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Premenstrual Dysphoric Disorder

  • Cynthia M. Johnson, MA
Publication Type:


Premenstrual Dysphoric Disorder



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.


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.

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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


The doctor will ask about symptoms and past health. 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 two menstrual cycles. This may confirm PMDD.

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


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


There are no current guidelines to prevent PMDD.

Lifestyle Changes

Lifestyle changes that may ease symptoms include:

  • Engaging in regular physical activity
  • Practicing relaxation methods, such as deep breathing and yoga
  • Cognitive behavioral therapy (CBT) with a therapist




  • PMS and PMDD. MGH Center for Women's Health website. Available at: http://womensmentalhealth.org/specialty-clinics/pms-and-pmdd.
  • Premenstrual dysphoric disorder (PMDD). Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/premenstrual-dysphoric-disorder.html.
  • Premenstrual syndrome. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/premenstrual-syndrome.


  • Beverly Siegal, MD, FACOG
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.