Many women experience some type of pesky symptom or another before they get their period, like breast tenderness, cramps, or irritability.
But what happens if you feel severely depressed, anxious, or even suicidal when it’s almost time for your period every month? Experiencing these feelings could potentially be a sign of premenstrual dysphoric disorder (PMDD).
So what exactly is PMDD? Premenstrual dysphoric disorder is a condition that affects 3% to 8% of women and people who were assigned female at birth during their reproductive years. Those with PMDD may experience symptoms related to the disorder until they go through menopause.
PMDD results in monthly physical and mental symptoms correlating with the menstrual cycle. “You can look at it as a severe form of PMS, or premenstrual syndrome,” says Tahara DeBarrows, a licensed marriage and family therapist specializing in depression with Grow Therapy. PMS is more well-known and far more common than PMDD, affecting up to three out of four people with periods – but PMDD is more intense.
Here’s what you need to know about the signs, causes, and treatments for PMDD and how to tell it apart from other conditions.
Mental and physical symptoms of PMDD
“Premenstrual dysphoric disorder manifests through a range of mental and physical symptoms, including breast tenderness and suicidal thoughts, which typically arise during the luteal phase of the menstrual cycle,” according to DeBarrows. This phase occurs after ovulation and before the onset of menstruation.
“More specifically, PMDD symptoms typically occur during the week before your period starts,” DeBarrows says. For some people, the signs might begin to show as early as 10 days before menstruation. Everyone is different, but it’s usually within the seven to ten-day window. Symptoms will subside within the first few days after you get your period.
| Mental/Emotional Symptoms | Physical Symptoms |
| Feeling sad | Bloating |
| Feeling angry or irritable | Breast tenderness |
| Feeling tense or anxious | Cramps |
| Having suicidal thoughts | Headaches |
| Having mood swings | Joint aches |
| Crying frequently | Muscle aches |
| Losing interest in activities and things that you once enjoyed | |
| Experiencing food cravings and overeating | |
| Feeling easily overwhelmed and like you are not in control | |
| Having trouble staying focused or thinking | |
| Tiredness | |
| Having difficulties with sleep |
The specific diagnostic criteria for PMDD have been outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). To get a formal diagnosis of PMDD from a mental health professional, you need to exhibit at least five signs of PMDD during most menstrual cycles throughout the previous year. Additionally, other mental health and medication conditions that could cause similar symptoms must be ruled out.
Common PMDD causes and risks
The precise cause of PMDD remains unclear. Some people are more likely than others to develop this disorder. DeBarrows says having a history of anxiety, depression, or trauma can make you more likely to develop PMDD. Having a family history of PMDD or even PMS can also increase your risk.
Moreover, PMDD can worsen other mental and behavioral health issues, such as borderline personality disorder, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD).
How to differentiate between PMDD and PMS
Premenstrual syndrome, more commonly known as PMS, affects up to 75% of women, while 20% of women suffer from severe symptoms that affect their daily lives.
There is a lot of overlap between PMS symptoms and PMDD symptoms, which can make it confusing for someone who’s trying to determine which condition they might have.
| Mental/Emotional Symptoms | Physical Symptoms |
| Feeling depressed | Acne |
| Feeling anxious or tense | Bloating |
| Feeling angry or irritable | Breast tenderness |
| Crying | Cramps |
| Mood swings | Changes to alcohol tolerance |
| Experiencing food cravings and changes to appetite | Constipation |
| Having difficulties sleeping | Diarrhea |
| Having trouble concentrating | Headaches |
| Withdrawing from social situations | Water retention and weight gain |
| Changes to sex drive | Joint pain |
| Muscle pain | |
| Tiredness |
As you can see, many symptoms are the same for PMS and PMDD. However, the critical difference lies within the severity of symptoms and the impact that these symptoms have on your life.
“People experience PMS and PMDD symptoms during the week leading up to menses, and may have similar complaints,” says Julia Preamplume, a licensed clinical social worker specializing in depression with Grow Therapy. “However, when someone experiences PMDD, these symptoms cause significant distress and may interfere with work, school, relationships, and other important aspects of a person’s life.”
“Furthermore, PMDD mood symptoms are typically more intense than PMS mood symptoms would be, with more extreme mood shifts, too, says DeBarrows. “Also, suicidal ideation is only linked with PMDD, not PMS,” Preamplume says.
In a nutshell, PMS will likely cause less debilitating symptoms, and won’t cause too much interference with day-to-day functioning, unlike PMDD.
Differences between PMDD and depression
When people talk about depression, they are usually talking about the mood disorder formally known as major depressive disorder (MDD). This disorder is linked to ongoing feelings of sadness and a loss of interest and joy in activities. Just as there are similarities between PMS and PMDD, there is also a significant overlap between depression symptoms and PMDD symptoms.
