Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a mental health condition that can occur in two to five percent of women, usually starting one week before your period. Many women experience premenstrual syndrome (PMS), which includes mood changes, breast tenderness, bloating, headache, poor concentration, sleep disturbance, and change in appetite. PMDD is a more serious condition that can impair functioning. 

What are the typical symptoms of PMDD?

  • Mood swings
  • Depression
  • Anxiety
  • Decreased interest
  • Decreased concentration
  • Lack of energy
  • Change in appetite
  • Sleep changes
    • Insomnia
    • Hypersomnia

What causes PMDD?

It is not clear what causes PMMD. According to some theories, changes in hormones during the menstrual cycles can lead to changes in chemicals in the brain (e.g. serotonin, GABA), which can lead to problems in mood and emotion regulation. 

Women who have a personal history of mood changes related to reproductive events, such as giving birth or having a miscarriage, are more likely to have PMDD. Women with a personal history of depression, anxiety or bipolar disorder are also at an increased risk.

How is PMDD diagnosed?

PMDD can be diagnosed by a primary care provider or a mental health specialist. Women can monitor their symptoms for two consecutive menstrual cycles to confirm the diagnosis.

PMDD symptom trackers that may be helpful:

How is PMDD treated?

Non-medication options

  • Engaging in regular exercise
  • Heathy diet
  • Stress reduction management, including:
    • Yoga
    • Mindfulness practices
    • Psychotherapy or counseling
  • Diet supplementation may be helpful, including:
    • Calcium
    • Omega-3-fatty acids (fish oil)

Medication treatment

Antidepressants are considered the most effective pharmacological treatment for PMDD. They can be used intermittently for the duration of the symptoms or continuously. Usually a low dose can be used and most women have a rapid response.

Hormonal treatments may not be as helpful as antidepressants, but some oral contraceptive pills, such as Yasmin, have shown positive results.

Last reviewed: 
April 2018
Alternative Names: 
PMDD
Premenstrual dysphoric disorder

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