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Premenstrual Dysphoric Disorder


Pronounced: PRE-men-strawl dis-FOR-ick dis-OR-der


Premenstrual dysphoric disorder (PMDD) occurs just prior to menstruation and is characterized by significant:

  • Depression
  • Irritability
  • Tension

PMDD is much more severe and less common than premenstrual syndrome (PMS).

Causes  ^

The exact cause is not known.

Risk Factors  ^

Factors that may increase your chance of PMDD include:

  • Hormonal changes
  • Family history of PMDD
  • Extra stress or a traumatic life event
  • Depression or another mental health condition

Microscopic View of Hormone Receptor
molecule and receptor

Menstruation causes many hormonal changes, which may play a role in PMDD.

Copyright © Nucleus Medical Media, Inc.

Symptoms  ^

PMDD may cause:

  • Extreme sadness
  • Frequent crying
  • Irritability
  • Anxiety
  • Unusually strong cravings for certain foods
  • Difficulty concentrating or paying attention
  • Insomnia
  • Panic attacks
  • Mood swings
  • Fatigue or lack of energy
  • Physical symptoms, such as sore breasts, headaches, joint or muscle pain, swelling, or bloating

Symptoms typically begin 10-14 days prior to the start of menstruation.

Diagnosis  ^

PMDD will be diagnosed based on your symptoms. You may be asked to keep a record of when your symptoms occur and how severe they are.

Your doctor may also order:

  • Blood tests
  • Tests to check hormone levels

Treatment  ^

Talk with your doctor about the best treatment plan for you. Treatment options include:

Lifestyle Changes

These steps can help manage symptoms of PMDD:

  • Exercise throughout the week.
  • Get plenty of rest.
  • Eat a balanced diet with plenty of fruits, vegetables, and whole grains.
  • Avoid alcohol, tobacco, and caffeine.
  • Learn stress management techniques.
  • Improve your sleep habits.


PMDD may be treated with:

  • Antidepressants
  • Oral contraceptives
  • Nutritional supplements

Prevention  ^

To help reduce your chance of PMDD, take these steps:

  • Get plenty of exercise and rest
  • Eat a well-balanced diet
  • Manage stress

American Congress of Obstetricians and Gynecologists

Office on Women's Health


Health Canada

The Society of Obstetricians and Gynaecologists of Canada


PMS and PMDD. MGH Center for Women's Health website. Available at: Accessed October 8, 2015.

Premenstrual dysphoric disorder (PMDD). American Academy of Family Physicians Family Doctor website. Available at: Updated April 2014. Accessed October 8, 2015.

Premenstrual syndrome. EBSCO DynaMed website. Available at: Updated January 9, 2015. Accessed October 8, 2015.

Last reviewed September 2015 by Andrea Chisholm, MD  Last Updated: 9/30/2013