What Is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a mood disorder that occurs during the premenstrual phase of the menstrual cycle. While similar to that of premenstrual syndrome (PMS), the symptoms of PMDD are much more severe and can lead to extreme mood changes that can disrupt daily life and functioning.

Here we talk more about the symptoms and causes of PMDD, and how it is diagnosed. We also discuss premenstrual dysphoric disorder treatments and self-care options which are helpful for managing this condition.

Causes of Premenstrual Dysphoric Disorder

The cause of PMDD is complex. According to research published in 2022, individuals with this condition appear to have a genetic sensitivity to the sex hormone allopregnanolone combined with the neurotransmitter serotonin being less available, and ovarian reproductive steroids may play a role as well.

Other evidence supports the role of reproductive steroids in PMDD. More specifically, a different study noted that PMDD may be related to alterations in the cellular responses involved in the metabolism of the reproductive steroids estrogen and progesterone.

One's environment can also have an impact on how PMDD appears. For example, research has shown that experiencing high levels of stress can increase the severity of this condition. 

Symptoms of Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder symptoms begin during the luteal phase, or after ovulation, and end shortly after menstruation starts. They include:

• Feelings of sadness, hopelessness, or depressed mood
• Increased anxiety
• Having a sense of overwhelm or loss of control
• Food cravings and overeating
• Irritability or anger that is directed toward others
• Lack of interest in activities
• Lack of energy and fatigue
• Physical symptoms, including breast tenderness, bloating, and joint or muscle pain
• Severe mood swings
• Sleep disturbances
  
• Trouble concentrating or thinking

Studies also indicate that women with PMDD have a four times greater risk of suicidal ideation and a seven times higher risk of attempting suicide. If suicidal thoughts or behaviors are present, seek immediate medical attention.

Diagnosis of Premenstrual Dysphoric Disorder

While PMS can have an impact on a woman's life and functioning, it is not a classified disorder. Conversely, premenstrual dysphoric disorder is classified as a mental disorder by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

The diagnosis of premenstrual dysphoric disorder usually begins with a healthcare provider taking a health history and doing a physical exam. To be diagnosed with PMDD, people must:

• Experience at least five symptoms across two domains, one involving mood and the other being physical symptoms
• Experience these symptoms during the premenstrual phase, with the symptoms mostly absent within the week following menses

These symptoms must also interfere with functioning in work, school, relationships, and other important life areas and not be related to an existing condition or caused by substance use. PMDD is generally confirmed by having patients track their symptoms over at least two menstrual cycles.

Treatment for Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder treatments are focused on minimizing and managing the symptoms of the condition. Some of the treatment options include:

• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), which have been shown to be effective in treating PMDD symptoms
• Oral contraceptives
• Lifestyle adaptations including changes in diet, exercise, and stress management techniques
• Medications to treat physical symptoms, including diuretics for fluid retention and anti-inflammatory drugs for pain
• Changes in menstrual products, particularly if these tend to cause discomfort or irritation

Cognitive-behavioral therapy (CBT) is another option for treating premenstrual dysphoric disorder. CBT may be used alone or in conjunction with other treatments and helps by improving PMDD symptoms.

Over-the-counter pain relievers might also be helpful for relieving physical symptoms such as joint pain, cramps, headaches, muscle aches, and breast tenderness. A healthcare provider can help determine what type of treatment is best based on the symptoms present and their severity.

Self-Care for Premenstrual Dysphoric Disorder

The mood changes and physical symptoms of PMDD can make it difficult to cope with daily life and manage relationships. A person with PMDD might feel irritable, depressed, and angry, which can lead to taking out those feelings on the people around them.

In addition to getting treatment from a medical professional, there are self-care steps that can be taken to help manage the symptoms of this condition. Premenstrual dysphoric disorder self-care can take the form of:

• Alternative, natural treatments. This includes meditation, regular exercise, and yoga. These can help by making it easier to manage stress. Such practices may also be helpful for coping with PMDD symptoms of anxiety and depression. 
• Herbal supplements. Use caution and talk to a physician before using any herbal remedies to alleviate PMDD symptoms. Some herbal supplements, such as St. John’s wort, can have adverse reactions when taken with other medications.
• Getting plenty of rest and eating a healthy diet. Avoiding high-salt foods may help prevent bloating and water retention. Minimizing sugar and simple carbohydrate consumption can prevent fluctuations in blood sugar levels. Focus on eating complex carbs, getting plenty of fiber and protein, and drinking enough fluids.

When to Seek Professional Help

Coping strategies can be helpful for easing PMDD symptoms, but a healthcare provider should be contacted if symptoms do not improve with self-treatment. They should also be consulted if symptoms interfere with daily functioning, mental well-being, or one's relationships or job.