What Is PMDD (Premenstrual Dysphoric Disorder)?

Some mood changes before your period is normal, but intense depressive episodes are not.

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Most people are familiar with the symptoms of PMS, or premenstrual syndrome. The majority of people with periods have some degree of PMS symptoms each cycle. However, some people may have symptoms so severe that it starts to affect their life and overall health. In this case, they may have PMDD, which is short for premenstrual dysphoric disorder.

Dysphoria comes from the Greek word for “hard to bear.” In psychology, dysphoria is often used to describe low mood and dissatisfaction. In its simplest form, premenstrual dysphoric disorder is basically a condition that causes depressive episodes corresponding to the menstrual cycle.

What Is Premenstrual Dysphoric Disorder?

PMDD is a health condition linked to changing hormone levels throughout the menstrual cycle. After ovulation, hormones like estrogen and progesterone decrease in the body, and they stay low until the start of the period. These hormone changes are also what cause PMS. However, people with PMDD are more sensitive to these hormone changes, causing intense, disruptive mental and physical symptoms.

What distinguishes PMS from PMDD is that PMDD symptoms are severe enough to affect your function and quality of life. Someone who’s experiencing PMS might be grumpy and irritable, but someone who’s having PMDD might feel hopeless, distraught, or even suicidal. Their symptoms might hurt their relationships or even affect their career.

The symptoms of PMDD typically start one or two weeks before the start of the period (after ovulation). They usually start to fade a day or two after the period has started. This two-week period is called the luteal phase of the menstrual cycle.

Symptoms are similar to those of PMS, but more severe. They include:

  • Irritability, sadness, despair, anxiety, and/or anger that is intense enough to affect others
  • Loss of energy, motivation, and interest in hobbies and relationships
  • Bodily pains, such as muscle aches, menstrual cramps, and breast tenderness

How Is It Treated?

There are different options for treating PMDD depending on your needs. Some people benefit from antidepressants, such as SSRIs (selective serotonin reuptake inhibitors). Interestingly, some people may only need to take the antidepressant during the one or two weeks that they have symptoms. This is called “intermittent dosing” or “pulsing.”

Another way to treat premenstrual dysphoric disorder is with hormone therapy, particularly hormonal birth control. This includes the Pill or the hormonal IUD. These can help level out hormone changes throughout the menstrual cycle, which may reduce PMDD symptoms.

Lifestyle also plays a role. A healthy diet and regular exercise may improve symptoms (or at least not worsen them). Limiting or avoiding smoking, alcohol, and caffeine may also help.

Getting Help for PMDD

Some pain and mood changes before your period are normal, but it’s not normal to have intense mood changes that disrupt your life every month. You don’t have to live with severe physical and mental health symptoms before every period. Reach out to a doctor about your concerns and the symptoms you’re experiencing. They can help you find a diagnosis and—if necessary—begin treatment to find relief.