Premenstrual dysphoric disorder (PMDD) is a health issue that is similar to premenstrual syndrome (PMS) but more severe. Many people who menstruate may have experienced some symptoms of PMS around the time of their periods. Doctors estimate that up to three-quarters of menstruators have symptoms of PMS, like fatigue, tender breasts, food cravings, cramps, or mood changes.

PMDD, however, is different from PMS. It causes emotional and physical symptoms that are more debilitating than PMS. These symptoms can get in the way of your daily life and impact work, school, and relationships.

PMDD Factsheet 

What is PMDD?

PMDD is a more extreme form of PMS that happens one or two weeks before your period starts. It will occur as hormone levels fall post ovulation.

PMDD affects up to 5% of menstruators of childbearing age and can lead to anxiety or depression.

What are the symptoms?

• Extreme irritability or anger that may impact others
• Sadness or despair, sometimes suicidal ideation
• Feeling tense or anxious
• Panic attacks
• Mood changes or crying a lot 
• Lack of interest in activities once otherwise enjoyed 
• Trouble concentrating 
• Fatigue or low energy
• Food cravings that can lead to binge eating
• Sleep issues 
• Not feeling in control 
• Cramps, bloating, breast tenderness, headaches and migraines, and joint or muscle pain

What are the treatments?

• Antidepressants, aka, selective serotonin reuptake inhibitors (SSRIs). The Food and Drug Administration (FDA) has approved three SSRIs for PMDD treatment:
  • Sertraline
  • Fluoxetine
• Paroxetine HCI
• Birth control pills. The FDA has approved birth control pills with drospirenone and Ethinyl estradiol for PMDD treatment.
• Over-the-counter pain relievers like:
  • Ibuprofen
  • Naproxen
  • Aspirin
• Stress management and relaxation techniques

Is PMDD Serious?

PMDD is not a condition to be taken lightly – many times, it can get so severe that some people will go to a doctor or nurse to discuss their treatment options. 

If your PMDD gets to a point where you are thinking of hurting yourself or others, be sure to call 911 immediately.

What Causes PMDD?

Researchers are still unsure about the direct cause of PMDD. Some believe it could be hormonal changes throughout the menstrual cycle that contribute to it. Other researchers think that a brain chemical called serotonin may also be a factor in PMDD since serotonin levels shift throughout the menstrual cycle.

What Is the Difference Between PMS and PMDD?

Premenstrual syndrome (PMS) is a term that has an extensive history both culturally and clinically. PMS can be stigmatized in our society to explain or dismiss a person’s mood, depression, anger, or behavior. 

PMS involves various emotional and/or physical symptoms in a clinical setting like bloating, food cravings, breast tenderness, sadness, and irritability. However, an individual with PMS experiences fewer severe premenstrual symptoms than someone who has PMDD.

According to recent statistics, PMS is more common than PMDD, with as many as 80% of menstruators experiencing some symptoms. These symptoms are easier to manage than those suffering from PMDD and will not need more intensive treatment. 

In addition, PMS is not classified as a mental illness according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), whereas PMDD is.

PMDD mood symptoms usually recur in the luteal phase of most menstrual cycles. About 2-8% of menstruators meet the criteria for PMDD. In addition, PMDD can be a spectrum, with some people experiencing it as mild, moderate, or severe. 

PMDD is also the only kind of premenstrual disorder classified in the DSM-V. Even though PMS and PMDD can be used interchangeably in our culture, they are two very distinct conditions. Therefore, it is essential to use the proper terminology when talking about PMDD. That way, this condition can be understood better so there are more awareness, education, and treatment options in the future. 

Are There Any New Treatments for PMDD That Are Being Studied?

Last year, a preliminary study conducted by Swedish researchers discovered a new class of drugs that can help with PMDD symptoms. The study was recently published online in December of 2020 in the American Journal of Psychiatry. 

However, this study included only 95 women, meaning that it will require more studies with a larger population in the future (this portion of the study features the gendered term “women” as that is what is indicated in the research, and it does not talk about any variability. We have used the language in these statistics because this is what was reported in the study). In essence, more information will need to be gathered before this treatment can be recommended. 

The drugs studied belong to a class known as selective progesterone receptor modulators (SPRMs). This class of drugs could potentially provide future relief for people dealing with this condition. Carly Snyder, MD, a reproductive psychiatrist based in New York, said: “Given the limited options for treatment as of now, any additional option that may be effective and that doesn’t present excess risks would be promising.

Currently, SPRMs are being used for emergency contraception and for treating uterine fibroids.  

Resources

If you believe you have PMDD, you can take a self-screening test at https://iapmd.org/self-screen. It is also essential to make an appointment with your doctor. That way, you can discuss treatment options and how you can better manage your PMDD. 

Your doctor will ask you about your health history and perform a physical examination. Therefore, it is essential to keep a calendar or journal of your symptoms so that your doctor can understand what is going on and be better equipped to diagnose PMDD.

To be diagnosed with PMDD, you have to have five or more PMDD symptoms, with one needed to be a mood-related symptom.