Premenstrual Dysphoric Disorder (PMDD)

In honor of Women’s History Month, we wanted to shed light on a condition that affects around 5-10% of women worldwide (around 31 million), premenstrual dysphoric disorder (PMDD). It is crucial to spread awareness for this condition because of the current stigma surrounding women’s health. Due to this, it can be difficult to get an accurate diagnosis which can invalidate those who experience PMDD. This can lead to an increase of mental health symptoms such as depression, anxiety and even increase risk of suicide. If you are struggling with PMDD, or are in crisis and don’t know where to start, call 988 to inquire about next steps or to be connected with mental health professionals or additional resources in your area. Just know you are not alone and your experience is valid. We see your struggle and we are here for you.

Q&A

What is PMDD?

PMDD was officially added to the Diagnostics and Statistical Manual of Mental Disorders (DSM) in 2013 and is classified as a depressive disorder. It is a severe form of PMS which can affect women physically and mentally. PMDD can last at least 1-2 weeks at the end of the menstrual cycle and symptoms tend to dissipate once your period comes or a few days after.

What causes PMDD?

The exact cause of PMDD is still being researched, but possible causes include a sensitivity to hormonal fluctuations, neurochemical imbalances, trauma, stress, genetics, and more. Co-occuring mental health such as anxiety, depression, ADHD, etc., and physical conditions can exacerbate symptoms as well such as thyroid or hormonal imbalances, autoimmune conditions, digestive problems such as IBS, and more.

What are common symptoms of PMDD?

Note that symptoms can vary from person to person, but below you can see what symptoms can contribute to a potential diagnosis.

According to the Office on Women’s Health (OASH) within the US Department of Health and Human Services (HHS) symptoms of PMDD include:

Lasting irritability or anger that may affect other people
Feelings of sadness or despair, or even thoughts of suicide
Feelings of tension or anxiety
Panic attacks
Mood swings or crying often
Lack of interest in daily activities and relationships
Trouble thinking or focusing
Tiredness or low energy
Food cravings or binge eating
Trouble sleeping
Feeling out of control
Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain

How is PMDD diagnosed?

In general, to diagnose PMDD the following criteria must be met:

Over the course of a year, during most menstrual cycles, you must have 5 or more symptoms (see symptoms above) that have been present during the week before your period and stop within a few days after your period starts. Symptoms must be severe and lead to significant distress. They must affect your ability to function in your daily life which can include social, work, school or other situations. Symptoms must exclude other medical or mental health conditions.

What should you know before acquiring a PMDD diagnosis?

Your provider (a OBGYN, psychiatrist, GP, etc) may ask that you keep a journal or diary of your symptoms for a few months. Note that some providers may try to rule out any other mental health conditions before diagnosing you with PMDD. Common conditions that can mimic PMDD can be depression, anxiety, bipolar 2, and more. To know whether you are receiving an accurate diagnosis, it may be helpful to find a second opinion. Due to its later addition to the DSM, the overlap between other physical or mental health conditions, it still is being researched, lack of public awareness, and or stigma it may be hard to get an official diagnosis. According to the National Institution of Health (NIH), It can take an average of 20 years for an accurate diagnosis, but well informed providers can help with a timely diagnosis.

What is the treatment for PMDD?

Your healthcare provider may prescribe certain medications to help you manage your symptoms of PMDD. These medications can include: antidepressants or hormonal birth control.
Your health care provider may recommend some dietary changes as well as supplements to take.
OTC pain medication for cramps and other aches and pains.
Regular exercise to improve your mood.
Stress management
therapy
Other lifestyle changes to improve overall well-being.

Overall if you resonate with any of these symptoms and it is interfering with your daily life we encourage you to speak to your medical provider. If you think it is something worth looking into further, try to see if you can get an accurate diagnosis from a medical professional. If they don’t diagnose you right away, try to be patient and know that your experience is still valid. If a provider overlooks your symptoms, try to get an additional opinion and support. You deserve to be seen, heard, and validated- always.