Premenstrual dysphoric disorder: symptoms, causes and treatment
Many women feel changes in their body or mood in the days before their period. More than 90% of women say they get some premenstrual symptoms. When these symptoms happen every month and affect your daily life, it's called premenstrual syndrome (PMS).1
If PMS symptoms make it hard to do your job or interact with others, you might have premenstrual dysphoric disorder (PMDD). PMDD is a more serious form of PMS and only affects a small number of women.1
What is premenstrual dysphoric disorder?
PMDD is like PMS, but with more intense symptoms which can significantly disrupt a woman’s life. It happens in the week or two before your period. This is when your hormone levels go down after ovulation. PMDD can cause worse symptoms than PMS. These may include irritability and depression.2
What are common symptoms of PMDD?
The symptoms of PMDD and PMS are similar. But PMDD symptoms are more intense.3
Emotional symptoms of PMDD include:1, 2, 3
- Anger
- Irritability
- Anxiety
- Panic attacks
- Feeling hopeless or depressed
- In severe cases, there may be thoughts of self-harm
- Feeling overwhelmed or out of control
- Lack of interest in daily activities and relationships
- Mood swings
- Trouble concentrating
Physical symptoms of PMDD include:1, 2, 3
- Bloating
- Breast tenderness
- Changes in appetite
- Cramps
- Headaches
- Joint or muscle pain
- Sleep problems
- Fatigue
What are the causes and risk factors for PMDD?
Researchers are not sure what causes PMDD. Changes in hormones during the menstrual cycle might be a reason. Levels of a brain chemical called serotonin also go up and down during menstruation. Some people may be more sensitive to changing serotonin levels.3
People who have had major depression are more likely than others to have PMDD.2
How is PMDD is diagnosed?
PMDD is diagnosed when:2, 4
- A person has 5 or more PMS symptoms
- At least one of the symptoms must be a mood symptom
PMDD symptoms typically start the week before your period and stop once your period starts. They usually don’t happen for the rest of the month.4
PMDD symptoms can make common daily activities difficult.4
Doctors can make the diagnosis if the pattern of symptoms lasts for at least 2 periods in a row and are not caused by another health condition.4
What are the treatment options for PMDD?
Doctors typically recommend medicine to treat PMDD.2
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) may be used. The U.S. Food and Drug Administration (FDA) approved 3 SSRIs to treat PMDD:
- Sertraline
- Fluoxetine
- Paroxetine HCI
Birth control pills are another medicine used to treat PMDD. The FDA has approved one type of birth control pill to treat PMDD.2
Over-the-counter pain relievers may help with physical symptoms. These include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen or aspirin.2 Talk to your doctor before taking NSAIDs. Using these medicines for a long time can hurt your stomach.
Coping strategies and lifestyle tips for PMDD
Managing stress through relaxation techniques, such as meditation or yoga, may help.2
Lifestyle changes, such as eating a healthy variety of foods, cutting back on salt and sugar, and getting more exercise may help.2, 5
When to seek medical help for PMDD
If you have PMS symptoms that affect your daily life, ask your doctor about PMDD and treatment options.3 If you or a loved one is in distress and need immediate care, help is available to you 24/7.
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