Premenstrual Dsyphoric Disorder

Learning Objectives

  • Explain symptoms and treatments for premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is a health problem that is similar to premenstrual syndrome (PMS) but is more serious. Premenstrual dysphoric disorder (PMDD) causes severe irritability, depression, or anxiety in the week or two before your period starts. Symptoms usually go away two to three days after your period starts. Premenstrual dysphoric disorder (PMDD) causes a severe and disabling form of premenstrual syndrome affecting 1.8–5.8% of menstruating women. Anyone suffering from PMDD may need medicine or other treatment to help with your symptoms.

Symptoms of PMDD include the following:[1]

  • 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

Researchers do not know for sure what causes PMDD or premenstrual syndrome (PMS). Hormonal changes throughout the menstrual cycle may play a role. A brain chemical called serotonin may also play a role in PMDD since serotonin levels change throughout the menstrual cycle. Some women may be more sensitive to these changes.


Treatments for PMDD include the following:

  • Antidepressants called selective serotonin reuptake inhibitors (SSRIs) change serotonin levels in the brain. The FDA approved three SSRIs to treat PMDD:
    • Sertraline
    • Fluoxetine
    • Paroxetine HCI
  • The FDA has approved a birth control pill containing drospirenone (droh-SPIR-uh-nohn) and ethinyl estradiol (ETH-uh-nil es-truh-DEYE-ohl), to treat PMDD.
  • Over-the-counter pain relievers may help relieve physical symptoms, such as cramps, joint pain,
    A person doing yoga. They are in the warrior 2 pose.

    Figure 2. Yoga is a low impact, physical activity that can help you relax and release tension.

    headaches, backaches, and breast tenderness and include ibuprofen, naproxen, and aspirin.

  • Stress management, such as relaxation techniques and spending time on enjoyable activities, may help.
  • Making healthy changes, such as eating a healthy combination of foods across the food groups, cutting back on salty and sugary foods, and getting more physical activity, may also help relieve some PMDD symptoms.

When drug-based treatments are ineffective or produce significant side effects, then removing the ovaries through oophorectomy can produce an immediate and permanent cure. Typically, the uterus is removed during the same surgery, and the woman is prescribed a low-dose estrogen patch to reduce the symptoms produced by surgically induced menopause.

Key Takeaways: Premenstrual dysphoric disorder

Watch It

What’s the difference between premenstrual syndrome (PMS) and PMDD? Dr. Lita Landry explains the differences in this clip from The Doctors.

You can view the transcript for “Could Your PMS Actually Be PPMD?” here (opens in new window).

Try It


premenstrual dysphoric disorder (PMDD): a more serious form of PMS marked by severe irritability, depression, or anxiety in the week or two before your period starts

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: The American Psychiatric Association.