Premenstrual dysphoric disorder (PMDD) refers to a group of emotional and physical symptoms that starts a week or two before your period.

PMDD is similar to premenstrual syndrome (PMS), but its symptoms, especially the emotional ones, are more severe.

If you tend to have to have severe PMS symptoms that interrupt your daily life, you may have PMDD. Read on to learn more about its symptoms and how it’s treated.

Typically, PMDD symptoms start within 7 to 10 days of the start of your period, though they may start a little earlier or later.

Similar to PMS, PMDD has both emotional and physical symptoms. But you may have more emotional symptoms than physical ones, or vice versa.

Emotional symptoms of PMDD can include:

  • agitation or nervousness
  • anger
  • crying spells
  • feeling out of control
  • forgetfulness
  • loss of interest in activities and relationships
  • irritability
  • moodiness
  • panic attacks
  • paranoia
  • sadness
  • thoughts of suicide

Physical symptoms of PMDD can include:

  • acne
  • back pain
  • bloating
  • breast swelling and tenderness
  • gastrointestinal issues, including constipation, diarrhea, nausea, or vomiting
  • cramps
  • dizziness
  • headache
  • heart palpitations
  • appetite changes
  • joint or muscle pain
  • muscle spasms
  • painful periods
  • reduced sex drive

These symptoms, especially the emotional ones, can take a big toll on your daily life, getting in the way of work, school, or relationships. They tend to go away on their own once your period starts, only to return after the next time you ovulate.

Experts are still trying to figure out the underlying cause of PMDD. But most believe it’s a response to the changing hormone levels that occur during your cycle.

Throughout your cycle, your body goes through a natural rise and fall in its levels of the hormones estrogen and progesterone. This can have an effect on your levels of serotonin, a neurotransmitter that plays a big role in your mood.

People with PMDD might also simply be more sensitive to these hormonal fluctuations.

In 2017, researchers at the discovered that people with PMDD have genetic changes that make their cells overreact to estrogen and progesterone. They believe this overreaction may be responsible for PMDD symptoms.

There’s no specific test that doctors can use to diagnose PMDD. Instead, your doctor will likely start by doing a physical exam and ordering some basic blood tests.

This can help to rule out other potential causes of your symptoms, such as:

  • chronic fatigue syndrome
  • endometriosis
  • fibroids
  • fibromyalgia
  • hormone problems
  • major depression
  • migraine disorder
  • menopause
  • panic disorder

Make a note of when your symptoms tend to appear and disappear. Be sure to give this information to your doctor.

To make things easy, considering use a period-tracking app if you don’t already. Look for one that allows you to add your own symptoms you’d like to track. You can also print out a chart to track your symptoms.

After a few months of tracking your symptoms, you’ll be able to see how they change throughout your cycle and impact your daily life. This can be extremely helpful for ruling out other conditions.

Make sure to tell your doctor about any mental health conditions you’ve experienced in the past. For some, hormonal changes before their period can make preexisting symptoms worse.

Diagnostic criteria

Generally, your doctor will consider a PMDD diagnosis if you experience at least five of the following symptoms starting seven to ten days before your period:

  • mood swings
  • marked irritability or anger
  • depressed mood
  • feelings of hopelessness
  • anxiety or tension
  • reduced interest in friends, work, and other activities
  • trouble concentrating
  • fatigue, lack of energy
  • appetite changes
  • trouble sleeping or sleeping too much
  • feeling out of control
  • physical symptoms, such as bloating, breast tenderness, joint or muscle pain, and headache

Speak up!

  • PMDD can have a major impact on your daily life. If you feel like your doctor isn’t listening to your concerns or taking your symptoms seriously, you can always seek out a second opinion from another doctor.
  • The International Association for Premenstrual Disorders (IAPMD) has an international database that can help you find a doctor in your area who’s familiar with diagnosing and treating PMDD.

There’s no single treatment for PMDD, but several things can help keep your symptoms in check. You may have to try a few different approaches before you find what works best for you.

Lifestyle changes

For some, making a few adjustments to daily habits can have a big effect on PMDD symptoms.

