Premenstrual dysphoric disorder (PMDD)
Your health expert: Dr Samantha Wild, Bupa GP and Clinical Lead for Women’s Health
Content review by Victoria Goldman, January 2024
Next review due January 2027
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). It can cause emotional and physical symptoms that start in the days or weeks before your period. Treatments for PMDD include talking therapies, prescription medicines, and surgery.
About premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects your mood and mental health. The symptoms of PMDD affect you every month in the two weeks before your period. These symptoms are similar to PMS, but you’ll probably feel much more angry, anxious, and irritable. Physical symptoms of PMS and PMDD include bloating, tender breasts, and headaches.
If you have PMDD, your symptoms will be severe enough to affect your work, relationships, and social life. PMDD can be a very distressing condition, but treatment will help. Most women get premenstrual symptoms at some time in their lives. Up to one in three women will be diagnosed with severe PMS. Up to 1 in 10 women will be diagnosed with PMDD.
Causes of premenstrual dysphoric disorder
Doctors don’t know exactly what causes premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD). The conditions may be linked to the changing hormone levels in your body at certain times of the month. Some people may be more sensitive to these than others. These hormones interact with your brain's mood-influencing chemicals – for example, serotonin. You may be more likely to get severe PMS or PMDD if you:
- have had depression in the past
- have a close relative with PMS or PMDD
- smoke
- have gained weight
- are under stress
- have been sexually abused or suffered domestic violence
Symptoms of premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) symptoms can be similar to those of premenstrual syndrome (PMS). But the emotional and behavioural symptoms will be much worse.
The emotional and behavioural symptoms of PMDD include:
- irritability, anger or aggression
- low mood or depression
- anxiety
- reduced interest in your work, hobbies, and social life
- forgetfulness and difficulty concentrating
- tiredness
- feeling overwhelmed or out of control
- sleeping a lot or finding it hard to sleep
PMDD symptoms can be similar to depression. But if you have PMDD, you may have some physical PMS symptoms too. These may include:
- feeling bloated
- tender breasts
- headaches
- backache
- constipation or diarrhoea
The timing and severity of your symptoms will also indicate whether or not you have PMDD. If you have PMDD, your symptoms will:
- appear in the two weeks before your menstrual period
- get better when you start your period or soon after
- disappear between your periods
If you think you have PMDD or your PMS symptoms are severely affecting your daily life, contact your GP.
Diagnosis of premenstrual dysphoric disorder
If you have severe premenstrual syndrone (PMS) symptoms, you should speak to your GP. If you think you have PMDD, keep a diary of your period and symptoms for at least two months before you see a GP. This will help you and your GP to see if your symptoms are related to your periods. If you don’t get treatment for premenstrual dysphoric disorder (PMDD), your symptoms may keep getting worse.
PMS can’t be diagnosed with any specific tests. So your GP will usually make a diagnosis based on how you describe your symptoms and when they occur. But before diagnosing PMDD, your GP may need to rule out other underlying health conditions that could be causing similar symptoms. They may offer you a blood test to rule out thyroid problems, anaemia, and the perimenopause.
Self-help for premenstrual dysphoric disorder
Self-help measures are unlikely to ease premenstrual dysphoric disorder (PMDD) symptoms on their own.But following a healthy lifestyle may help to improve your overall physical and mental health. A healthy lifestyle could include:
- being more active
- eating a healthy balanced diet
- eating regular meals including starchy carbohydrates such as wholemeal bread, pasta, rice, and potatoes
- avoiding sugary snacks and reducing salt
- avoiding caffeine and alcohol
- trying to reduce stress
- trying to get enough sleep
Self-help measures may ease some of the physical symptoms of PMDD.
- Wearing a supportive bra may help breast tenderness.
- Over-the-counter painkillers such as ibuprofen or paracetamol can help ease headaches or other aches and pains. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist.
Food supplements or herbal remedies may be more helpful for mild premenstrual syndrome (PMS) than PMDD. If you’re considering taking supplements or herbal remedies for PMDD symptoms, talk to your doctor or pharmacist first. They can give you advice about safe doses and possible interactions with other medicines you’re taking.
Treatment of premenstrual dysphoric disorder
Premenstrual dysphoric disorder (PMDD) is usually treated with medicines and talking therapies. The symptoms usually get better quite quickly with treatment. But they will come back if you stop the treatment. If your PMDD is very severe, the symptoms may be treated with surgery to remove your ovaries.
Medicines for PMDD
Selective serotonin re-uptake inhibitors (SSRIs) are antidepressants that may also help PMDD symptoms. These medicines include:
- fluoxetine
- sertraline
- paroxetine
SSRIs work by keeping your serotonin levels within the normal range around the time of your period. They can cause some side-effects – for example, nausea, low energy, and feeling sleepy. If you’re under 18, a specialist will need to decide if this is the right treatment for you.
Your GP may recommend the combined contraceptive pill for PMDD if you also want to use oral contraception. The combined pill prevents ovulation and affects your hormone levels. It may ease severe PMS symptoms but it doesn’t help everyone with PMDD. You may sometimes be advised to take these pills every day, without a break.
