Most women experience a little moodiness in the days or weeks just before their menstrual period, along with other premenstrual symptoms. However, for those with the mood disorder known as premenstrual dysphoric disorder (PMDD), these mood changes can take over life, damaging professional and personal relationships. 

Some women describe severe PMDD symptoms as a vicious cycle that actively destroys their life for two weeks, after which they must spend the next two weeks repairing the damage, only to start the cycle again. 

Fortunately, for women who suffer from PMDD, there are effective treatments that can help them regain control over their symptoms, emotions, and lives. 

We’re discussing everything there is to know about PMDD here, so keep reading if you find that you struggle more than you should month after month. You can learn to manage and control your mood and anything related to PMDD. 

What Is Premenstrual Dysphoric Disorder?

Premenstrual dysphoric disorder is an extreme type of premenstrual syndrome (PMS). This disorder causes many emotional and physical symptoms that can start as early as 2 weeks before your period. PMDD isn’t just about being a little moody or short-tempered. PMDD typically causes intense emotions that severely impact interpersonal relationships. In the most severe cases, some even have suicidal thoughts. An estimated 5 – 8% of women live with PMDD.

PMDD vs PMS

Although both PMDD and PMS are tied to your menstrual cycle and the resulting hormonal fluctuations, PMDD differs from PMS in some important ways. While many symptoms are similar, PMDD is much more severe than PMS. PMDD can potentially interrupt your life and lessen your overall quality of life.

Levels of estrogen and progesterone can be the same in two women, yet one will experience PMS while the other has PMDD symptoms. We don’t know exactly why this is, but one theory is that some women are more sensitive to hormone levels changes than others.

A whopping 90% of women report experiencing some PMS symptoms, including headaches, bloating, or moodiness. While these symptoms can interfere with life and, in extreme cases, cause some women to miss work or school, PMS is nowhere near the intensity of PMDD. 

“PMDD is not simply a more intense version of PMS. PMDD can significantly impact your life. The symptoms experienced, both physical and emotional, can be overwhelming. It’s important to know you do not have to struggle with this on your own. Talk to your healthcare provider about treatment options.”

Talkspace therapist Jill E. Daino, LCSW-R

Symptoms of Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder symptoms can be divided into emotional and physical symptoms. 

Emotional symptoms of PMDD include:

  • Having dramatic mood swings
  • Feeling unusually emotional and crying easily
  • Experiencing a lack of energy
  • Feeling “on edge”
  • Being unable to focus or finding it difficult to concentrate
  • Not being interested in activities that used to be enjoyable
  • Feeling anxious and tense
  • Being angry and irritable
  • Feeling totally out of control or wildly overwhelmed
  • Experiencing negative or even suicidal thoughts

Physical PMDD symptoms often include:

  • Joint and muscle pain
  • Breast tenderness
  • Being bloated
  • Headaches
  • Trouble sleeping or sleeping too much
  • Change in appetite and cravings

Does PMDD get worse over time?

For some women, the symptoms of PMDD — both physical and emotional — can steadily worsen over time until menopause. Some women even experience a sharp increase in symptoms as they reach peri-menopause.

Diagnosing Premenstrual Dysphoric Disorder

PMDD is diagnosed using the criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). According to this guide, a woman must experience five or more of the following premenstrual dysphoric disorder symptoms during most menstrual cycles over a year, and at least one symptom must be in the first four on the list. 

  • Depressed mood, feeling hopeless, having self-deprecating thoughts
  • Feeling tense or having extreme anxiety
  • Affective lability (having strong emotions)
  • Feeling constantly angry or irritable 
  • Loss of interest in normal activities
  • Trouble concentrating
  • Feeling lethargic
  • Change in appetite, food cravings, overeating
  • Insomnia or hypersomnia
  • Feeling overwhelmed or out of control
  • Physical symptoms like breast tenderness, joint pain, muscle pain, headaches, bloat, or weight gain

For a PMDD diagnosis, symptoms must be severe enough to hamper your ability to function well in school, at work, and/or in social situations or relationships. The symptoms also must not be explainable by any other mental or physical health condition, including clinical depression, anxiety disorder, or bipolar disorder. Comorbid PMDD refers to PMDD that appears alongside bipolar disorder.

PMDD is generally considered an endocrine disorder since it’s related to hormone levels. However, the DSM-5 lists PMDD as a mental health condition since women with PMDD experience a wide range of mental health symptoms like depression, anxiety, and in extreme cases, suicidal thoughts.

As part of the diagnostic process, a mental health professional or doctor will meet with you, interview you about your symptoms, and review medical history. 

What Causes Premenstrual Dysphoric Disorder?

The exact cause of PMDD isn’t fully understood. Many researchers believe it’s due to unusual or extreme sensitivity to hormonal changes in a woman’s body (levels of estrogen and progesterone). 

“While research is still emerging around the causes for PMDD, it’s important to note that genetics likely play a role. Tracking your symptoms over time will help you discuss them with your healthcare provider and help you plan your self care and medical strategies in advance.”

Talkspace therapist Jill E. Daino, LCSW-R

A woman is more likely to suffer from PMDD if her mother, sister, or another close relative also suffers or suffered from it. Other factors that may influence whether a woman develops PMDD or not can include smoking cigarettes and suffering physical or emotional trauma.

Treatment for Premenstrual Dysphoric Disorder

Treatment for premenstrual dysphoric disorder focuses on minimizing and/or eliminating symptoms. Usually, a woman’s doctor works with her mental health provider or team to devise a treatment plan. 

Medication

During PMDD, there’s a significant drop in serotonin levels. Take note that a regular birth control pill would not alleviate the symptoms of PMDD, but some contain Ethinyl estradiol and drospirenone, which can help with mood changes and other physical symptoms. While every woman’s plan will be unique, common treatments include prescribing medications like antidepressants, often selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Sarafem (fluoxetine) and Zoloft (sertraline). Research shows promising results after using SSRIs — between 60 and 75% of women with PMDD saw a drastic improvement in symptoms.

Other medications used to treat PMDD include oral contraceptives to help regulate hormones and anti-inflammatory medications for headaches and muscle and joint pain. In the US, only one contraceptive is approved by the FAA for treating PMDD. That is Yaz, a monthly pack that contains 24 tablets. This contraceptive has a shorter, pill-free period than other oral contraceptives.

Lifestyle changes 

Lifestyle changes can also sometimes be effective in easing the symptoms of PMDD. Things that can be helpful might include:

  • Avoiding foods that trigger PMDD symptoms, such as sugar, salt, chocolate, caffeine, and alcohol
  • Exercising daily (which releases serotonin naturally)
  • Eating a high-protein diet
  • Practicing stress management techniques like meditation, yoga, journaling for your mental health, and deep-breathing exercises

Therapy

Counseling can also be hugely beneficial in helping learn ways to improve communication skills and learn coping skills that can help navigate and manage severe PMDD symptoms. Cognitive behavioral therapy has also been explored, but so far, there’s not enough to suggest that it can actually help with PMDD specifically.

You don’t have to suffer from PMDD symptoms without help. Talk with your doctor or mental health professional about treatments for this often debilitating condition, so you can start feeling better and more in control of your life.

Talkspace is an online therapy platform that offers convenient and accessible therapy for women who want help with PMDD. Especially for the busy lifestyles most women today live, the convenience of getting therapy when and where you want can be a game-changing experience. Reach out to learn more about therapy for PMDD through Talkspace today.