Premenstrual Dysphoric Disorder (PMDD)

By Naomie Natasha

Premenstrual dysphoric disorder is a condition in which women have worsening symptoms of irritability and stress before having their menstruation. These are emotional or physical symptoms that take place about 5-11 days before they have their monthly period. They always vanish when they start their period.

PMDD is similar to premenstrual syndrome (PMS) but it is worse. It is a health problem that causes anxiety and other problems in 1 or 2 weeks before a woman gets her period. Some women experience mild symptoms while others have worse symptoms which have bad effects in their lives (1).

They have difficulties working, socializing and even their relationships are affected.

Symptoms of Premenstrual Dysphoric Disorder (PMDD)

Many women with this condition experience some or all of the symptoms that are listed here. They include;

Emotional Symptoms

  • Not interested in activities you enjoy
  • feeling hopeless
  • mood swings
  • Feeling like crying all the time
  • Feeling tense most times
  • Feeling hopeless
  • Difficulty in concentrating
  • Feeling angry and overwhelmed
  • Decreased energy levels
  • Suicidal feelings
Physical Symptoms

  • Feeling bloated
  • Breast swelling or tenderness
  • Decrease in appetite or having specific food cravings
  • Insomnia
  • Pain in muscles

Symptoms are experienced only in a week or 2 after ovulation and will disappear a day after getting a period.

During the worst time of Premenstrual Dysphoric Disorder, some women often retreat to their bed. There are times when hospitalizations may be warranted.  

It is a serious condition where some women get so fatigued and can’t keep their eyes open.

One woman reported that it got worse when she was in her 30s where she felt like she was going through bereavement because of her depression (2). She would recover but again get worried because she would know it would happen again in a couple of week’s time.

PMDD and Suicidal Feelings

If you are reading this and suspect you have premenstrual dysphoric disorder which is making you feel suicidal, please call 911, a suicidal hotline, or go straight to a hospital where you will get the help that you need.

Some key points about PMDD are that its symptoms are worse than PMS and they require medication. The second point is that they disrupt normal daily functioning and they can last until menopause.

Causes of Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Dysphoric Disorder is an endocrine disorder meaning it is caused by changes of hormone levels in the body. The exact cause of this disorder is not yet fully understood but the following factors have been associated with it:

Sensitivity to increase in hormone levels is the cause of some women developing this disorder. The monthly menstrual cycle has normal hormonal changes and if a woman reacts abnormal to these changes, PMDD is triggered.

Stressful and traumatic events may lead to PMDD to develop but there is no evidence to explain how.  

A study (3) has revealed a link between premenstrual dysphoric disorder and low levels of serotonin. Serotonin is a nerve signal transmitter in the brain and when brain cells that control sleep, moods and pain become low, PMDD symptoms develops.

Other factors that may trigger premenstrual dysphoric disorder include thyroid disorders, lack of exercise, being overweight, family with PMDD and drugs abuse.

Diagnosis of PMDD

If you think you have any of the symptoms listed above, see a doctor immediately. Your doctor will conduct a medical history where you are supposed to tell all the symptoms you experience. An exam will be done in order to rule out related diseases and conditions such as endometriosis, menopause and fibroids.

You can be diagnosed with premenstrual dysphoric disorder if you have more than the 5 symptoms listed here and they start 1 or 2weeks after ovulation and disappear after getting your period.

The symptoms should at least include the following;

  • Feeling tense in the first and second week before period starts
  • mood changes
  • Feeling hopelessness
  • Feeling tired and depressed

Treatment of Premenstrual Dysphoric Disorder

Your symptoms are supposed to be reviewed by your doctor. After determining your symptoms are due to Premenstrual Dysphoric Disorder, your doctor will recommend specific treatments to manage your disorder.

There are medications that will help women suffering from PMDD. Ovulation and central nervous system medication will play a big part in bringing comfort to women with this disorder. Examples of these medications include;

  • SSRI antidepressants such as Sarafem and Celexa.
  • Oral contraceptives have been used greatly to help women with PMDD. These are contraceptives that have Ethinylestradiol and Drospirenone.

Gonadotropin releasing hormone analogs are medications which are used to treat women with premenstrual dysphoric disorder. They include Lupron and Zoladex.

Pain killers can be taken such as ibuprofen and NSAIDS to help with symptoms of breast tenderness, muscle pain, headache and backache. Diuretics can be prescribed to relieve symptoms of bloating and fluid retention.


There are some doctors who recommend supplements for treating PMDD though there is no evidence to support effectiveness. Examples of supplements recommended include the following;

  • Magnesium oxide
  • Supplements with calcium
  • Evening primrose oil

There was a study (4) that found out that Vitamin B6 is an inexpensive and effective treatment of premenstrual dysphoric disorder.

Alternative Remedies

Alternative remedies like exercises have been seen to ease the symptoms of PMDD. They include the following;

  • Acupuncture
  • Saffron therapy

And photic stimulation

If it’s possible, consistently exercise to help in managing some of the symptoms of this disorder. Dietary changes such as low intake of salt, alcohol and sugar will surely help in the management of PMDD.

Relaxing activities such as watching movies, reading and walking are helpful because they will relieve tension and depression caused by PMDD.


  1. Dante, G., & Facchinetti, F. (2011, March). Herbal treatments for alleviating premenstrual symptoms: a systematic review [Abstract]. Journal of Psychosomatic Obstetrics and Gynecology, 32(1):42-51. Retrieved from
  2. Grohol, J. M. (2017). Symptoms of premenstrual dysphoric disorder. PsychCentral. Retrieved from 
  3. Nevatte, T., O’Brien, P. M., Bäckström, T., Brown, C., Dennerstein, L., Endicott, J., … Yonkers, K. (2013, August). ISPMD consensus on the management of premenstrual disorders [Abstract]. Archives of Women’s Mental Health, 16(4):279-91. Retrieved from
  4. Pearlstein, T., & Steiner, M. (2008, July). Premenstrual dysphoric disorder: Burden of illness and treatment update. Journal of Psychiatry and Neuroscience, 33(4). Retrieved from