Premenstrual dysphoric disorder (PMDD)

What is premenstrual dysphoric disorder (PMDD)?

PMDD causes severe emotional and psychological distress in the lead-up to your period. This condition can negatively impact your work, relationships and quality of life.

PMDD symptoms

PMDD symptoms start one to two weeks before your period. Symptoms usually settle after your period starts.

Emotional symptoms

Common emotional symptoms include:

• extreme or sudden mood changes, such as sadness, feeling teary or increased sensitivity to rejection
• increased irritability, anger or conflict with other people
• feeling depressed, hopeless, worthless or guilty
• feeling tense, anxious or ‘on edge’
• feeling overwhelmed or out of control
• reduced interest in usual activities such as work, school, friends or hobbies
• trouble concentrating.

Physical symptoms

• tiredness or low energy
• change in appetite, such as overeating or craving specific foods
• trouble falling or staying asleep (insomnia)
• sore or swollen breasts
• joint or muscle pain
• bloating
• weight gain.

What causes PMDD?

We don’t know exactly why some people have PMDD. It may be associated with the hormone progesterone interacting with certain chemicals in the brain. Other factors can influence symptoms, including stress levels, physical and emotional health and lifestyle.

How is PMDD diagnosed?

PMDD is diagnosed based on your symptoms and how they affect you. You must have at least five symptoms across two menstrual cycles to be diagnosed with the condition.

PMDD is sometimes mistaken for other conditions, such as bipolar disorder. It was only recognised by the World Health Organization as a separate medical condition needing diagnosis and treatment in 2019.

It’s important to see a doctor who specialises in women’s health and understands PMDD. An early diagnosis will help you get timely treatment.

If you think you might have PMDD, track your symptoms, how they affect you and what helps. Record this information across a couple of menstrual cycles. Visit the International Association for Premenstrual Disorders (IAPMD) website for a printable tracker.

Book a longer appointment with your doctor to discuss your symptoms and medical history. Say you think you may have PMDD. They may recommend certain tests to rule out other conditions.

How is PMDD different to PMS?

It’s easy to mistake PMDD for PMS and other mental health conditions because symptoms can be similar. But PMDD causes severe emotional and mood-related symptoms before your period that make it hard to function at work, school and in relationships.

Managing PMDD

Management of PMDD depends on your symptoms and how much they impact your daily life. You may need one or a combination of treatments.

You can get help from your doctor and other specialists (e.g. a gynaecologist, an endocrinologist, a psychologist or allied health practitioners).

Hormonal treatments

The combined oral contraceptive pill can help regulate hormone levels and relieve symptoms.

Gonadotropin-releasing hormone (GnRH) medicine can be used to suppress oestrogen production and menstruation. This is used in cases where other medicines haven’t worked, or the cause of symptoms is unclear.

Medicine

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can be used to treat PMDD. These commonly prescribed antidepressants can ease symptoms of moderate to severe depression. They can be taken continuously or in the last two weeks of your menstrual cycle.

Healthy lifestyle

A healthy lifestyle can help reduce PMDD symptoms. For example:

• try different relaxation techniques (e.g. mindfulness and meditation)
• do regular physical activity (e.g. aerobic exercise, strength training, yoga, Pilates)
• eat a balanced diet.

Other treatments

Other treatments may help manage symptoms. For example:

• certain vitamin, mineral and herb supplements – ask an accredited naturopath for more information
• take calcium (1,000–1,200 mg per day for adults)
• take anti-inflammatory drugs to help manage symptoms such as headaches and cramps.

You can also try:

• cognitive behavioural therapy (CBT) – a psychological treatment to help you manage distressing emotional symptoms
• acupuncture – a holistic approach to symptom management.

Surgery

In severe cases of PMDD, where medical therapies have failed, your gynaecologist may recommend a hysterectomy and removal of both ovaries and fallopian tubes. Removal of ovaries before the age of 64 can lead to surgical menopause and an increased risk of heart and bone disease.

It’s important to understand the risks and benefits of this procedure before you make a decision.

When to see your doctor

See your doctor if you are worried about PMS symptoms or think you may have PMDD.

Other resources and support

• Visit the International Association for Premenstrual Disorders (IAPMD) website
• Read PMS, PMDD and you