Premenstrual dysphoric disorder (PMDD) is a severe and less common form of premenstrual syndrome (PMS). PMDD causes physical and emotional symptoms that happen 1 to 2 weeks before a menstrual period. These problems impact life.

Causes

The cause is not known.

Risk Factors

PMDD is more common in women of reproductive age and women who are White. Things that may raise the risk are:

A personal or family history of mental health problems, such as depression
Having a family member with PMS or PMDD
Being overweight or obese
Smoking
Extra stress or a traumatic life event

Microscopic View of Hormone Receptor

Menstruation causes many hormonal changes, which may play a role in PMDD.

Symptoms

Severe problems may be:

Physical:
- Fatigue
- Cramps and bloating
- Nausea
- Swelling of hands or feet
- Headache
- Swollen or tender breasts
- Muscle or back pain
- Weight gain
Emotional:
- Irritability and mood swings
- Frequent crying
- Sleep problems
- Changes in sex drive
- Loss of hope or control
- Problems with focus or paying attention
- Tension
- Confusion
- Restlessness
- Loss of interest in people and activities
- Appetite changes, such as eating too much or strong food cravings

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. This may be enough to make the diagnosis. You may be asked to keep track of the problems you have over 2 menstrual cycles. This may confirm PMDD.

In women who do not menstruate, blood tests may be done to check hormone levels against symptoms.

Treatment

The goal of treatment is to ease physical and emotional symptoms. PMDD is first treated with habit changes. Medicines may be used when symptoms do not get better with these changes. Choices may be:

Exercising 3 times a week to ease symptoms and promote feelings of well-being
Lowering stress through things like medicine, deep breathing, yoga, and cognitive behavioral therapy (CBT)
Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) to ease physical symptoms
Oral contraceptives to suppress ovulation
Antidepressants to ease depression, irritability, and some physical symptoms

Prevention

There are no guidelines to lower the risk of PMDD. The cause is not known.

RESOURCES:

American Congress of Obstetricians and Gynecologists
http://www.acog.org

Office on Women's Health
http://www.womenshealth.gov

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca/en/health-canada.html

The Society of Obstetricians and Gynaecologists of Canada
http://sogc.org

References:

Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2016 Aug 1;94(3):236-240.

PMS and PMDD. MGH Center for Women's Health website. Available at:
...(Click grey area to select URL)
Accessed January 17, 2020.

Premenstrual dysphoric disorder (PMDD). Family Doctor—American Academy of Family Physicians website. Available at:
...(Click grey area to select URL)
Updated May 14, 2019. Accessed January 17, 2020.

Premenstrual syndrome. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/premenstrual-syndrome . Updated August 22, 2019. Accessed January 17, 2020.

Last reviewed September 2019 by EBSCO Medical Review Board Beverly Siegal, MD, FACOG
Last Updated: 7/15/2020

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