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Premenstrual Dysphoric Disorder


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).


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.


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.


Your doctor will diagnose PMDD 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


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


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

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

Revision Information

  • 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 September 25, 2014.

  • Premenstrual dysphoric disorder (PMDD). American Academy of Family Physicians Family Doctor website. Available at: Updated April 2014. Accessed September 25, 2014.

  • Premenstrual syndrome. EBSCO DynaMed website. Available at: Updated July 8, 2014. Accessed September 25, 2014.