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Premenstrual Dysphoric Disorder

The Silent Battle: Understanding Premenstrual Dysphoric Disorder (PMDD)

Every month, countless women across the world silently endure a battle that often goes unnoticed. This is not the typical discomfort that can accompany menstruation; this is something far more serious.

Premenstrual Dysphoric Disorder, or PMDD, is a condition that affects women both physically and mentally, causing severe distress and disruption in their lives.

In today’s article, we’ll discuss the world of PMDD, shedding light on PMDD causes, symptoms, diagnosis, and available treatment options.

What is Premenstrual Dysphoric Disorder (PMDD)?

PMDD is a severe form of premenstrual syndrome (PMS) that affects a small but significant portion of women during their reproductive years.

Unlike PMS, which can cause discomfort and mild mood swings, PMDD results in extreme emotional and physical symptoms. These symptoms typically emerge during the second half of the menstrual cycle and subside shortly after the start of menstruation.

PMDD is more than just the usual “bad mood” or “period blues”; it can be profoundly debilitating.

PMDD Causes

While the exact PMDD causes are not fully understood, it is believed to result from a combination of various factors, including hormonal, neurochemical, genetic, and environmental influences.

1. Hormonal Fluctuations:

Hormonal imbalances play a significant role in the development of PMDD. During the menstrual cycle, levels of two key hormones, estrogen, and progesterone, fluctuate. In women with PMDD, these hormonal changes trigger a cascade of physical and emotional PMDD symptoms. It is believed that certain women are more sensitive to these hormonal shifts, which can lead to the severe symptoms associated with PMDD.

2. Neurotransmitter Imbalances:

Neurotransmitters are chemicals in the brain that transmit signals between nerve cells. In the case of PMDD, there is evidence to suggest that there may be imbalances in specific neurotransmitters, such as serotonin. Serotonin is known to regulate mood, and alterations in its levels can lead to symptoms of depression, anxiety, and irritability—common features of PMDD.

3. Genetic Predisposition:

Genetics also seem to play a role in PMDD. If you have a family history of PMDD, you may be at a higher risk of developing the condition. Researchers have identified certain genetic markers associated with PMDD, which suggests that some individuals may have a genetic predisposition to the disorder.

4. Environmental Factors:

Environmental factors, such as stress and lifestyle choices, can exacerbate the PMDD symptoms. High levels of stress can lead to an overproduction of cortisol, the stress hormone, which can further disrupt hormonal balance. Additionally, a sedentary lifestyle and poor dietary habits can contribute to PMDD symptoms.

What Are the Risk Factors for PMDD?

As the exact PMDD causes remain complex and multifactorial, certain risk factors can increase the likelihood of developing this challenging condition. Understanding these risk factors is essential for early recognition and management of PMDD.

1. Family History:

One of the most significant risk factors for PMDD is a family history of the condition. If you have a mother, sister, or other close female relatives who have experienced PMDD, you may be at an increased risk of developing it yourself. Genetic factors likely play a role in PMDD, and a family history of the disorder can be a strong indicator.

2. Mood Disorders:

Individuals with a history of mood disorders such as depression, bipolar disorder, or anxiety may be more susceptible to PMDD. The presence of these preexisting mental health conditions can make the emotional PMDD symptoms more severe. It’s important to recognize that PMDD is distinct from these mood disorders, even though it may share some symptoms.

3. Lifestyle Factors:

Certain lifestyle factors can exacerbate the PMDD symptoms. High levels of chronic stress, for instance, can have a detrimental impact. Stress triggers the release of cortisol, a stress hormone, which can further disrupt hormonal balance and amplify PMDD symptoms. Additionally, physical inactivity and an unhealthy diet can contribute to the severity of PMDD symptoms.

4. Hormonal Imbalance:

Although hormonal fluctuations are considered a cause of PMDD, women with irregular menstrual cycles, or those with conditions like polycystic ovary syndrome (PCOS), may be at an increased risk. These conditions can lead to more significant hormonal imbalances and potentially worsen PMDD symptoms.

5. Age and Childbirth:

PMDD typically affects women of reproductive age, with symptoms usually appearing in the late teens to early 40s. Women who have not given birth may be at a slightly higher risk. However, the reasons behind this association are still being studied.

What Are PMDD Symptoms?

Premenstrual Dysphoric Disorder is a condition that can cause severe and disruptive symptoms, affecting both the emotional and physical well-being of those who experience it.

1. Emotional Symptoms:

PMDD disorder often leads to pronounced emotional changes that can significantly impact a person’s daily life. These emotional symptoms typically include:

2. Physical Symptoms:

In addition to emotional symptoms, PMDD can also cause a range of physical discomforts, including:

3. Cognitive Symptoms:

PMDD disorder can affect cognitive functions and may lead to difficulties with concentration and memory.

How Is PMDD Diagnosed?

Diagnosing Premenstrual Dysphoric Disorder (PMDD) involves a comprehensive evaluation by a healthcare professional to determine if the symptoms experienced are indeed related to PMDD and not another medical or psychiatric condition. 