These include:

  • Getting frequent exercise. This doesn’t have to be an intense workout in a gym. Taking a quick 30-minute walk around your neighborhood everyday can help to boost your mood.
  • Keeping your stress in check. It’s hard to avoid stress completely, but try to stay on top of your main stressors. This might include reaching out to a co-worker for help, taking up a relaxation technique, such as yoga or meditation, or investing in a good day planner.
  • Indulging in moderation. Try to cut back on sweets and snacks that are high in sodium. You might also find some relief by limiting your consumption of caffeine and alcohol.
  • Eating for your mood. Aim for foods containing lean protein and complex carbohydrates. Think fish, nuts, chicken, and whole grains. These types of food can increase your levels of tryptophan, a chemical that your body uses to make serotonin. Remember, hormonal changes can cause a dip in your serotonin levels.

Keep in mind that these changes can take a few weeks before they start having a significant impact on your symptoms. Don’t be discouraged if you don’t notice immediate results.

Read more about natural remedies for PMDD.

Therapy

Working with a therapist can help you navigate the emotional challenges that come with PMDD. A specific type of therapy called cognitive behavioral therapy (CBT) can be particularly helpful.

This approach helps you to develop new behaviors and thought patterns to help you better navigate difficult situations. Using CBT, a therapist can help you develop new tools to use when your mood starts to plummet before your period.

Worried about the cost? Check out these therapy options for every budget.

What about medication?

If other treatments aren’t offering any relief, your doctor may recommend medication to help with your symptoms.

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, are the main drug treatment for both the emotional and physical symptoms of PMDD. They work by increasing serotonin levels in the brain.

SSRIs used to treat PMDD include:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac, Sarafem)
  • paroxetine (Paxil, Pexeva)
  • sertraline (Zoloft)

Other antidepressants sometimes used to treat PMDD include:

  • buspirone
  • duloxetine (Cymbalta)
  • venlafaxine (Effexor)

Some find that taking the same dose every day helps, while others increase their dose during the week or two leading up to their period. Your doctor will work with you to find a medication and dosage that offers the most benefit with the fewest side effects.

Hormonal medications

PMDD symptoms tend to start once you ovulate. Hormonal medications, including birth control pills, that prevent you from ovulation may help you avoid PMDD symptoms altogether.

Birth control pills

For some, hormonal birth control pills help to reduce PMDD symptoms. But for others, they only make symptoms worse.

Yaz is currently the only birth control pill that’s approved by the Food and Drug Administration for the treatment of PMDD. But doctors can still prescribe other birth control pills for PMDD. This is what’s known as an off-label use of a medication.

Most birth control pills come with 21 active pills, followed by a week of placebo pills that only contain sugar. If you’re taking birth control pills for PMDD, your doctor might advise you to take an active pill every day. This will prevent you from having a period.

Birth control pills may not be a safe option if you’re over the age of 25 or if you smoke.

Gonadotropin-releasing hormone (GnRH) agonists

GnRH agonists, such as leuprolide, stop your ovaries from producing estrogen and progesterone.

While this can be a huge help for PMDD symptoms, it also temporarily puts you into menopause, which can cause its own PMDD-like symptoms, including:

  • depression
  • anxiety
  • trouble concentrating

Your doctor can give you low doses of estrogen and progesterone to help prevent these side effects. But even low doses of these may trigger PMDD symptoms.

Living with PMDD can feel overwhelming at times and have a significant impact on your daily life. But awareness about premenstrual disorders is growing. And in response, new resources are popping up that can help you connect with others and learn more about the condition.

  • In addition to the provider directory mentioned earlier, IAPMD offers a range of other resources as well. These include symptom tracking sheets, informational pamphlets you can share with loved ones, online support group listings, and more.
  • Me v PMDD is a free app that lets you track both your symptoms and treatments. The company also has a blog that frequently shares stories from real people living with PMDD.

Suicide prevention

  • If you think someone is at immediate risk of self-harm or hurting another person:
  • •  Call 911 or your local emergency number.
  • •  Stay with the person until help arrives.
  • •  Remove any guns, knives, medications, or other things that may cause harm.
  • •  Listen, but don’t judge, argue, threaten, or yell.
  • If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

PMDD tends to resolve on its own once you hit menopause and stop menstruating. You might also find that your symptoms evolve over time, sometimes for the better.

Tracking your symptoms can help you get a better idea of how your symptoms change over time and which treatments work best.

Remember, you may need to try several treatments before you find what works for you. This can be a frustrating process, so don’t hesitate to reach out to others either online or in your community.

Whether it’s to vent your frustrations or talk about a potential treatment option, connecting with others can help make the process a little easier.