What Is Premenstrual Dysphoric Disorder (PMDD)?
Published on May 27, 2025
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Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome (PMS). In addition to physical PMS symptoms, such as fatigue, bloating, and breast soreness, PMDD can cause intense mood changes, anxiety, and depression in the week or two before a menstrual period. While most people have some uncomfortable symptoms before their period, PMDD symptoms are intense enough to disrupt daily life.
Like PMS, PMDD happens when hormone levels drop after ovulation, but PMDD symptoms are much more intense. Symptoms should go away within a couple of days after a period starts, but they may reappear monthly. Some people with PMDD need medicine to manage their symptoms.
Signs and Symptoms of Premenstrual Dysphoric Disorder (PMDD)
PMDD symptoms start in the week or two before a period. The condition includes both physical and emotional symptoms that are severe enough to interfere with work, school, social life, and other aspects of daily living.
Physical symptoms include:
- Swollen or tender breasts
- Headache
- Bloating
- Weight gain
- Muscle or joint aches
- Fatigue or low energy
Emotional symptoms include:
- Depressed or sad mood
- Irritability and anger
- Feeling on edge or overwhelmed
- Anxiety
- Mood swings
- Crying without an obvious cause
- Less interest in friends, school, work, and other activities
- Difficulty concentrating
- Changes in appetite, eating more or less than usual
- Changes in sleep habits, sleeping more or less than usual
- Thoughts of suicide
Causes and Risk Factors of Premenstrual Dysphoric Disorder (PMDD)
Researchers don't know what causes PMDD. They suspect it happens when levels of the hormones estrogen and progesterone plunge before a period. Another possible factor is falling levels of serotonin, a brain chemical that helps regulate mood. Some women are more sensitive to these hormonal and chemical changes than others.
A few factors may increase the risk of PMDD, including:
- A personal or family history of PMDD, PMS, depression, or postpartum depression
- Cigarette smoking
- Obesity
- Past abuse or other traumatic experiences
- Anxiety
How Is Premenstrual Dysphoric Disorder (PMDD) Diagnosed?
Doctors diagnose PMDD based on a physical exam and a questionnaire of symptoms. It may be helpful to keep a diary of symptoms to share with your doctor. You must have at least five symptoms, including one mood symptom such as irritability or anxiety, to be diagnosed with PMDD.
The symptoms need to start in the week before menstruation and go away within a few days after a period starts. They must cause enough distress to interfere with daily life.
Treatment and Medication Options for Premenstrual Dysphoric Disorder (PMDD)
Treatments for PMDD include antidepressant medicines, hormone therapy, and lifestyle changes.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) help with symptoms like headaches, cramps, sore breasts, and joint pain. These pain relievers include:
- ibuprofen (Advil, Motrin)
- naproxen (Aleve)
- aspirin
Antidepressants
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) treat PMDD by increasing the amount of serotonin available in the brain. Women with PMDD can take an antidepressant continuously, or only in the two weeks before a period.
Commonly used SSRIs include:
- citalopram (Celexa)
- escitalopram (Lexapro)
- fluoxetine (Prozac)
- sertraline (Zoloft)
Venlafaxine (Effexor) is an SNRI prescribed to treat PMDD, and tends to be used if you experience unpleasant side effects with SSRIs.
Hormone Therapy
Hormone therapy using birth control pills may reduce PMDD symptoms. A pill containing the progestin hormone drospirenone and a form of estrogen called ethinyl estradiol is FDA approved for treating PMDD.
Leuprolide (Lupron), a type of medicine called a gonadotropin-releasing hormone (GnRH) agonist, reduces PMDD symptoms by essentially stopping ovulation and menstruation. Because it has a lot of side effects, including hot flashes, vaginal dryness, and bone loss, Lupron is only used when SSRIs and birth control pills haven't helped.
Researchers are studying new medications that might help relieve the symptoms of PMDD. A class of drugs called selective progesterone receptor modulators that's under investigation might be helpful for the emotional symptoms of PMDD. These drugs work by blocking the hormone progesterone.
Light Therapy
Research suggests that exposure to bright light in the morning may improve mood in people with PMDD. Though light therapy is safe to try, additional studies are needed to confirm that it works.
Cognitive-Behavioral Therapy (CBT)
This form of talk therapy focuses on changing a person's perceptions to improve their symptoms. Early evidence suggests that CBT may offer some benefit for PMDD without the side effects of medication, but it warrants further investigation.
Surgery
Surgery to remove the uterus, fallopian tubes, and ovaries (hysterectomy and bilateral salpingo-oophorectomy) is a final option for women who have tried every other treatment but still have debilitating symptoms. Surgery relieves PMDD symptoms by stopping ovulation. It will put you into menopause and you won't be able to get pregnant afterward.
