Table of Contents

What Is Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). The severity of the symptoms is more extreme in PMDD, which may cause disruption to daily life, influencing an individual’s ability to work and maintain healthy relationships. This disorder manifests in physical (breast tenderness, fatigue, bloating, headaches) and emotional ways (mood swings, irritability, anxiety, depression). For most women, PMS symptoms are manageable, but PMDD is not.

While exact causes are unclear to experts, low levels of hormones are believed to be a leading cause. Decreasing levels of estrogen and progesterone after ovulation and before menstruation may trigger PMDD. Low levels of serotonin may exacerbate the premenstrual dysphoric disorder symptoms. Because of the close relationship between menstruation and PMDD, this disorder often goes misdiagnosed or undiagnosed. This cyclical mood disorder is frequently confused with bipolar or borderline personality disorder.

With help from a professional, PMDD is treatable through medication, therapy, and lifestyle changes.

Premenstrual Dysphoric Disorder (PMDD) Diagnosis

Although there is no single PMDD diagnosis test, medical professionals will typically conduct a mixture of physical examinations and mood tracking.

Symptoms must only occur in the luteal phase of the menstrual cycle (1-2 weeks before menstruation) and end within 4 days after bleeding begins. If symptoms are present at other stages of a woman’s menstrual cycle, another cause is likely.

As people may have PMDD alongside other mental health conditions, establishing cause and effect can be difficult. People with chronic depression or anxiety may also experience worsened conditions during the premenstrual period.

Diagnostic Criteria

For a diagnosis, at least 5 of the following 11 symptoms outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) should be present during the premenstrual (luteal phase) period.

  1. Noticeably depressed mood, hopeless feelings, or self-deprecating thoughts
  2. Considerable anxiety, tension, feelings of being “keyed up” or “on edge”
  3. Marked affective lability
  4. Persistent and striking anger or irritability or increased interpersonal conflicts
  5. Reduced interest in daily activities (e.g., work, school, friends, and hobbies)
  6. Difficulty concentrating
  7. Lethargy, fatigue, or lack of energy
  8. Clear change in appetite, overeating, or specific food cravings
  9. Hypersomnia or insomnia
  10. Overwhelm or feeling out of control
  11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, bloating, or weight gain

If you experience PMDD symptoms and would like to be evaluated, find a LifeStance mental health clinic near you to schedule an initial consultation.

Online Questionnaire

Although an online questionnaire cannot replace the advice offered by medical professionals, taking an anonymous PMDD test online can help you understand your symptoms. The International Association for Premenstrual Disorders (IAPMD) offers a free screening tool that helps you assess whether you are suffering from PMS or PMDD.

Daily Mood Diary

To assess the relationship between your menstrual cycle and mood changes, your medical provider may ask you to keep a journal or log to record your symptoms. The Calendar of Premenstrual Experiences (COPE) is a standardized PMDD test that requires you to log 22 different symptoms of PMDD for each day of your cycle, supporting your doctor in an accurate diagnosis. Clinicians may request results for 2 complete menstrual cycles.

Physical Examination

Healthcare providers will conduct blood tests to eliminate other health conditions that may be provoking the symptoms, such as hormone levels, anemia, or thyroid problems. Because PMDD is a mood disorder, it cannot be diagnosed by physical examination alone, but a blood count will ensure the individual is otherwise healthy.

PMDD Treatment Options

PMDD can be treated in multiple ways, and a combination of several types is the most successful. Although PMDD has no permanent cure, treatment options will provide support for symptom management.

Medication

PMDD medications are frequently prescribed to mute the intense symptoms of PMDD. Typically, these include antidepressants (SSRIs), hormonal birth control medication, and over-the-counter pain medication.

Therapy and Counseling

Cognitive-behavioral therapy has been proven successful for some people with PMDD, providing coping mechanisms and mood management techniques. Your provider may refer you to a different type of therapy based on individual experiences and symptoms. LifeStance offers different types of therapy that can help treat PMDD. Find a provider near you to schedule an initial consultation.

Lifestyle Changes

Conservative therapies and natural remedies may be recommended first, as they have limited side effects. Prescription medication will be offered if symptoms persist after increased exercise, improved diet, and vitamins.

Surgical Options

In some cases, individuals with severe PMDD symptoms who have not responded well to other treatments may consider surgical interventions.

One such option is the removal of the ovaries (oophorectomy). This procedure eliminates the main source of hormone production in the body, which can alleviate PMDD symptoms. However, oophorectomy is a drastic measure and is usually considered as a last resort due to its irreversible nature and potential long-term consequences, such as early menopause.

If you’re looking for a therapist or a psychiatrist who specializes in Premenstrual Dysphoric Disorder, select “Women’s Issues” in the Treatment Areas drop-down box in our mental health care provider directory.

Common PMDD Medications

Antidepressants

A clinician may prescribe selective serotonin reuptake inhibitors (SSRIs) to ease the depression that often accompanies PMDD. Particularly, these medications are offered if the individual experiences persistent depressive symptoms. Antidepressants that slow the reuptake of serotonin are effective for many women with PMDD. Usually, the first choice is one of the selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), or fluoxetine (Prozac). Another option is the serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor).

Pain and Anti-Inflammatory Medication

Self-medicating with over-the-counter pain and anti-inflammatory medication will help with many physical symptoms of PMDD, such as headaches, muscle discomfort, and breast swelling.

