by EBSCO Medical Review Board


Premenstrual dysphoric disorder (PMDD) is a severe and less common form of premenstrual syndrome (PMS). PMDD causes physical and emotional symptoms that happen 1 to 2 weeks before a menstrual period. These problems impact life.


The cause is not known.

Risk Factors

PMDD is more common in women of reproductive age and women who are White. Things that may raise the risk are:

  • A personal or family history of mental health problems, such as depression
  • Having a family member with PMS or PMDD
  • Being overweight or obese
  • Smoking
  • Extra stress or a traumatic life event
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.


Severe problems may be:

  • Physical:
    • Fatigue
    • Cramps and bloating
    • Nausea
    • Swelling of hands or feet
    • Headache
    • Swollen or tender breasts
    • Muscle or back pain
    • Weight gain
  • Emotional:
    • Irritability and mood swings
    • Frequent crying
    • Sleep problems
    • Changes in sex drive
    • Loss of hope or control
    • Problems with focus or paying attention
    • Tension
    • Confusion
    • Restlessness
    • Loss of interest in people and activities
    • Appetite changes, such as eating too much or strong food cravings


The doctor will ask about your symptoms and health history. A physical exam will be done. This may be enough to make the diagnosis. You may be asked to keep track of the problems you have over 2 menstrual cycles. This may confirm PMDD.

In women who do not menstruate, blood tests may be done to check hormone levels against symptoms.


The goal of treatment is to ease physical and emotional symptoms. PMDD is first treated with habit changes. Medicines may be used when symptoms do not get better with these changes. Choices may be:

  • Exercising 3 times a week to ease symptoms and promote feelings of well-being
  • Lowering stress through things like medicine, deep breathing, yoga, and cognitive behavioral therapy (CBT)
  • Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) to ease physical symptoms
  • Oral contraceptives to suppress ovulation
  • Antidepressants to ease depression, irritability, and some physical symptoms


There are no guidelines to lower the risk of PMDD. The cause is not known.


American Congress of Obstetricians and Gynecologists 

Office on Women's Health 


Health Canada 

The Society of Obstetricians and Gynaecologists of Canada 


Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2016 Aug 1;94(3):236-240.

PMS and PMDD. MGH Center for Women's Health website. Available at: Accessed January 17, 2020.

Premenstrual dysphoric disorder (PMDD). Family Doctor—American Academy of Family Physicians website. Available at: Updated May 14, 2019. Accessed January 17, 2020.

Premenstrual syndrome. EBSCO DynaMed website. Available at:  . Updated August 22, 2019. Accessed January 17, 2020.

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