What In The Actual Hell?

Premenstrual Dysphoric Disorder: What You Need to Know

Premenstrual Dysphoric Disorder (PMDD), is an extreme form of Premenstrual Syndrome (PMS) that can have serious physical and emotional effects. It affects up to 8% of all menstruating women, and it can be a difficult condition to manage. Here is what you need to know about PMDD.

Causes of PMDD

The cause of PMDD is not known. It’s believed to be related to hormonal fluctuations during the menstrual cycle that affect the production of certain neurotransmitters in the brain, such as serotonin. Some researchers also believe that genetics may play a role. More research is needed.

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More Research Is Needed

The Difference Between PMS and PMDD

PMS and PMDD are both caused by hormonal changes leading up to menstruation. PMS is marked by physical and psychological discomfort such as mood swings, cramping, bloating, breast tenderness, headaches, fatigue and irritability. These premenstrual symptoms are often mild enough that they don’t interfere with everyday activities.

PMDD, is characterized by much more severe premenstrual symptoms. In fact sometimes PMDD is referred to as severe premenstrual syndrome, affecting both physical and emotional functioning.

Women may have extreme mood swings, depression, anxiety and irritability. They may also experience insomnia, severe physical pain, and extreme fatigue. Premenstrual symptoms for women with PMDD can be so severe that they interfere with day-to-day activities; in some instances they can cause suicidal ideation.

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If you believe that someone else is in danger of suicide and you have their contact information, contact your local law enforcement for immediate help. You can also encourage the person to contact a suicide prevention hotline using the information above.

PMDD Symptoms

PMDD is characterized by a severe premenstrual flare-up of physical and emotional symptoms that can interfere with daily life.

Psychological symptoms may include irritability, fatigue, depression, anxiety, difficulty concentrating, poor self image, and changes in sleep patterns.

Premenstrual symptoms related to fluid retention, respiratory problems, eye complains, skin problems, and gastrointestinal symptoms including abdominal cramps, pelvic heaviness, nausea and vomiting are included in the list of physical symptoms of PMDD.

Other premenstrual symptoms including pressure headaches or migraines, changes in appetite, food cravings, heart palpitations, and diminished sex drive are also part of the 49 most common symptoms of premenstrual dysphoric disorder as listed by John Hopkins Medicine online.

What sets PMDD apart from PMS is the severity of symptoms.

It Can Be Hard To Get A Diagnosis


In order to diagnose PMDD a doctor will review your symptoms and the patterns associated with those symptoms. It’s important to keep track of your symptoms and their timing so that you can provide the doctor with accurate information about when they occur. It’s also important to be honest about the severity of your symptoms.

To make the diagnosis of PMDD, at least five mood and physical symptoms must be present in the week or two before your period for most menstrual cycles. And these symptoms must subside within a few days of starting your period as quickly as they come on.

A PMDD Diagnosis Can Take Time

We’ve read that it can take anywhere from 3 months to 12 years to be diagnosed with PMDD.  This is because symptoms of PMDD often come and go, and a physician needs to be able to identify any patterns that may exist. Further, most women, and most doctors, are not taught about when menstrual cycles require medical attention.

We also don’t usually know how to push back when a doctor is dismissive of our symptoms.

It Can Be Hard To Get The Right Diagnosis

This leads to under diagnosis, where patients are told that their psychological, and particularly their physical symptoms associated with their menstrual cycles, are just part of being a woman.

Misdiagnosis is also often common, such as depression or ‘you just have PMS’. And sometimes patients are over diagnosed; according to Harvard Health, it is all too common for women with PMDD to be incorrectly diagnosed with a mood disorder.

Based on this information, we suspect that the 8% population described above is low and that many women are simply taught to think that their severe symptoms are just part of their menstrual cycle, or in the other extreme that they are experiencing severe mood disorders.

PMDD and Perimenopause

PMDD can sometimes worsen during perimenopause. This is due to the hormonal changes that occur during this transition period, particularly estrogen levels that can fluctuate significantly.

As perimenopausal women often struggle to understand what is happening to their bodies due to a lack of education and research on everything related to the menopausal transition, the importance of tracking your menopausal symptoms, particularly during the luteal phase of your menstrual cycle is really important.

As a reminder, the luteal phase of your cycle happens in the second phase of your menstrual cycle. In a 28-day cycle it begins around day 15 and ends when you get your period.

Medication for PMDD

Medications are often required to manage PMDD symptoms. These include antidepressants and oral contraceptives. The low-dose birth control pill called Yaz is FDA approved for treatment of PMDD. Other birth control pills with similar formulations are prescribed to treat PMDD; this is considered off-label use. Your doctor can explain the risks and benefits of each treatment option. While medication is important, treatment typically needs to extend beyond medication and include other strategies as outlined below.