Gonadotropin-Releasing Hormone (GnRH) Agonists

GnRH agonists, such as leuprolide (Lupron), are medications that suppress the production of estrogen and progesterone, leading to a temporary menopause-like state. They are sometimes used in severe cases of PMDD when other treatments have not been effective. However, they are typically used for short-term relief due to the potential for side effects associated with hormonal changes.

Hormonal Birth Control

As the oral combination hormonal birth control pill stops the period, many people who menstruate cite eased symptoms of PMDD. Evidence is unclear, however, as some people experience worsened symptoms while on the pill.  One type of hormonal birth control, called Yaz, has been approved by the FDA to treat PMDD. It contains a hormone, drospirenone, that helps treat symptoms in people with PMDD, according to studies.

If you’re looking for a psychiatrist who specializes in Premenstrual Dysphoric Disorder medication management, select “Women’s Issues” in the Treatment Areas drop-down box in our psychiatrist directory.

LifeStance Health is a national leader in mental, behavioral, and emotional wellness with multiple locations in 33 states. Services vary by location.

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Who Can Treat PMDD?

PMDD can be treated by various healthcare professionals. Your primary care physician (PCP) or gynecologist can be a good starting point for evaluating and diagnosing PMDD. They can provide initial assessments, discuss treatment options, prescribe medications, but most likely will refer you to a mental health care provider.

While PMDD is classified as a mental health disorder, it is important to recognize that it has a biological basis, as it is thought to be related to hormonal fluctuations during the menstrual cycle. Reproductive endocrinologists can help evaluate hormonal imbalances and may provide treatment options such as hormonal therapies or assist with the management of PMDD symptoms alongside reproductive health concerns.

Psychiatrists, Nurse Practitioners (NPs), or Physician Assistants (PAs) can assess PMDD symptoms, provide a diagnosis, and prescribe appropriate medications such as SSRIs or SNRIs. They may also recommend  psychotherapy or counseling provided by Psychologists and Therapists. They may employ approaches such as cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), or mindfulness-based techniques.

LifeStance is your online resource for finding the right mental health professionals to deal with PMDD, and other related women mental health issues. Find a mental health care clinic near you or search our directory of psychiatrists, therapists and psychologists by applying the “Women’s Issues” filter in the drop-down “Treatment Areas” box.

Types of Therapy for PMDD

Cognitive Behavioral Therapy (CBT)

CBT is the most common form of talk therapy on offer for people with PMDD. The counseling may improve sleep, anxiety, and depression while easing other PMDD symptoms. As this form of therapy alters unhealthy thoughts, it may help people manage their symptoms internally. It teaches essential skills to deal with anxiety, depression, and stress, helping those who menstruate manage the physical and emotional symptoms of PMS and PMDD.

Mindfulness-Based Cognitive Therapy (MBCT)

MBCT focuses on increasing awareness and acceptance of negative thoughts, feelings, and sensations, helping people accept their symptoms. It incorporates techniques like yoga, meditation, and deep breathing into treatment. As this type of therapy naturally combines elements of healthy lifestyle change, it can be especially helpful for many people.

Dialectical Behavior Therapy (DBT)

DBT combines elements of CBT with mindfulness practices. It can be helpful for individuals with PMDD who experience intense mood swings, emotional dysregulation, or self-destructive behaviors. DBT focuses on increasing emotional awareness, developing coping skills, and enhancing distress tolerance.

If you are looking for a therapist to treat PMDD, browse our therapist directory and apply the “Women’s Issues” filter in the “Treatment Areas” drop down box.

Lifestyle Changes to Support PMDD Treatment

Exercise

Exercising regularly has shown to improve mood by reducing anxiety and stress. The boost in endorphins often felt from cardiovascular exercise may reduce pain felt during PMS or PMDD. Medical professionals often encourage exercise as the first point in attempting to help people manage their symptoms.

Vitamins

Research into the success of vitamins in treating symptoms of PMDD is limited, but these may help manage symptoms naturally.

  • Calcium – can ease the physical and emotional symptoms of PMDD.
  • Magnesium – is used to ease breast soreness and bloating.
  • Vitamin E – may reduce prostaglandins (known to cause pain) in the body.
  • Vitamin B-6 – can reduce fatigue, irritability, and insomnia.

Herbal Supplements

Many people report herbal supplements as an effective treatment for PMDD symptoms, although supporting scientific research is limited. In some cases, herbal supplements may interfere with medical prescriptions—always check with your doctor before starting any additional treatment. Popular herbal supplements include:

  • John’s Wort – this depression-reducing natural remedy may ease the anxiety, depression, and irritability associated with PMDD.
  • Chasteberry – take this natural remedy to minimize breast swelling and pain.
  • Evening Primrose Oil – studies show that evening primrose oil may ease the digestive issues and mood swings associated with PMDD.

Diet

Cutting back on caffeine and unhealthy or processed foods may reduce the symptoms associated with PMDD. Dieticians suggest limiting the intake of excess sugar and salt and increasing the amount of vitamin-rich foods in a person’s diet.

photo of LifeStance provider Nicholette Leanza, LPCC-S

Clinically Reviewed By:

Nicholette Leanza, LPCC-S
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Nicholette is a faculty member at John Carroll University’s Clinical Counseling program, and she is also the host of the LifeStance podcast, Convos from the Couch.