While the week before a period starts can be emotionally and physically challenging for many people, for others, premenstrual symptoms can be so debilitating that they affect their ability to handle day-to-day responsibilities.
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) marked by intense physical and emotional symptoms. The condition requires long-term treatment to manage symptoms.
Keep reading to learn about PMDD symptoms so you can identify the patterns in your own cycle and take the next steps towards diagnosis and treatment.
What is PMDD?
PMDD is a severe mood disorder characterized by emotional, behavioral, and physical symptoms during a menstrual cycle.
“Premenstrual dysphoric disorder consists of heightened sensitivities to normal fluctuations that occur during the menstrual cycle,” says Brianna Dawson, NP, CRNP, a board-certified psychiatric nurse practitioner and owner of Behavioral Wellness for Women. “The fluctuations in estrogen and progesterone levels throughout the menstrual cycle can lead to mood instability, causing irritability, anxiety, appetite, and sleep changes.”
According to Kecia Gaither, MD, a double-board-certified physician in OB/GYN and maternal-fetal medicine and Director of Perinatal Services at NYC Health + Hospitals/Lincoln, PMDD symptoms occur during the luteal phase, which is the time between ovulation and the start of menstruation.
While the symptoms of PMS and PMDD are similar, PMDD is more severe and can interfere with your work, school, relationships, and overall well-being due to the heightened emotional and physical symptoms.
Core PMDD Symptoms: What to Look For
PMDD symptoms are categorized into three main areas: emotional/mood, physical, and cognitive/behavioral.
Emotional and Mood Symptoms
- Severe depression: People with PMDD may experience persistent feelings of hopelessness or emptiness and self-deprecating thoughts.
- Intense anxiety: Feelings of tension or being “on edge” can indicate PMDD anxiety.
- Mood swings: Sudden changes in your emotional state, with shifts from happiness to sadness, anxiety, or irritability, are signs of PMDD mood swings.
- Irritability and anger: PMDD can cause severe irritability and bouts of anger, which can ultimately increase interpersonal conflicts.
- Feelings of overwhelm or being out of control
Physical Symptoms
- Fatigue: Significant tiredness or lack of energy can be a symptom of PMDD fatigue.
- Sleep disturbances: PMDD is known to cause sleep problems like insomnia or hypersomnia.
- Pain: People with PMDD may experience joint or muscle pain.
- Changes in appetite: The condition can lead to overeating or a specific craving for certain types of food.
- Bloating, headaches, and breast tenderness or swelling
Cognitive and Behavioral Symptoms
- Brain fog: PMDD may cause difficulty concentrating or focusing, forgetfulness, confusion, or inability to find the right words.
- Withdrawal from usual activities: Loss of interest in work, school, hobbies, or social activities is a sign of withdrawal in PMDD.
- Feeling overwhelmed by everyday tasks
Key Characteristics of PMDD Symptoms
Dr. Gaither says that PMDD symptoms typically start in the last one to two weeks of your menstrual cycle in the luteal phase. “Symptoms usually begin after ovulation and resolve within a few days after menstruation occurs,” she explains.
Dawson adds that symptoms of PMDD can significantly interfere with a person’s daily functioning, such as work, school, social activities, and relationships, which is why it requires medical treatment.
The disruption caused by PMDD symptoms can cause a lot of emotional distress. People with PMDD can experience hopelessness, extreme irritability, anxiety, and even suicidal thoughts, making it a serious medical condition that requires treatment.
How PMDD Symptoms Differ from PMS Symptoms
PMS and PMDD both occur before the days of your period, but have different impacts on your physical and mental well-being.
