What is premenstrual dysphoric disorder (PMDD)?

Most people who menstruate experience premenstrual syndrome (PMS) symptoms a week or two before their period. This often means bloating, moodiness, and headaches — symptoms that can make life a bit uncomfortable but generally not unbearable. But some people experience symptoms so severe that they interfere with daily functioning. 

Approximately 5% of menstruating people experience something called premenstrual dysphoric disorder (PMDD). People with PMDD feel extremely irritable, anxious, and depressed in the weeks leading up to their period. Symptoms typically resolve within a few days of starting your period, but they can take a serious toll on your emotional and physical well-being. 

If PMDD is new to you or you’re interested in learning more about the condition, here’s what you need to know about risk factors, diagnosis, and symptom management. 

What does a PMDD episode feel like?

PMDD affects people during the luteal phase of their menstrual cycle — meaning the time between ovulation and the start of their period. Symptoms typically peak around the first day of the cycle and linger for several days. 

PMDD affects everyone differently, but common emotional symptoms include: 

• Anxiety 
• Panic attacks
• Feelings of sadness and hopelessness 
• Crying for no reason
• Trouble sleeping 
• Low energy or fatigue 
• A change in eating habits, like food cravings or binge eating 
• Extreme irritability 
• Trouble concentrating 
• Lack of interest in hobbies, relationships, and daily activities 
• Suicidal thoughts* 

Many people with PMDD also experience physical issues, like bloating, breast tenderness, exhaustion, headaches, and joint or muscle pain.

*The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988. If you’re experiencing a life-threatening emergency or you need immediate help, please call 911.

PMDD vs PMS

PMDD and PMS share many symptoms, but PMDD is more debilitating. While PMS can cause physical and emotional discomfort, PMDD symptoms are distressing enough to interfere with work, daily activities, and relationships. 

With PMS, you may feel irritable or a bit off, but it probably won’t prevent you from going to work, meeting with friends, or cooking dinner. But with PMDD, symptoms can be so severe that you’re unable to manage normal responsibilities or enjoy time with others.  

What causes PMDD?

We don’t yet know the exact reason why some people develop PMDD, but there are several theories. To start, hormones likely play a role. People with PMDD may be sensitive to changes in hormones like estrogen and progesterone. A drop in serotonin levels — the brain chemical responsible for regulating mood — may also contribute to symptoms. 

Other risk factors for developing PMDD include:

• Genetics: PMDD might be genetic, meaning you may be more likely to develop the condition if someone in your family experiences PMS or PMDD.
• Trauma: Exposure to adverse childhood events — particularly emotional abuse — may increase a person’s risk of PMDD. 
• Temperament: Some research suggests that people with neurotic tendencies, meaning trouble managing stress and regulating emotions, may be more likely to have impaired functioning around their period.

How long do the effects of PMDD last?

PMDD is a chronic condition that typically requires treatment to effectively manage symptoms. Unmanaged PMDD has the potential to impact work, relationships, and overall quality of life. 

People with PMDD are also more likely to have co-occurring mental health conditions. Mental health conditions that frequently occur alongside PMDD include autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), and eating disorders. People with PMDD are also at an increased risk of experiencing suicidal thoughts. It’s also associated with unhealthy lifestyle habits, like addictive behaviors and poor quality sleep. 

Diagnosing and treating PMDD

If PMDD symptoms are starting to affect your quality of life, don’t hesitate to speak with a mental health provider, gynecologist, or primary care doctor. In most cases, your provider will conduct a physical exam, psychiatric evaluation, and additional tests to rule out other conditions. For example, PMDD is sometimes misdiagnosed as a thyroid disorder. 

Your provider might also ask you to track the type, severity, and duration of your symptoms. A PMDD diagnosis requires five or more PMDD symptoms, including one mood-related symptom, for at least two cycles. PMDD typically begins during a person’s 20s, with symptoms worsening over time.

When it comes to managing symptoms, most people benefit from therapy, medication, or both. 

• Talk therapy: Talk therapy, like cognitive behavioral therapy (CBT), can teach people how to understand and regulate their emotions. It’s also effective for managing co-occurring conditions, like anxiety, seasonal affective disorder (SAD), and eating disorders. 
• Medications: Some psychiatric medications and birth control pills are considered a first-choice treatment for PMDD. If you think you’d benefit from trying a medication, speak with your provider about your specific needs. Some people take medications on an ongoing basis, while others only take them during certain points in their cycle.

Five additional strategies for dealing with PMDD

In addition to talk therapy and medication management, there are several strategies to help cope with symptoms and improve functioning. These include:

1. Eating a balanced diet: This means eating more unprocessed foods — like fresh fruits, vegetables, and complex carbs — and less salty and sugary foods.
2. Limiting addictive substances: Try to reduce or eliminate addictive substances — like caffeine, alcohol, and nicotine — especially before bed. 
3. Staying connected: It’s normal to want to be alone when you’re not feeling your best, but sharing your experience with a trusted friend can help you cope with symptoms. 
4. Prioritizing sleep: Create healthy sleep habits by following a consistent sleep schedule, avoiding screens before bed, and designing a comfortable sleep environment.
5. Considering supplements: Although research is limited, some people believe that dietary supplements — like calcium, magnesium, and vitamin B6 — may help people manage PMDD symptoms. 

Find care with Rula

Premenstrual dysphoric disorder (PMDD) is a depressive disorder that can cause irritability, depression, and fatigue during certain points of the month. People with PMDD, which is more severe than PMS, may require professional support to manage their symptoms and feel their best. That’s where Rula can help. 

Rula’s therapist-matching program helps people find a mental health provider who’s in-network with their insurance and accepting new clients in just a few clicks. From there, you can schedule your first live video therapy session for as soon as tomorrow.

Find a therapist with Rula