Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-based mood disorder with emotional, mental, and physical symptoms arising during the luteal/premenstrual phase of the menstrual cycle and subsiding within a few days of menstruation. PMDD affects about 1 in 20 women and AFAB (assigned female at birth) individuals of reproductive age.
Symptoms May Include:
- Mood/emotional changes (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
- Irritability, anger, or increased interpersonal conflicts
- Depressed mood, feelings of hopelessness, feeling worthless or guilty
- Anxiety, tension, or feelings of being keyed up or on edge
- Decreased interest in usual activities (e.g., work, school, friends, hobbies)
- Difficulty concentrating, focusing, or thinking; brain fog
- Tiredness or low-energy
- Changes in appetite, food cravings, or overeating
- Hypersomnia (excessive sleepiness) or insomnia (trouble falling or staying asleep)
- Feeling overwhelmed or out of control
- Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating or weight gain
These symptoms occur during the week or two before menstruation and go away within a few days after bleeding begins. A diagnosis of PMDD requires the presence of at least five of these symptoms.
What causes PMDD?
While PMDD is directly connected to the menstrual cycle, it is not caused by a hormone imbalance, as is commonly believed. PMDD is a severe negative reaction to the natural rise and fall of estrogen and progesterone that happens each month between ovulation and menstruation, or one’s period. It is a suspected cellular disorder in the brain, and research is still ongoing to pinpoint the exact causes of symptoms.
PMDD is commonly misdiagnosed
The symptoms of PMDD can often mimic those of other disorders, including major depressive disorder, generalized anxiety disorder, panic disorder, bipolar disorder, or borderline personality disorder. In PMDD, symptoms that overlap with these disorders occur only on the days between ovulation and the end of menstruation, so tracking symptoms and cycles is crucial. However, many patients are not advised to track their symptoms alongside their menstrual cycle, leading to misdiagnoses and often ineffective treatment for PMDD.
PMDD is not PMS
PMDD is often minimized as “just PMS.” However, PMS and PMDD are different both in severity and the primary symptoms that women and AFAB individuals experience. It is characterized by mood, emotional, or mental health symptoms and is severe enough to affect a person’s relationships, work, school, and quality of life.
PMS is characterized by primarily physical symptoms that typically don’t interfere much with life or quality of life. PMS is discomfort, whereas PMDD is debilitating.
What should I do if I suspect I have PMDD?
The best thing to do if you think you have PMDD is to track your daily symptoms along with your menstrual cycles. In fact, two months of daily symptom ratings are required for a doctor to make a PMDD diagnosis, according to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Daily tracking will show you and your doctor whether your symptoms are related to your menstrual cycle or not, to then make the best diagnosis and begin effective treatment.
While PMDD is now recognized in the DSM-5 and ICD-11, the diagnosis is still new, so not all health professionals have experience diagnosing and treating it. We have a provider directory on our website which lists doctors and other health professionals recommended by others living with PMDD. If there is a recommended provider in your area, it may be helpful to make an appointment with them to start. If there is not a recommended provider in your area, we suggest seeing a gynecologist or psychiatrist in your area and using the resources and information on our website to help them become more informed about PMDD and help you advocate for your experience.
Finally, if you think you may have PMDD, seek support. At IAPMD, we offer free one-on-one and group peer support where you can share your experience, ask questions, and get support from others who completely understand and want to help you find a path to feeling better.
What can others do to support someone with PMDD?
If someone you love or care about has PMDD, there is a lot you can do to help. One of the most important things you can do is to support them and validate that what they’re feeling is real and painful. Supporting someone with PMDD doesn’t mean you need to solve their problems, it means listening to them and letting them know you are there for them, even if that means giving your loved one some space and patience if they need it.
If you are a partner, parent, or close friend of someone with PMDD, you may offer to be their PMDD partner/advocate as they manage symptoms and explore treatments. As a PMDD partner/advocate, you can help them remember to track their symptoms, follow their treatment plan, practice self-care and coping skills, and attend doctor’s appointments with them, if this is something they’re comfortable with and would find helpful. PMDD can feel extremely isolating, so to know that someone is there for you through the rollercoaster of symptoms can make a world of difference.
Disclaimer: The content of this blog is based on research and information available at the time of writing. As new research is made available, we will work to update and adjust our content as appropriate. If you have general questions, or concerns related to your own individual circumstances, please contact our Consumer Support Team, or speak to a healthcare practitioner for more specific questions about your individual circumstances.