Premenstrual Dysphoric Disorder (PMDD)

Overview

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). It causes physical and emotional symptoms every menstrual cycle in the week or two before your period. PMS causes bloating, headaches and breast tenderness.

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 this condition?

PMDD affects up to 10% of women or people assigned female at birth (AFAB) of reproductive age.

Symptoms and Causes

What are the symptoms of PMDD?

Symptoms of PMDD vary by individual. They tend to appear a week or two before menstruation and go away within a few days of your period starting. In addition to PMS symptoms like cramping and bloating, you may have:

For some people, symptoms of PMDD last until menopause.

What causes PMDD?

Experts don’t know why some people 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 risk factors for PMDD?

You may be more prone to PMDD if you have:

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 and live in the U.S., call or text the Suicide and Crisis Lifeline at 988. This national network of local crisis centers provides 24/7 free and confidential support. You can also dial 988 if you’re worried about a loved one who may need help.

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 treated?

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

  • Antidepressants called SSRIs (selective serotonin reuptake inhibitors) to help manage your brain’s serotonin levels. Examples of SSRIs include sertraline, fluoxetine and paroxetine HCI.
  • Hormonal birth control pills that have drospirenone and ethinyl estradiol.
  • Dietary changes such as cutting back on certain foods and caffeine. Vitamins such as B-6 and magnesium may also reduce your symptoms.
  • 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.

Can you cure PMDD naturally?

There are some ways to manage symptoms of PMDD that don’t involve medication. For example, you can practice yoga, try meditation or find other ways to improve your mood. Changing certain aspects of your diet may also bring relief. Additionally, support groups or resources may help you. Be sure to talk to your provider about all the treatment options available.

Care at Cleveland Clinic

Prevention

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 can I expect if I have this condition?

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. Most people don’t have symptoms after menopause.

Living With

When should I see 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 do I have PMDD?
  • What’s 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?

Frequently Asked Questions

What’s the difference between PMS and PMDD?

PMDD and PMS are similar in that they both happen in the week or two before your period begins when your hormone levels drop. They both cause physical symptoms like cramps, headaches or bloating. However, PMDD also causes serious symptoms that may disrupt your mood.

What does a PMDD episode look like?

Symptoms of PMDD start 10 to 14 days before your period and usually go away within the first two days of your period. This means that a person with PMDD could feel the effects of PMDD for over two weeks each menstrual cycle. During this time, it’s important to follow your provider’s recommendations for treatment. Take extra care of yourself and lean on loved ones for support.

Is PMDD considered a mental illness?

PMDD is a mental health condition listed in the DSM-5 as a "depressive disorder." The DSM-5 stands for Diagnostic and Statistical Manual of Mental Disorders and is a criteria for diagnosing mental health conditions.

Is PMDD a form of bipolar disorder?

No. PMDD and bipolar disorder aren’t the same condition. They do, however, have similar symptoms. During a depressive episode in bipolar disorder, you may feel irritable or like you’re losing control. You may also have suicidal thoughts. It’s important to get support and seek help if you have symptoms of either condition.

A note from Cleveland Clinic

PMDD is a serious disorder that can negatively affect your life, relationships and career. Women or people AFAB 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.

Last reviewed by a Cleveland Clinic medical professional on 02/02/2023.

References

  • American Academy of Family Physicians (AAFP). Premenstrual Dysphoric Disorder. (https://familydoctor.org/condition/premenstrual-dysphoric-disorder) Accessed 2/2/2023.
  • International Association for Premenstrual Disorders. What Is PMDD? (https://iapmd.org/about-pmdd) Accessed 2/2/2023.
  • Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. (https://www.ncbi.nlm.nih.gov/books/NBK532307/) 2022 May 5. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan-. Accessed 2/2/2023.
  • Planned Parenthood. What Is Premenstrual Dysphoric Disorder (PMDD)? (https://www.plannedparenthood.org/learn/health-and-wellness/menstruation/what-premenstrual-dysphoric-disorder-pmdd) Accessed 2/2/2023.
  • U.S. Department of Health and Human Services (HHS) Office on Women’s Health. Premenstrual Dysphoric Disorder (PMDD). (https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd) Accessed 2/2/2023.

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