Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a mental health condition. It can happen in 2 to 5 percent of women,. It often starts 1 week before your period. Many women have premenstrual syndrome (PMS), with symptoms such as:

• Mood changes
•  Breasts feel tender
• Bloating, headache
• Not able to concentrate
• Changes in sleep
• Changes in appetite (eating more or less food than normal)

 PMDD is a serious condition that can make it harder to do day-to-day activities. 

What are the symptoms of PMDD?

• Mood swings
• Depression
• Anxiety (feeling worried)
• Lack of interest in daily activities
• Not able to concentrate
• Lack of energy
• Change in appetite
• Sleep changes
  • Insomnia (having a hard time falling asleep)
  • Hypersomnia (feeling very sleepy even though you got enough sleep)

What causes PMDD?

It is not clear what causes PMMD. Some theorists say that changes in hormones during the menstrual cycles (periods) can change chemicals in the brain (like serotonin and GABA). This can lead to problems in mood and managing emotions.

Women who have a personal history of mood changes linked to reproductive events, like 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 a higher risk.

How is PMDD diagnosed?

Your primary care provider or a mental health specialist can diagnose PMDD. You can track your symptoms for 2 menstrual cycles in a row to confirm the diagnosis.

PMDD symptom trackers that may be helpful:

• DRSP scale
• Me v PMDD
• A mood log

How is PMDD treated?

Non-medicine options

• Engaging in regular exercise
• Eating a variety of fruits and vegetables and limiting processed foods
• Using stress management techniques, like:
  • Yoga
  • Practicing mindfulness 
  • Psychotherapy or counseling
• Dietary supplements may be helpful, such as:
  • Calcium
  • Omega-3-fatty acids (fish oil)

Medicine treatment

Antidepressants are considered the most effective medicine treatment for PMDD. The first line of treatment are selective serotonin reuptake inhibitors (SSRIs). The second line of treatment are serotonin and norepinephrine reuptake inhibitors (SNRIs). 

Antidepressants can be used on and off or continuously for the length of your symptoms. A low dose can often be used. Antidepressants can quickly improve symptoms in most women. 

Hormonal treatments may not be as helpful as antidepressants. Some birth control pills, such as ones with drosperinone (like Yasmin^®) have shown positive results.