Complementary and Integrative Therapies
Some research suggests that chasteberry (Vitex agnus castus) may improve PMDD symptoms. Dosing recommendations vary, so it may take some trial and error to determine what works for you.
St. John's Wort seems to help with the physical symptoms of PMDD, but it doesn't do much to relieve emotional symptoms like depression, anxiety, and irritability. Also, it can interact with birth control pills and reduce their effectiveness.
The FDA doesn't regulate supplements like it does medicines. Talk to your doctor before you try any complementary therapy, to make sure it's safe for you.
Dietary supplements like vitamin B6, calcium, and magnesium have also been studied for treating PMDD. So far, none of these supplements have been confirmed to work.
Lifestyle Changes for Premenstrual Dysphoric Disorder (PMDD)
Following a healthy lifestyle can make you feel better overall. Your doctor might suggest that you:
- Do aerobic exercises like walking or bike riding for 30 minutes at least five days a week.
- Eat a well-balanced diet with plenty of fruits, vegetables, and whole grains.
- Try to get seven to nine hours of sleep a night.
- Cut back on alcohol, sugar, salt, and caffeine.
- Don't smoke.
- Reduce stress with relaxation techniques like deep breathing and meditation.
How Long Does Premenstrual Dysphoric Disorder (PMDD) Last?
Everyone has a different experience with PMDD. Some people's symptoms last longer than others. In general, symptoms should improve within a couple of days after your period starts, but they may return the next month. Treatment can make PMDD symptoms more manageable and help you live better with this condition. PMDD may not be preventable because it's related to changing hormone levels.
Complications of Premenstrual Dysphoric Disorder (PMDD)
PMDD symptoms can be severe enough to interfere with work, school, and other aspects of daily life. Women with PMDD are more likely to miss work, be less productive when they are at work, have problems in their romantic relationships, and have difficulty parenting their children. Some women have thoughts of self-harm or suicide, which requires immediate medical attention.
Research and Statistics: How Many People Have Premenstrual Dysphoric Disorder (PMDD)?
Between 70 percent and 90 percent of people who get a period have some premenstrual symptoms. Out of those, an estimated 3 to 8 percent have PMDD. A study published 2024 that only included people with a confirmed PMDD diagnosis found that the actual number was much lower — about 1.6 percent of menstruating women worldwide.
Disparities and Inequities in Premenstrual Dysphoric Disorder (PMDD)
With PMDD, the usual disparities are reversed. Black women have the advantage of being much less likely to be diagnosed with this condition than white women. An older study found that around 2.9 percent of Black women have PMDD, compared with 4.4 percent of white women. Researchers aren't sure why this is the case. There haven’t been any newer published studies further investigating this disparity.
Related Conditions to Premenstrual Dysphoric Disorders (PMDD)
PMDD can overlap with these conditions:
- Anxiety disorders: Feelings of intense fear or anxiety triggered by things that are not usually dangerous.
- Somatoform disorders: Mental disorders that cause physical symptoms like pain, stomachache, shaking, or numbness.
- Major depressive disorder: A down mood that lasts for at least two weeks and affects daily life. About half of people with PMDD also have depression.
- Bipolar disorder: A condition that causes emotional highs and lows.
- Thyroid disease: An overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid gland.
Support for People With Premenstrual Dysphoric Disorder (PMDD)
The International Association for Premenstrual Disorders (IAPMD)
The IAPMD offers six Facebook support groups for people with PMDD, their partners, parents, and friends. These groups are available to people all over the world, and they offer a safe space for people to share experiences and learn from each other.
The Takeaway
- Premenstrual dysphoric disorder (PMDD) is a collection of symptoms like irritability, anger, breast tenderness, and difficulty sleeping that starts about a week before a menstrual period and can be severe enough to disrupt daily life.
- Doctors diagnose PMDD based on a physical exam and symptoms.
- PMDD should improve on its own within a couple of days after a period starts, but treatments like antidepressants and birth control pills can make symptoms less severe.
Common Questions & Answers
What are symptoms of premenstrual dysphoric disorder?
PMDD combines physical symptoms like bloating and sore breasts with emotional symptoms, such as irritability, depression, and a lack of energy.
Is PMDD considered a mental illness?
Yes, PMDD is a mental health condition. It's listed as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
What does PMDD feel like?
PMDD is a more severe form of PMS, with extreme mood changes plus physical symptoms.
What is the best treatment for PMDD?
Lifestyle changes are recommended as the primary therapy, and they can also make medications more effective. Antidepressants that make more serotonin available in the brain are often used for PMDD because they're effective at relieving symptoms.
