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Premenstrual Dysphoric Disorder

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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:

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.


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.

Revision Information

  • American Congress of Obstetricians and Gynecologists

  • Women's

  • Health Canada

  • The Society of Obstetricians and Gynaecologists of Canada

  • PMS and PMDD. Mass General Hospital Center for Women's Health website. Available at: . Accessed August 14, 2012.

  • Premenstrual dysphoric disorder (PMDD). Family website. Available at: . Updated August 2010. Accessed August 14, 2012.

  • Premenstrual syndrome. EBSCO DynaMed website. Available at: . Updated June 14, 2012. Accessed August 14, 2012.