Overview

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMS causes bloating, headaches and breast tenderness a week or two before your period.

With PMDD, you might have PMS symptoms along with extreme irritability, anxiety or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life.

How common is PMDD?

PMDD affects up to 10% of women who have periods.

Who might get PMDD?

You may be more prone to PMDD if you have:

Anxiety or depression.
PMS.
Family history of PMS, PMDD or mood disorders.

Symptoms and Causes

What causes PMDD?

Experts don’t know why some women get PMDD. Decreasing levels of estrogen and progesterone hormones after ovulation and before menstruation may trigger symptoms. Serotonin, a brain chemical that regulates mood, hunger and sleep, may also play a role. Serotonin levels, like hormone levels, change throughout your menstrual cycle.

What are the symptoms of PMDD?

PMDD symptoms appear a week or two before menstruation and go away within a few days after your period starts. In addition to PMS symptoms, you may have:

Anger or irritability.
Anxiety and panic attacks.
Depression and suicidal thoughts.
Difficulty concentrating.
Fatigue and low energy.
Food cravings or binge eating.
Headaches.
Insomnia.
Mood swings.

Diagnosis and Tests

How is PMDD diagnosed?

Your healthcare provider will take a medical history and evaluate your symptoms. You may need to track your symptoms through one or two menstrual cycles. To diagnose PMDD, your provider will look for five or more PMDD symptoms, including one mood-related symptom. Your provider will rule out or diagnose other conditions such as anxiety, depression or reproductive disorders.

Management and Treatment

How is PMDD managed or treated?

Your healthcare provider may recommend one or more of these treatments to help manage PMDD:

Antidepressants to help manage your brain’s serotonin levels.
Dietary changes, such as cutting back on salty, fatty or sugary foods and caffeine.
Hormonal birth control that has drospirenone and ethinyl estradiol.
Over-the-counter pain medicines to ease cramps (dysmenorrhea), headaches, breast tenderness and other physical symptoms.
Regular exercise to improve mood.
Stress management tools, such as deep breathing exercises and meditation.

What are the complications of PMDD?

Untreated PMDD can lead to depression and, in severe cases, suicide. The disorder can cause severe emotional distress and negatively affect relationships and careers.

If you’re experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 1.800.273.8255. This national network of local crisis centers provides 24/7 free and confidential emotional support to people in suicidal crisis or emotional distress.

Prevention

How can I prevent PMDD?

Treating existing depression or anxiety may make it less likely that PMS could become PMDD. But PMDD could be related to the way your hormones work, and you might not be able to prevent it. In that case, treatment can bring relief.

Outlook / Prognosis

What is the prognosis (outlook) for people with PMDD?

With treatment, most people with PMDD get relief from their symptoms and are able to enjoy life more fully. Talking to a mental health specialist or joining a support group may also help.

Living With

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

Extreme anxiety and panic attacks.
Feeling like you’ve lost control.
Severe depression or suicidal thoughts.
Thoughts of harming yourself or others.
Uncontrolled anger.

What questions should I ask my healthcare provider?

If you have PMDD, you may want to ask your healthcare provider:

Why did I get PMDD?
What is the best treatment for me?
What are the treatment side effects?
Should I change my birth control?
What lifestyle changes can I make to manage symptoms?
Am I at risk for major depression or suicide?
What should I do if I feel seriously depressed or suicidal?
Should I look out for signs of complications?

A note from Cleveland Clinic

PMDD is a serious disorder that can negatively affect your life, relationships and career. Women with PMDD may harm themselves or others. If you consistently experience severe depression and anxiety or other PMDD symptoms in the weeks leading up to your period, seek help from your healthcare provider. Medications can get hormone or serotonin levels in check so that you feel more like yourself. PMDD isn’t a problem you have to live with. Don’t put off getting the medical and mental health care you need.

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Premenstrual Dysphoric Disorder (PMDD)