The diagnosis typically follows a specific process:

1. Clinical Assessment:

Your healthcare provider will begin by conducting a detailed clinical assessment. This involves discussing your medical history, including any family history of PMDD or related mood disorders, and documenting your symptoms.

2. Symptom Tracking:

To establish a diagnosis, your healthcare provider may ask you to keep a menstrual diary for several months. This diary will help track the timing and severity of your symptoms, providing crucial data to confirm a pattern related to your menstrual cycle.

3. Differential Diagnosis:

It’s important to rule out other medical and psychiatric conditions that may present with similar symptoms to PMDD. This step is essential to ensure an accurate diagnosis. Conditions such as depression, anxiety, and other mood disorders should be considered.

4. Diagnostic Criteria:

To be diagnosed with PMDD, your symptoms must align with specific diagnostic criteria. These criteria are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The key features include experiencing emotional and physical symptoms during the luteal phase of the menstrual cycle, the absence of these symptoms during the follicular phase, and significant interference with daily life and functioning.

5. Laboratory Tests:

While there are no specific laboratory tests to diagnose PMDD, your healthcare provider may recommend blood tests to rule out other potential causes of your symptoms. Hormone levels and thyroid function may be assessed to ensure they are within the normal range.

PMDD Treatment

PMDD treatment options may vary depending on the severity of PMDD symptoms and the individual’s needs. Here’s a brief overview of the PMDD treatment approaches:

1. Lifestyle Modifications:

For some individuals with mild to moderate PMDD, making certain lifestyle changes can be effective in reducing symptoms. These may include:

2. Psychotherapy:

Cognitive-behavioral therapy (CBT) and other forms of psychotherapy can be beneficial in addressing the emotional symptoms of PMDD. Psychotherapy can help individuals develop coping strategies, manage mood swings, and reduce anxiety and depression.

3. Medications:

In more severe cases of PMDD, medications may be recommended:

  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, have been shown to be effective in treating PMDD. These medications can help regulate mood and reduce emotional symptoms.
  • Hormonal Therapy: Hormonal treatments, such as birth control pills, may be prescribed to help regulate the menstrual cycle and hormonal fluctuations. Gonadotropin-releasing hormone agonists (GnRH agonists) can temporarily suppress ovulation, which can alleviate PMDD symptoms, but they are generally used as a last resort.

4. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs):

For individuals with physical symptoms like breast tenderness and bloating, over-the-counter NSAIDs may provide relief. These drugs can help reduce inflammation and discomfort associated with PMDD.

5. Dietary Supplements:

Some individuals may benefit from dietary supplements, such as calcium, magnesium, and vitamin B6, which can help manage PMDD symptoms. It’s essential to consult with a healthcare provider before taking any supplements to ensure they are safe and appropriate for your specific needs.


Premenstrual Dysphoric Disorder (PMDD) is a silent battle that affects the lives of many women, often in profound ways. At Manhattan Medical Arts, we are committed to providing the best care and support for women dealing with PMDD disorder and other medical conditions. 

We hope this blog has has been helpful, and give you enough knowledge to make informed decisions and manage PMDD disorder in a better way. If you or a loved one is struggling with PMDD, please don’t hesitate to contact us for personalized and compassionate care. Together, we can help you reclaim control over your life and conquer the silent battle of PMDD.

Frequently Asked Questions

What triggers premenstrual dysphoric disorder?

The exact cause of PMDD isn’t fully understood, but hormonal fluctuations, neurotransmitter imbalances, genetics, and environmental factors can trigger it.

Is PMDD considered a mental illness?

PMDD is not a mental illness, but it’s a severe form of premenstrual syndrome (PMS) with significant emotional and physical symptoms.

What does a PMDD episode look like?

A PMDD episode typically involves severe mood swings, depression, anxiety, fatigue, physical discomfort like breast tenderness and bloating, and cognitive difficulties, occurring in the luteal phase of the menstrual cycle.

Is PMDD a hormone imbalance?

PMDD is associated with hormone imbalances, especially in estrogen and progesterone levels.

Does PMDD get worse with age?

PMDD symptoms may remain consistent over time or improve with age, particularly after menopause.

What is the best treatment for PMDD?

The best treatment for PMDD depends on individual needs and symptom severity. Options include lifestyle changes, psychotherapy, medications like SSRIs, hormonal therapy, and dietary supplements. Consult a healthcare provider for personalized treatment.

– Disclaimer –
This blog is for informational & educational purposes only, and does not intend to substitute any professional medical advice or consultation. For any health related concerns, please consult with your physician, or call 911.

Medically Reviewed

Last reviewed by Dr. Syra Hanif, M.D. on 11/06/2023

Learn more about our editorial process.

  • About The Author

    Dr. Syra Hanif M.D.

    Board Certified Primary Care Physician

Dr. Syra Hanif is a board-certified Primary Care Physician (PCP) dedicated to providing compassionate, patient-centered healthcare.

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