Symptoms of major depressive disorder include:
- Depressed or sad mood
- Lack of interest and pleasure with activities or things you used to like
- Difficulty sleeping or sleeping excessively
- Appetite and weight changes
- Fatigue
- Moving or speaking slowly
- Experiencing guilt
- Feeling like you’re worthless
- Having trouble with concentration, decisions, and thinking
- Thinking about death
- Having suicidal thoughts
Depression and PMDD share symptoms like sadness and suicidal thoughts, but differ mainly in their relation to the menstrual cycle. PMDD symptoms emerge before menstruation and ease shortly after, while depression persists regardless of menstrual changes.
For a major depressive disorder diagnosis, symptoms must significantly impair functioning for at least two weeks, whereas PMDD symptoms occur during most menstrual cycles during most months of the year.
Treatment options for PMDD
Numerous treatment options are available to alleviate the symptoms of PMDD. There is no universal treatment or specific medication that fits everyone. Instead, your healthcare team—including your OB/GYN, therapist, and psychiatrist—will collaborate to create a personalized plan that caters to your unique needs and addresses all of your concerns.
A variety of PMDD treatments include:
Antidepressants: Particularly selective serotonin reuptake inhibitors (SSRIs), are often prescribed to alleviate PMDD symptoms and enhance quality of life. The FDA has approved three SSRIs for this purpose: fluoxetine, paroxetine, and sertraline.
Birth control pills: OB/GYNs often prescribe oral contraception, particularly combined hormonal contraceptives with drospirenone and ethinyl estradiol, to treat PMDD. These birth control methods help regulate hormone levels, alleviating both mental and physical premenstrual symptoms.
Holistic remedies: Some people may see benefits from vitamins and supplements, says DeBarrows. However, it’s best to speak with your doctor before beginning or stopping any supplements.
Therapy: Therapy is highly beneficial for individuals with PMDD, aiding in symptom management and overall mental health improvement. A qualified therapist provides stress management techniques and coping strategies for the emotional challenges associated with menstruation.
Cognitive behavioral therapy (CBT) is particularly effective, helping individuals connect their thoughts, feelings, and behaviors to reframe negative thoughts positively. Other talk therapy methods also effectively address depression and anxiety symptoms.
Lifestyle changes: Small lifestyle changes can significantly improve PMDD symptoms. Regular exercise, yoga, and mindfulness practices can help alleviate symptoms, lower cortisol levels, and enhance mood. Additionally, prioritizing quality sleep and a nutritious diet is essential for overall health.
Self-care strategies for managing PMDD
It is possible to find relief from your PMDD symptoms. The following coping skills can help.
Tracking and journaling
Tracking your symptoms is essential for identifying triggers and patterns, especially throughout your monthly cycle. Log the onset, triggers, frequency, and intensity of symptoms daily.
Preamplume suggests using a mood-tracking app or journal for several weeks to help identify patterns to discuss with healthcare professionals. Observing symptoms over time can provide insight, and referring to your journal can offer comfort during emotional fluctuations, reminding you that these feelings are often cyclical.
Healthy lifestyle changes
Embracing a healthy lifestyle can work wonders in easing symptoms like bloating, fatigue, and cramps. Small, intentional choices, like swapping a drive for a walk or reaching for nutritious snacks, can lead to remarkable improvements. Plus, regular exercise not only boosts your mood but also helps relieve PMDD symptoms, making you feel more comfortable and energized.
Relaxation
Stress can worsen PMDD symptoms, so it’s important to identify triggers and incorporate daily relaxation techniques like yoga, meditation, and journaling. Engaging in enjoyable activities and tracking emotional symptoms can help you find effective strategies for managing stress and promoting calmness.
Seeking support
When holistic treatments aren’t enough to manage PMDD, it’s important to build a strong support system and spend time with friends and family. Recognizing the hereditary nature of PMDD can also be helpful. Seeking a therapist specializing in women’s mental health can provide guidance and motivation.
Online and community support groups offer valuable insights and encouragement. Consulting healthcare professionals can provide options like contraceptives and hormone therapy, while psychiatrists may prescribe medications for emotional challenges.
Let Grow Therapy support you
Menstruation varies for every woman and those who menstruate but do not identify as a woman, and so do the emotional symptoms that come with it. At Grow Therapy, we understand the impact of PMDD and are here to support you with emotional and therapeutic needs.
Our list of licensed therapists includes experts trained in women’s mental health, and they can help you make sense of the emotional states that come with PMDD. By working together, we can create a customized care plan based on your unique experience.
Don’t suffer alone. Let us support you as you manage your symptoms and lead a happier, healthier life.
