Premenstrual dysphoric disorder (PMDD) occurs just prior to menstruation and is characterized by significant:

  • Depression
  • Irritability
  • Tension
PMDD is much more severe than PMS

PMS affects about 75% of women. PMDD affects 2%-10% of all women during their reproductive years. With treatment, the condition can be managed. Some women no longer have any symptoms once PMDD has been diagnosed and treated.


The factors that cause PMDD are not known. Some possible causes of PMDD include:

  • Hormonal changes caused by high hormones in latter half of a normal (ovulatory) menstrual cycle
  • Traumatic life events
  • Stress

Microscopic View of Hormone Receptor

molecule and receptor
Menstruation causes many hormone changes which may play a role in PMDD.
© 2009 Nucleus Medical Art, Inc.

Risk Factors

The following factors increase your chance of developing PMDD:


Symptoms include:

  • Extreme sadness
  • Frequent crying
  • Irritability
  • Feelings of anxiousness or nervousness
  • Unusually strong cravings for certain foods
  • Difficulty concentrating or paying attention
  • Insomnia
  • Panic attacks
  • Mood swings
  • Fatigue or lack of energy
  • Physical symptoms include sore breasts, headaches, joint or muscle pain, swelling, and bloating

To be properly diagnosed with PMDD, usually at least five symptoms need to be present. Symptoms typically begin 10-14 days prior to the start of menstruation. They begin to decrease once menstruation begins. Symptoms that occur at other times during the cycle suggest other underlying mood or anxiety disorders.


Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will ask detailed questions about your symptoms and when they occur.

You may also be asked to keep a chart or record of your symptoms. Record when they occur and the severity of each. Your doctor will compare your symptoms to days of your menstrual cycle. This will help to determine if you suffer from PMDD.


Talk with your doctor about the best treatment plan for you. Treatment options include:

Lifestyle Changes

These steps can help manage symptoms of PMDD:

  • Regular exercise 3-5 times per week
  • Get plenty of rest
  • Eat a balanced diet with plenty of fruits, vegetables, and whole grains
  • Diet should also exclude sugar, caffeine, and alcohol


The following can help manage symptoms of PMDD:


To help reduce your chance of getting PMDD, take the following steps:

  • Get plenty of exercise and rest
  • Eat a well-balanced diet
  • Manage stress