Lifestyle Strategies for PMDD

Making small changes to your diet and lifestyle can help relieve PMDD symptoms. Eating a balanced diet that is low in processed foods, avoiding alcohol and caffeine, getting out for walks regularly, and engaging in relaxation techniques can all help reduce the severity of physical and emotional symptoms. Getting enough sleep is also very important. We know this last one can be particularly tricky.

It’s important to remember that everyone’s experience with PMDD is different, so the best approach will be one that works for you. Talk to your doctor if you are concerned about any of the symptoms of PMDD or are feeling overwhelmed by your menstrual cycle.

You should be thriving, not just surviving. If you are indeed, just surviving, know that you deserve better and that being miserable, and in some cases desperate, on a monthly basis is no way to live.

Cognitive Behavioral Therapy and PMDD

Cognitive behavioral therapy (CBT) is a type of psychotherapy that focuses on identifying and changing unhelpful thoughts and behaviors. This approach can be beneficial in managing psychological symptoms as it helps to identify the underlying cause of feelings such as depression, anxiety, or irritability.

CBT can also help people learn new coping strategies and gain insight into the behavior patterns that may contribute to symptoms women experience in the luteal phase of their menstrual cycles.

CBT involves learning a range of skills, such as relaxation techniques, problem-solving methods, and communication skills. Working with a mental health professional who specializes in CBT can help PMDD sufferers develop these skills and find ways to better manage their symptoms.

Supplements for PMDD Management

There are supplements that may help manage symptoms. For example, omega-3 fatty acids have been found to be effective in reducing the intensity of PMDD symptoms such as depression and irritability. Vitamin B6 and calcium have also been shown to reduce premenstrual mood swings.

It’s important to remember that supplements can interact with medications and have risks, so it is best to speak with your doctor or pharmacist before trying any new supplement or herbal remedy.

Alternative Treatments for PMDD

In addition to medications and lifestyle changes, there are several alternative treatments that may help with PMDD symptoms. These include acupuncture, yoga and meditation, and massage therapy. Each of these approaches can be beneficial in reducing stress levels and improving emotional regulation.

It’s important to remember that not all alternative treatments have been studied for safety and effectiveness, so it is best to speak with your doctor before trying anything new. Additionally, some alternative treatments may interact with medications or other therapies, so it is important to discuss any potential risks with your doctor prior to using any new treatment.

Navigating the Emotional Impact of PMDD

Having PMDD can be emotionally difficult. It’s important to remember that seeking help for your symptoms is the best way to manage them. Sometimes it takes persistence to get the help you need. That can make having a supportive social network particularly beneficial. Whether you have friends, family, or an online support group, talking about your challenges and hearing about how others are navigating their health can be empowering.

Getting support from a mental health professional can help you learn the skills mentioned above, and they can also help you learn to advocate for the care and support you deserve. Too many of us are still being dismissed and left to believe that suffering is okay. It is not.

Finding ways to take breaks and rest, even if small, can make a big difference. Taking regular breaks from your daily routine can help reduce stress levels and improve your mood. This can be as simple as setting an alarm several times a day to practice deep breathing for a few minutes.

In addition to improving physical symptoms, working on your sleep hygiene routine, exercising regularly, and eating a healthy diet can all help you to better manage the emotional impact of PMDD.

self care can help with premenstrual dysphoric disorder
Make Your Health A Priority

Tips for Managing PMDD

Here are some tips to help you navigate PMDD and perimenopause:

  • Make your health a priority and decide to take charge of managing your wellbeing.
  • Track your symptoms in conjunction with your menstrual cycles and write them down.
  • Prepare for your medical appointments. Bring a list of questions, and share the information you have found and what treatment options you would like to explore.
  • Be honest with your medical provider – don’t downplay your symptoms.
  • Find an online support group for PMDD and/or perimenopause.
  • Talk to your friends; you may be surprised to hear about their experiences and struggles.
  • Understand that there is never only one solution: you will need to develop a tool box to manage both PMDD and perimenopause.
  • What is works for you today will likely need to be tweaked or changed in the future.

The Hero Bit

Managing PMDD can be difficult, but it’s important to remember that you’re not alone. There are support groups and online communities where people who have similar experiences can connect and offer advice and encouragement. Having a supportive network of friends and family members can also be very helpful.

PMDD can be a difficult condition to manage, especially as it’s often dismissed as PMS. If you think you may have PMDD, start tracking your symptoms in conjunction with your menstrual cycles. Tracking your symptoms to provide your doctor with accurate information will help you advocate for the care you need.

Both perimenopause and PMDD do not figure prominently, if at all, in most medical school curriculums. It’s important to know that getting the care you deserve may take some time. Try not to get discouraged and persevere.

Taking charge of your health can be daunting, but will allow you to write the health story you deserve.


The intent of this information is to provide the reader with knowledge to support more efficient and effective communication with their medical providers. This information is not intended as medical advice.