What is the definition of Premenstrual Dysphoric Disorder?

Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS).

PMS refers to a wide range of physical or emotional symptoms that most often occur about 5 to 11 days before a woman starts her monthly menstrual cycle. In most cases, the symptoms stop when, or shortly after, her period begins.

What are the alternative names for Premenstrual Dysphoric Disorder?

PMDD; Severe PMS; Menstrual disorder - dysphoric

What are the causes for Premenstrual Dysphoric Disorder?

The causes of PMS and PMDD have not been found.

Hormone changes that occur during a woman's menstrual cycle may play a role.

PMDD affects a small number of women during the years when they are having menstrual periods.

Many women with this condition have:

  • Anxiety
  • Severe depression
  • Seasonal affective disorder (SAD)

Other factors that may play a role include:

  • Alcohol or substance abuse
  • Thyroid disorders
  • Being overweight
  • Having a mother with a history of the disorder
  • Lack of exercise

What are the symptoms for Premenstrual Dysphoric Disorder?

The symptoms of PMDD are similar to those of PMS. However, they are very often more severe and debilitating. They also include at least one mood-related symptom. Symptoms occur during the week just before menstrual bleeding. They most often get better within a few days after the period starts.

Here is a list of common PMDD symptoms:

  • Lack of interest in daily activities and relationships
  • Fatigue or low energy
  • Sadness or hopelessness, possibly thoughts of suicide
  • Anxiety
  • Out of control feeling
  • Food cravings or binge eating
  • Mood swings with bouts of crying
  • Panic attacks
  • Irritability or anger that affects other people
  • Bloating, breast tenderness, headaches, and joint or muscle pain
  • Problems sleeping
  • Trouble concentrating

What are the current treatments for Premenstrual Dysphoric Disorder?

A healthy lifestyle is the first step to managing PMDD.

  • Eat healthy foods with whole grains, vegetables, fruit, and little or no salt, sugar, alcohol, and caffeine.
  • Get regular aerobic exercise throughout the month to reduce the severity of PMS symptoms.
  • If you have problems sleeping, try changing your sleep habits before taking medicines for insomnia.

Keep a diary or calendar to record:

  • The type of symptoms you are having
  • How severe they are
  • How long they last

Antidepressants may be helpful.

The first option is most often an antidepressant known as a selective serotonin-reuptake inhibitor (SSRI). You can take SSRIs in the second part of your cycle up until your period starts. You may also take it the whole month. Ask your provider.

Cognitive behavioral therapy (CBT) may be used either with or instead of antidepressants. During CBT, you have about 10 visits with a mental health professional over several weeks.

Other treatments that may help include:

  • Birth control pills typically help reduce PMS symptoms. Continuous dosing types are most effective, especially those that contain a hormone called drospirenone. With continuous dosing, you may not get a monthly period.
  • Diuretics may be useful for women who have significant short-term weight gain from fluid retention.
  • Other medicines (such as Depo-Lupron) suppress the ovaries and ovulation.
  • Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramps, and breast tenderness.

Most studies have shown that nutritional supplements, such as vitamin B6, calcium, and magnesium are not helpful in relieving symptoms.

What is the outlook (prognosis) for Premenstrual Dysphoric Disorder?

After proper diagnosis and treatment, most women with PMDD find that their symptoms go away or drop to tolerable levels.

What are the possible complications for Premenstrual Dysphoric Disorder?

PMDD symptoms may be severe enough to interfere with a woman's daily life. Women with depression may have worse symptoms during the second half of their cycle and may need changes in their medicine.

Some women with PMDD have suicidal thoughts. Suicide in women with depression is more likely to occur during the second half of their menstrual cycle.

PMDD may be associated with eating disorders and smoking.

When should I contact a medical professional for Premenstrual Dysphoric Disorder?

Call 911 or a local crisis line right away if you are having thoughts of suicide.

Call your provider if:

  • Symptoms DO NOT improve with self-treatment
    Symptoms DO NOT improve with self-treatment
  • Symptoms interfere with your daily life
    Symptoms interfere with your daily life
Depression

REFERENCES

Gambone JC. Menstrual cycle-influenced disorders. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 36.

Mendiratta V, Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 37.

Novac A. Mood disorders: depression, bipolar disease, and mood dysregulation. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier; 2018:755-765.

  • Condition: Premenstrual Dysphoric Disorder
  • Journal: The American journal of psychiatry
  • Treatment Used: Ulipristal Acetate
  • Number of Patients: 95
  • Published —
This study investigated the use of ulipristal acetate (UPA)as a treatment for premenstrual dysphoric disorder (PMDD).
  • Condition: Premenstrual Syndrome (PMS)
  • Journal: Journal of alternative and complementary medicine (New York, N.Y.)
  • Treatment Used: Vitamin B6 vs Broad-Spectrum Micronutrients
  • Number of Patients: 78
  • Published —
This study compared the effectiveness of vitamin B6 versus broad-spectrum micronutrients (vitamins and minerals) in patients with premenstrual syndrome (physical and emotional symptoms that occur in the one to two weeks before a woman's period; PMS).