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Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a serious form of premenstrual syndrome (PMS). Both conditions trigger physical and emotional symptoms linked with the hormonal changes that happen before your period (the luteal phase). 

PMDD vs. PMS: What’s the difference?

Premenstrual dysphoric disorder and premenstrual syndrome are similar, but PMDD is more intense. PMS is more common and causes mild discomfort. PMDD is less common and has much more intense symptoms.

PMDD can cause strong emotional and physical symptoms that interfere with your mood, body, daily life, relationships and mental health. It can cause extreme mood shifts, including sudden sadness and anger. PMDD symptoms typically begin seven to 10 days before your period and improve after your period starts. It is considered a serious health condition.

If PMS doesn’t fully explain how awful you feel before your period, you could have premenstrual dysphoric disorder. PMDD is real and more common than many people think. It can last for a long time without the right treatment.

What are common PMDD symptoms?

PMDD affects both your body and your mind. It makes everyday life harder. Symptoms show up in the days before your period and usually improve a few days after it starts.

Emotional symptoms may include:

  • Mood swings: Sudden changes in emotion that you feel like you can’t control
  • Depression and anxiety: Feeling sad, worried or overwhelmed
  • Irritability or anger: Feeling easily frustrated or having sudden bursts of anger
  • Trouble focusing: Difficulty paying attention or making decisions
  • Feeling overwhelmed: Having a sense of panic or hopelessness, sometimes leading to panic attacks
  • Sensitivity to rejection: Feeling deeply hurt or upset by small things

Physical symptoms may include:

  • Food cravings: A strong desire for certain foods, often carbs or sweets
  • Breast tenderness: Pain, swelling or sensitivity in your breasts
  • Headaches or joint pain: Aches that happen before your period
  • Bloating or weight gain: Feeling swollen or gaining weight temporarily
  • Trouble sleeping: Sleeping too much or struggling to fall asleep
  • Fatigue: Feeling exhausted even after you rest

If these symptoms happen every month before your period and make life hard, you may have PMDD.

Symptoms can vary with age, hormone shifts and life events. You might notice changes in your symptoms after pregnancy, menopause or stressful situations.

What causes PMDD?

PMDD happens because of hormone shifts that affect brain chemicals, especially one called serotonin. Serotonin helps control your mood and its levels can drop before your period, making PMDD symptoms worse. Some people are more sensitive to hormone changes, which increases their risk. 

You may also be more likely to have PMDD if you:

  • Smoke
  • Are under a lot of stress
  • Have other mood disorders
  • Have family members with PMDD

PMDD is not just your emotions, it’s not your fault and it’s not something you’re making up. It’s a real, treatable condition that affects up to one in 20 women.

You don’t have to push through PMDD on your own. It’s important to get care, because untreated PMDD may lead to severe depression or suicidal thoughts.

How is PMDD diagnosed?

If you think you might have premenstrual dysphoric disorder, talk to a health care provider. Many people struggle for years before realizing their symptoms go beyond PMS. PMDD can feel overwhelming but treatment can help. 

There’s no single test for PMDD. It can help to track your symptoms for two to three cycles and share this information with your provider. They can look for patterns in your mood and your physical symptoms before and after your period to make a diagnosis.

Keep a record of how you feel before, during and after your period:

  • Mood changes: Track your emotional shifts each month
  • Physical symptoms: Note bloating, food cravings or breast tenderness
  • Menstrual cycle patterns: Write down when your period starts and ends

Your provider can evaluate your symptoms and the impact they are having on your life. They can make sure you don’t have another mood disorder, like anxiety or depression. They can also evaluate whether you have PMDD in addition to another mood disorder.

How is PMDD treated?

PMDD is treatable. You have options and you can try different ones to see what works best for you.

Treatment focuses on managing mood swings, reducing physical symptoms and improving mental health. Your provider will partner with you to find a treatment plan that works for your body, your lifestyle and your goals.

Treatment may include:

  • Lifestyle changes: Getting restorative sleep and regular exercise and eating a balanced diet can make a big difference in the severity of your symptoms. 
  • Nutritional support: You may need more calcium, magnesium or vitamin B6.
  • Birth control pills: Medication can help balance hormone fluctuations before your period.
  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and other antidepressants can treat depression and anxiety related to PMDD and reduce emotional symptoms, food cravings and fatigue. 
  • Therapy: Talking to a mental health provider can help you manage emotional symptoms and create coping strategies.
  • Nutritional support: Supplements like calcium, magnesium and vitamin B6 may improve symptoms.
  • Herbal remedies: Chasteberry may help with mood swings, breast tenderness and cravings, but more research is needed.

Some treatments, like birth control pills, take time to work. Antidepressants may help within one cycle if you take them at the right time.

When should you talk to a health care provider about PMDD?

If PMDD symptoms are making your life difficult, it’s important to seek support so you can find relief. Talk to your provider if:

  • Symptoms affect work, school or relationships
  • You dread the days before your period each month
  • You’ve ever wondered, “Is this more than PMS?”
  • You have extreme mood swings or thoughts of self-harm

Living with PMDD can feel overwhelming. But with the right support, it can get better. You deserve to feel good in your body and your mind.

At Banner Health, our compassionate team of women’s health specialists understands the impact PMDD can have on your life. We offer a range of treatments to help keep monthly symptoms from affecting your mental health or daily life. Connect with an expert at Banner Health for the care you need.