Here’s a look at the differences between PMS and PMDD symptoms:
| Feature | PMS | PMDD |
| Intensity | Mild to moderate | Severe and debilitating |
| Mood swings | Present but manageable | Intense and unpredictable |
| Sadness and depression | May feel a bit down or emotional | Marked depression, feelings of hopelessness, or self-deprecating thoughts |
| Irritability and anger | Mild irritability | Severe irritability or anger, often leading to social withdrawal or interpersonal conflict |
| Anxiety | Mild nervousness or worry | Persistent and overwhelming anxiety and tension |
| Emotional impact | Symptoms are mild but don’t cause significant impairment | Causes severe emotional distress and cognitive impairment |
| Physical symptoms | Bloating, tiredness, breast tenderness, mild cramping | Similar symptoms, but more intense and more challenging to manage |
| Impact on day-to-day life | Rarely affects work, school, activities, or relationships | Significant interference with daily activities and relationships |
| Mood symptom requirement | Not required for diagnosis | At least one severe mood-related symptom (e.g., depression, anger, or anxiety) is required |
Diagnosing PMDD Based on Symptoms
A diagnosis for PMDD requires tracking your symptoms over at least two menstrual cycles. A PMDD diagnosis requires the presence of at least five or more specific symptoms during your menstrual cycle, with at least one severe mood symptom.
According to the DSM-5, the PMDD diagnosis criteria can include the following symptoms:
- Depressed mood, hopelessness, or self-deprecating thoughts
- Anxiety, tension, or feeling “on the edge”
- Increased or persistent anger, irritability, or interpersonal conflicts
- Decreased interest or pleasure in daily activities
- Lethargy
- Changes in appetite
- Insomnia or hypersomnia
- Feelings of being overwhelmed or out of control
- Physical symptoms, such as breast tenderness or swelling, muscle or joint pain, bloating, or weight gain
Many PMDD symptoms are similar to other conditions, which is why it’s crucial to rule out other possible causes. Make sure you’re examined for different conditions, such as depression, anxiety, or thyroid disorders, to ensure your symptoms aren’t an exacerbation of them.
When to Seek Medical Help for Your Symptoms
If you’re experiencing PMDD symptoms that are impairing your daily life, please consult a healthcare provider. They can confirm whether you’re experiencing PMDD or a similar condition and recommend effective treatment options.
Getting a proper diagnosis can not only confirm PMDD but also rule out other conditions and get relief.
It’s also important to note that PMDD increases the risk of suicidal thoughts. “Women who experience PMDD are at increased risk of suicidal thoughts and behavior and should therefore receive treatment as soon as possible, as their symptoms can impact their quality of life and functioning,” Dawson says.
Managing PMDD Symptoms
If you suspect you have PMDD, know that you’re not alone and treatment is available. PMDD symptoms are manageable through the following treatments and lifestyle adjustments:
- A diet with increased protein and carbohydrates
- Regular exercise
- Stress management techniques, such as meditation
- Vitamin supplements, such as vitamin B6, calcium, and magnesium
- Anti-inflammatory medications
- Selective serotonin reuptake inhibitors (SSRIs) for depression and anxiety
- Hormonal therapy, such as birth control pills
Conclusion
PMDD is a severe form of PMS characterized by intense emotional, physical, and behavioral symptoms that can affect your day-to-day life. Understanding the symptoms is the first step towards a proper diagnosis and treatment.
If you have PMDD, know that you’re not alone and don’t have to continue suffering—there’s help available. Start tracking your symptoms and consult with a healthcare provider to confirm if you have the disorder.
FAQs
Is PMDD just bad PMS?
While PMS and PMDD share similar symptoms, PMDD is much more severe and includes debilitating mood-related symptoms that can disrupt daily life.
What causes PMDD symptoms?
PMDD is believed to be caused by extreme sensitivity to hormonal changes after ovulation, which may impact neurotransmitters like serotonin that regulate mood. Some theories suggest a combination of hormone sensitivities and chemical imbalances in the brain causes PMDD.
Can PMDD symptoms change over time?
PMDD symptoms can shift in intensity as you age, especially during significant hormonal changes like pregnancy or perimenopause.
Are PMDD symptoms considered a mental illness?
PMDD is a hormone-related mood disorder. While it involves mental health symptoms, it is not considered a mental health disorder.