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Premenstrual Dysphoric Disorder


Pronounced: PRE-men-strawl dis-FOR-ick dis-OR-der
En Español (Spanish Version)

Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention


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 PMS.


The exact cause is not known.

Risk Factors

Factors that may increase the risk of PMDD include:

  • Having hormonal changes
  • Having a family history of PMDD
  • Experiencing a lot of stress or a traumatic life event
  • Having 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 include:

  • 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 (eg, sore breasts, headaches, joint or muscle pain, swelling, 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:

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.

Your doctor may recommend:

  • Antidepressants (selective serotonin reuptake inhibitors [SSRIs])
  • Oral contraceptives
  • Nutritional supplements


To 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



The Society of Obstetricians and Gynaecologists of Canada



PMS and PMDD. Mass General Hospital Center for Women's Health website. Available at: http://www.womensmentalhealth.org/specialty-clinics/pms-and-pmdd/. Accessed August 14, 2012.

Premenstrual dysphoric disorder (PMDD). Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/women/mental/752.html. Updated August 2010. Accessed August 14, 2012.

Premenstrual syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated June 14, 2012. Accessed August 14, 2012.

Last reviewed September 2013 by Andrea Chisholm, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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