRIs sertraline, fluoxetine, and paroxetine HCI. The oral contraceptives drospirenone and ethinyl estradiol have also been approved to treat the condition. You should talk to your doctor to determine if this option is right for you.

Cognitive-behavioral therapy (CBT) may also be used alone or in conjunction with other treatments. Over-the-counter pain relievers may also be helpful for relieving symptoms such as joint pain, cramps, headaches, muscle aches, and breast tenderness. 

Coping With Premenstrual Dysphoric Disorder

The mood changes and physical symptoms of PMDD can make it difficult to cope with daily life and manage your relationships. You might feel irritable, depressed, and angry, which can lead to taking out those feelings on the people around you.

In addition to getting treatment from a medical professional, there are self-care steps you can take to help manage the symptoms of this condition.

• Natural treatments such as meditation, regular exercise, and yoga can be effective in helping manage stress. Such practices may also help you cope with symptoms of anxiety and depression. 
• Herbal supplements such as St. John's wort may be helpful. However, you should use caution and talk to your doctor before you try using any herbal remedies to alleviate your symptoms. Some herbal supplements such as St. John’s wort, can have adverse reactions when taken with other medications.
• Getting plenty of rest and eating a healthy diet can also help. Avoiding high-salt foods may help prevent bloating and water retention. Minimize sugar and simple-carbohydrate consumption in order to prevent fluctuations in blood sugar levels. Focus on eating complex carbs, getting plenty of fiber and protein, and drinking enough fluids.

A Word From Verywell

Coping strategies can be helpful, but you should contact your healthcare provider if your symptoms do not improve with self-treatment or if your symptoms interfere with your daily functioning including your mental well-being, your relationships, or your job.