Resources We Trust
- Cleveland Clinic: Premenstrual Dysphoric Disorder (PMDD)
- Johns Hopkins Medicine: Premenstrual Dysphoric Disorder (PMDD)
- Mayo Clinic: Premenstrual Dysphoric Disorder: Different From PMS?
- Mind: Premenstrual Dysphoric Disorder (PMDD)
- 988 Lifeline: 988 Lifeline
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
- Premenstrual Dysphoric Disorder (PMDD). Cleveland Clinic. February 2, 2023.
- Treating Premenstrual Dysphoric Disorder. Harvard Medical School. January 19, 2023.
- Premenstrual Dysphoric Disorder (PMDD). Office on Women's Health. February 22, 2021.
- Premenstrual Dysphoric Disorder (PMDD). Johns Hopkins Medicine.
- Mishra S et al. Premenstrual Dysphoric Disorder. StatPearls. February 19, 2023.
- Carlini SV et al. Management of Premenstrual Dysphoric Disorder: A Scoping Review. International Journal of Women's Health. December 21, 2022.
- Carlini SV et al. Evidence-based treatment of Premenstrual Dysphoric Disorder: a concise review. Journal of Clinical Psychiatry. February 4, 2020.
- Comasco E et al. Ulipristal Acetate for Treatment of Premenstrual Dysphoric Disorder: A Proof-of-Concept Randomized Controlled Trial. The American Journal of Psychiatry. December 10, 2020.
- Parry BL et al. A 1-week sleep and light intervention improves mood in premenstrual dysphoric disorder in association with shifting melatonin offset time earlier. Archives of Women's Mental Health. December 15, 2022.
- Kancheva Landolt N et al. Short report: cognitive behavioral therapy - a primary mode for premenstrual syndrome management: systematic literature review. Psychology, Health & Medicine. December 2021.
- PMDD/PMS. MGH Center for Women's Mental Health.
- Surgery & Surgical Menopause. IAPMD.
- What is Chasteberry, and What Can It Do? Cleveland Clinic. November 22, 2022.
- Cerqueira RO et al. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Archives of Women's Mental Health. December 2017.
- Is St. John's Wort Effective for PMDD. MGH Center for Women's Mental Health. October 27, 2020.
- Burnett T. Premenstrual Dysphoric Disorder: Different from PMS? Mayo Clinic. January 19, 2024.
- Women's Health Team. PMDD vs. PMS: What's the Difference, and How Can You Feel Better? Essential Health. January 15, 2025.
- Treatment for Premenstrual Dysphoric Disorder (PMDD). Mind. October 2024.
- Hodgetts S. Premenstrual Dysphoric Disorder Harms Relationships for Both Sufferers and Their Partners — New Study. The Conversation. May 6, 2025.
- Premenstrual Dysphoric Disorder. Medline Plus. June 1, 2025.
- Reilly TJ et al. The prevalence of premenstrual dysphoric disorder: Systematic review and meta-analysis. Journal of Affective Disorders. March 15, 2024.
- Pilver CE et al. Health advantage for black women: patterns in pre-menstrual dysphoric disorder. Psychological Medicine. November 26, 2010.
- Slyepchenko A et al. Comorbid Premenstrual Dysphoric Disorder and Bipolar Disorder: A Review. Frontiers in Psychiatry. August 25, 2021.
Meet Our Experts
John Paul McHugh, MD
Medical Reviewer
Member of American College of Lifestyle Medicine
John Paul McHugh, MD, is an obstetrician-gynecologist and lifestyle medicine specialist in southern California. He has always placed wellness at the center of his work, in both delivering babies and improving practice standards. Dr. McHugh believes that bringing lifestyle medicine to the center of health and wellness empowers patients to make the change they seek and enjoy the benefits of true wellness.
He is a graduate of Harvard Medical School and the Massachusetts Institute of Technology and a fellow of the American College of Lifestyle Medicine. He served as a department chair at Scripps Mercy Hospital in San Diego and is now the chair-elect for the American College of Obstetricians and Gynecologists for California.
He has published several articles in the American Journal of Lifestyle Medicine and served as a peer reviewer for many articles. He contributed to the first textbook of lifestyle medicine in women's health: Improving Women's Health Across the Lifespan.
Stephanie Watson
Author
Stephanie Watson is a freelance health writer who has contributed to WebMD, AARP.org, BabyCenter, Forbes Health, Fortune Well, Time, Self, Arthritis Today, Greatist, Healthgrades, and HealthCentral. Previously, she was the executive editor of Harvard Women’s Health Watch and Mount Sinai’s Focus on Healthy Aging. She has also written more than 30 young adult books on subjects ranging from celebrity biographies to brain injuries in football.