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Premenstrual Dysphoric Disorder (PMDD) is the more severe sister of Premenstrual Syndrome (PMS). Here we look at how it can interfere with your life, and examine what you can do about it.

Between 2 and 10% of women of reproductive age experience the severe symptoms and menstrual dysfunction caused by Premenstrual Dysphoric Disorder. If Premenstrual Syndrome is a little tremor in the tectonic plates of our reproductive system, PMDD is a full-blown earthquake.[1]

The symptoms caused by Premenstrual Dysphoric Disorder are severe and can disrupt your work-life, social activities, relationships, and emotional wellbeing for the five- to eleven-day period before your menstruation begins.

Here, we explore what PMDD is, what causes PMDD, how it's diagnosed, and what can be done about it, including some really good methods that could help you to help yourself.

What is PMDD?

PMDD has really similar symptoms to PMS. However, the symptoms are generally much more severe, and include at least one mood-related symptom. Symptoms start about a week before your period is due and continue until a couple of days after your period has started.

Most common symptoms include [2]:

  • Anxiety, tension, feelings of being "on edge"
  • Lack of interest in daily activities
  • Depressed feelings, feelings of hopelessness, negative thoughts about yourself
  • Suddenly sad or tearful; sudden sensitivity to criticism or rejection
  • Difficulty concentrating
  • Lethargy
  • Changes in appetite; lack of appetite, increase in appetite, unusual cravings
  • Sleeping more or less
  • Feeling out of control
  • Sudden bouts of anger
  • Suicidal thoughts
  • Heightened symptoms of PMS: tender breasts, cramping, bloating, muscle pain, and weight gain.


There's no current consensus on the cause of Premenstrual Dysphoric Disorder. However, it appears that your environment, your genes, your general mental health, and social factors all have a role to play in its development.

On the genetic side, 70% of women whose mothers have PMS have PMS themselves, compared to only 37% of women whose mothers did not have PMS. Similarly, 93% of women who have an identical twin with PMS will also have PMS, compared to only 44% of non-identical twins.[3]

There's also strong evidence that women who are prone to developing depressive disorders will develop PMDD. Various studies have found that between 30% and 76% of women who have PMDD also have lifetime histories of depression. A family history of depression has also been reported in women diagnosed with moderate to severe PMS.[3]

It's possible that serotonin deficiency may also be a cause of PMDD.

Environmentally, it appears being overweight, abusing alcohol or substances, and not taking exercise regularly may also have a role to play in the development in PMDD.


In order for a diagnosis of PMDD, at least five of the above symptoms must be present. They must only be present in the luteal phase (the period leading up to menstruation, and in the first day or two of menstruation), and should not represent an increase in depression, an anxiety disorder, or a personality disorder already present.[1,2]

In addition, these symptoms must be present for at least two consecutive menstrual cycles and - in order for PMDD to be diagnosed, rather than another mood disorder - you must be symptom-free during your follicular phase (that is, approximately, the first fourteen days of your cycle).

Next, we look at what can be done for PMDD sufferers.

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