Premenstrual Dysphoric Disorder

What is Premenstrual Dysphoric Disorder?

Premenstrual Dysphoric Disorder also referred to as PMDD is a severe form of premenstrual syndrome (PMS) that affects 3 to 8% of menstruating women and may be triggered by environmental stress and hormonal changes during the menstrual cycle.

The symptoms of PMDD are like those of PMS but may be so severe that they interfere with relationships, work, or social activities.  Research has shown a link between PMDD and low levels of serotonin.  PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders V in 2013.

Substance abuse, being overweight, thyroid disorders, lack of physical activity, and a mother who has also had PMDD can all be possible causes of PMDD.  Correct diagnosis of the condition requires thyroid testing, psychiatric evaluation, and a physical exam.

What are the Symptoms of Premenstrual Dysphoric Disorder?

Usually begin five to eleven days before a woman starts her monthly period and may include fatigue or low energy, mood swings, irritability, problems concentrating, panic attacks, appetite changes, little interest in day to day activities and relationships, difficulty sleeping, bloating, breast tenderness, feeling overwhelmed, and joint or muscle pain.

Premenstrual Dysphoric Disorder Causes

Premenstrual dysphoric disorder (PMDD) doesn’t appear to have one specific cause, but it’s thought that a combination of hormone and psychological factors play a role.

Levels of estrogen and progesterone naturally fluctuate throughout our menstrual cycle, and they fluctuate particularly dramatically in the days leading up to menstruation. This can cause a wide range of physical and psychological symptoms known as premenstrual syndrome (PMS). It is thought that hormones could also affect serotonin, which is a chemical in the brain responsible for regulating mood. This explains the low moods and mood swings which tend to occur with PMS.

Some women, however, experience these symptoms much more severely than others, and this is known as PMDD. It isn’t clear why some women experience these severe symptoms when most others do not, but it is known that many women with PMDD also have anxiety, severe depression or seasonal affective disorder (SAD). It could be that these underlying mental health conditions could influence the severity of premenstrual symptoms, or it could simply be that the genetic makeup of women who are prone to these mental health conditions also makes them prone to PMDD.

Other health and lifestyle factors which also seem to play a role in PMDD include:

  • Alcohol or substance abuse
  • Family history of PMDD
  • Low levels of exercise
  • Obesity
  • Thyroid disorders

How is Premenstrual Dysphoric Disorder Treated?

Many doctors recommend lowering the intake of sugar, caffeine, salt, and alcohol and taking supplements such as calcium, Vitamin E, Vitamin B6, and magnesium. Regular swimming or walking appears to improve the premenstrual symptoms. Healthy foods containing whole grains, fruits, and vegetables are also recommended. Antidepressants such as Paxil CR, Zoloft, and Sarafem have been approved by the FDA for the treatment of PMDD. Birth control pills can help reduce symptoms of PMS, diuretics can help women who’ve gained weight due to fluid retention, and aspirin or ibuprofen may alleviate headaches, backaches, breast tenderness, and menstrual cramps.

Premenstrual Dysphoric Disorder Causes

It may not be possible to completely prevent PMDD, but women with the condition may be able to manage it by adjusting certain lifestyle factors.

Consuming a balanced diet with little salt, sugar, alcohol and caffeine may help to reduce the symptoms of PMDD. Regular exercise also helps to alleviate stress and can increase serotonin levels in order to improve mood. Adopting a healthy bedtime routine and sleep schedule may also help to improve sleep quality and energy levels.

For some women with PMDD, medication may help to prevent symptoms being too severe. Oral contraceptives can be particularly helpful in regulating hormone levels and therefore reducing symptoms. In some instances, antidepressants may also help to regulate mood. Cognitive behavioral therapy could also be an effective way to help an individual to cope with the fluctuating, extreme moods caused by PMDD.

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Last Reviewed:
October 09, 2016
Last Updated:
January 11, 2018
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