Gonadotropin releasing hormone (GnRH) analogues may be prescribed if SSRIs and the contraceptive pill haven’t helped severe PMDD symptoms. These medicines balance hormone levels in your body. You take them with hormone replacement therapy (HRT) to protect your bones. This is because GnRH analogues lower oestrogen levels and can cause osteoporosis if they’re given without HRT.
If you have troublesome physical symptoms, your doctor may offer you other medicines such as:
- a diuretic (water tablet) such as spironolactone to relieve tender breasts and bloating
- an oestrogen patch (usually with a progestogen) to balance out changing hormone levels
Talking therapies for PMDD
Cognitive behavioural therapy (CBT)is a type of talking therapy. It may help to stop the emotional symptoms of PMDD from affecting your daily life. It helps you change how you think, feel, and behave in response to your PMDD. You’ll learn how to recognise negative or unhelpful thinking patterns and replace them with positive or helpful ones.
Ask your GP if CBT is available in your area. In some areas, your GP may be able to refer you to a suitable therapist.
Surgery for PMDD
Surgery to have your ovaries removed (oophorectomy) is used as a last resort for PMDD. It stops your periods completely so you become menopausal. You then don’t get any PMS or PMDD symptoms at all. You should only consider surgery if you’re sure you don’t want to become pregnant in future.
If you’re considering this operation, your doctor may suggest you have an injection of a GnRH analogue first. A GnRH analogue reduces your oestrogen levels and stops your periods. This will give you an idea of what you may feel like after the surgery. It will also help to show if having surgery is likely to ease your PMDD symptoms. While you’re taking the GnRH analogue, you may be given hormone replacement therapy (HRT) to prevent bone loss.
Talking therapies for PMDD
Cognitive behavioural therapy (CBT)is a type of talking therapy. It may help to stop the emotional symptoms of PMDD from affecting your daily life. It helps you change how you think, feel, and behave in response to your PMDD. You’ll learn how to recognise negative or unhelpful thinking patterns and replace them with positive or helpful ones.Ask your GP if CBT is available in your area. In some areas, your GP may be able to refer you to a suitable therapist.Surgery for PMDD
Surgery to have your ovaries removed (oophorectomy) is used as a last resort for PMDD. It stops your periods completely so you become menopausal. You then don’t get any PMS or PMDD symptoms at all. You should only consider surgery if you’re sure you don’t want to become pregnant in future.If you’re considering this operation, your doctor may suggest you have an injection of a GnRH analogue first. A GnRH analogue reduces your oestrogen levels and stops your periods. This will give you an idea of what you may feel like after the surgery. It will also help to show if having surgery is likely to ease your PMDD symptoms. While you’re taking the GnRH analogue, you may be given hormone replacement therapy (HRT) to prevent bone loss.
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PMDD symptoms can start any time during the two weeks before your period. The symptoms usually ease after your period starts and are gone by the time your period ends.For more information, see our section on symptoms of premenstrual dysphoric disorder.
PMDD symptoms are usually treated with prescribed medicines or cognitive behavioural therapy (CBT), so it’s important to speak to your GP. But making some lifestyle changes may improve your physical and mental health.
For more information, see our section on self-help for premenstrual dysphoric disorder.Up to one in three women will be diagnosed with severe premenstrual syndrome (PMS).Around 1 in 10 women have PMDD. But no one knows for sure what causes PMS or PMDD or why some get it but others don’t.
For more information, see our section on causes of premenstrual dysphoric disorder.
PMDD symptoms can be similar to those of PMS, but the emotional and behavioural symptoms will be much worse. These symptoms may include irritability, anger, depression, anxiety, and reduced interest in your usual activities.
For more information, see our section on symptoms of premenstrual dysphoric disorder.
If your partner has PMDD, their symptoms may put a strain on your relationship. It’s important to be patient – remember that these symptoms are out of their control. They may find it difficult to deal with day-to-day activities when their symptoms flare up. Encourage your partner to contact their GP for treatment.
Depression
Antidepressants
Antidepressants are a type of drug that can be used to treat depression and other disorders.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy. It helps you change how you think, feel and behave.
Other helpful websites
- Mind
www.mind.org.uk - Royal College of Obstetricians & Gynaecologists
www.rcog.org.uk
Discover other helpful health information websites
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- Premenstrual syndrome and dysphoric disorder. BMJ Best Practice. bestpractice.bmj.com, last reviewed October 2023
- Premenstrual syndrome. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2019
- Premenstrual dysmorphic disorder. Medscape. emedicine.medscape.com, updated September 2021
- Premenstrual syndrome. Patient. patient.info, last updated November 2022
- Premenstrual syndrome. MSD Manuals. msdmanuals.com, reviewed/revised January 2023
- Evidence-based management of premenstrual disorders (PMD). International Association of Premenstrual Disorders. iapmd.org, updated January 2023
- Cognitive and behavioural therapies. Patient. patient.info, last updated December 2022
- Premenstrual dysphoric disorder. Mind. www.mind.org.uk, published August 2021
