Better Me

Premenstrual Dysphoric Disorder (PMDD), a Severe Form of PMS

It’s that time of the month. That time just before your period, or menstrual cycle, where you feel more bloated, tired and moody.

Yet lately, you’ve noticed your symptoms of PMS, or premenstrual symptoms, are way more extreme. You’re more short-tempered with friends and coworkers. You’re picking fights with your partner. You’re anxious and overwhelmed. Literally, you feel like you want to self-destruct on yourself and others.

Most women of childbearing age experience some degree of emotional and physical symptoms or side effects known as premenstrual syndrome (PMS) days before their period each month. But did you know that some experience more severe symptoms due to a condition called premenstrual dysphoric disorder (PMDD)?

It’s estimated that PMDD affects 5% of menstruating people, yet many may be unaware or this mood disorder. Read on to know more about PMDD, its causes, symptoms and treatment options.

What is premenstrual dysphoric disorder?

PMDD is a more severe form of its cousin premenstrual syndrome (PMS) and occurs during the same time period, the luteal phase of the menstrual cycle, when the uterus preps for the possibility of pregnancy with a surge of hormones. You may experience PMDD symptoms every day, or for a few days, within the phase.

“The impact of PMS on people’s lives is usually relatively mild, but the symptoms of PMDD are much worse and can have a serious impact on daily life,” said Sarah Schutte, MD, an OBGYN with Banner Health in Northern Colorado. “A person with PMS might feel moodier or easily annoyed, but women with PMDD might feel moments of rage. They may find themselves fighting with loved ones out of nowhere—even damaging relationships.”

What causes PMDD?

The exact causes are still not fully understood but researchers believe that PMDD is caused by changes in serotonin and hormonal levels. There’s also evidence that genetics (family history of PMDD), environmental stress and smoking are all possible risk factors for PMDD.

“Environmental stress, particularly interpersonal stress, has been associated with PMDD,” Dr. Schutte said. “A diagnosis of a major depressive disorder is associated with an increase in risk for PMDD but could just be cross-over or misdiagnosis of one for the other.”

What are the symptoms of PMDD?

Since PMDD is essentially a more aggressive form of PMS, the two disorders do share some symptoms. In fact, more than 150 physical, behavioral, emotional and cognitive symptoms have been linked to PMS. However, not all of them are dealt with by every menstruating person.

Behavioral symptoms of PMDD include:

  • Mood swings
  • Sudden sadness
  • Anger and irritability
  • Sense of hopelessness
  • Self-critical thoughts
  • Anxiety or depression

Physical symptoms of PMDD include:

  • Difficulty concentrating
  • Change in appetite
  • Diminished interest in usual activities
  • Decreased energy levels
  • Breast tenderness, bloating or weight gain
  • Joint or muscle aches
  • Sleeping too much or not sleeping enough

“Though more people are gaining awareness of PMDD, many still may not know to speak with their health care provider or a behavioral health specialist about their symptoms,” Dr. Schutte said. “If you have one or more of these symptoms, talk to your provider about the possibility that you may have PMDD.”

How is PMDD diagnosed?

If you are experiencing symptoms, talk with your doctor. Your provider will review your medical history, perform a physical and pelvic exam, and may run additional diagnostic tests. If you are experiencing mental health symptoms, your provider may want you to be evaluated by a behavioral health specialist.

According to the Association of Psychiatric Association, your provider can diagnose you with PMDD if you meet the following Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)   criteria:

  • Documentation of physical and behavioral symptoms (using diaries) for about a year.
  • Five or more of these symptoms must have occurred during the week prior to your period and stopped within a few days after your period starts.
  • Symptoms must have been present in most menstrual cycles that occurred the previous year and caused significant distress or interfered with daily activities.

How is PMDD treated?

PMDD is a serious, chronic condition but there are several treatment approaches that may help relieve or decrease the severity of your PMDD symptoms.

Take supplements
  • B6 vitamins
  • Black cohosh
  • Calcium, 600 mg twice daily
  • Chasteberry
  • Ginkgo biloba
  • Magnesium, 400 mg daily
  • SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors) are effective either taken continuously or just in the luteal phase. Non-serotonergic antidepressants are not effective for PMDD.
Oral contraceptives
  • Combination pills with estrogen and progestin
  • Progestin-only birth control pills

“For some people, the severity of symptoms increases over time and lasts until menopause,” Dr. Schutte said. “For this reason, some people with PMDD may require extended treatment and adjustments in treatment.”

Don’t suffer alone

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that can have a tremendous impact on your daily life. If you’re having any kind of PMS symptoms that are bothersome, talk to your provider and share what’s going on. There are several treatment options that may help reduce or clear up your symptoms.

Need help treating PMS and PMDD?

Schedule an appointment with a primary care provider near you.
Schedule an appointment with an OBGYN.

Related articles:

Gynecology Women's Health