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Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a health problem that is similar to premenstrual syndrome (PMS) but is more serious. PMDD causes severe irritability, depression, or anxiety in the week or two before your period starts. Symptoms usually go away two to three days after your period starts. You may need medicine or other treatment to help with your symptoms.    

What is PMDD?

PMDD is a condition similar to PMS that also happens in the week or two before your period starts as hormone levels begin to fall after ovulation. PMDD causes more severe symptoms than PMS, including severe depression, irritability, and tension.

Who gets PMDD?

PMDD affects up to 5% of women of childbearing age.1 Many women with PMDD may also have anxiety or depression.2

What are the symptoms of PMDD?

Symptoms of PMDD include:3

  • Lasting irritability or anger that may affect other people
  • Feelings of sadness or despair, or even thoughts of suicide
  • Feelings of tension or anxiety
  • Panic attacks
  • Mood swings or crying often
  • Lack of interest in daily activities and relationships
  • Trouble thinking or focusing
  • Tiredness or low energy
  • Food cravings or binge eating
  • Trouble sleeping
  • Feeling out of control
  • Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain


What causes PMDD?

Researchers do not know for sure what causes PMDD or PMS. Hormonal changes throughout the menstrual cycle may play a role. A brain chemical called serotonin may also play a role in PMDD. Serotonin levels change throughout the menstrual cycle. Some women may be more sensitive to these changes.

How is PMDD diagnosed?

Your doctor will talk to you about your health history and do a physical examination. You will need to keep a calendar or diary of your symptoms to help your doctor diagnose PMDD.

You must have five or more PMDD symptoms, including one mood-related symptom, to be diagnosed with PMDD.

How is PMDD treated?

Treatments for PMDD include:

  • Antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs change serotonin levels in the brain. The Food and Drug Administration (FDA) approved three SSRIs to treat PMDD:4
  • Birth control pills. The FDA has approved a birth control pill containing drospirenone (droh-SPIR-uh-nohn) and ethinyl estradiol (ETH-uh-nil es-truh-DEYE-ohl), to treat PMDD.
  • Over-the-counter pain relievers may help relieve physical symptoms, such as cramps, joint pain, headaches, backaches, and breast tenderness. These include:
  • Stress management, such as relaxation techniques and spending time on activities you enjoy5

Making healthy changes, such as eating a healthy combination of foods across the food groups, cutting back on salty and sugary foods, and getting more physical activity, may also help relieve some PMDD symptoms. But PMDD can be serious enough that some women should go to a doctor or nurse to discuss treatment options. And, if you are thinking of hurting yourself or others, call 911 right away.


  1. Potter, J., Bouyer, J., Trussell, J., Moreau, C. (2009). Premenstrual Syndrome Prevalence and Fluctuation over Time: Results from a French Population-Based Survey: Journal of Women’s Health; 18(1): 31–39.
  2. Pearlstein, T., Steiner, M. (2008). Premenstrual dysphoric disorder: burden of illness and treatment updateJournal of Psychiatry & Neuroscience; 33(4): 291–301.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: The American Psychiatric Association.
  4. The Medical Letter. (2003). Which SSRI? Med Lett Drugs Ther; 45(1170):93-5. 
  5. Goodale, I.L., Domar, A.D., Benson, H. (1990). Alleviation of premenstrual syndrome symptoms with the relaxation responseObstet Gynecol; 75(4):649-55.