Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) and may affect up to 1 in 12 individuals who menstruate. Many of those with PMDD have also been diagnosed with anxiety or depression. 

This article reviews basic facts about premenstrual dysphoric disorder—including how common it is, who gets it, and how likely it is to cause complications.

PMDD Overview

Premenstrual dysphoric disorder (PMDD) is a chronic condition that affects some individuals who menstruate. It causes premenstrual syndrome (PMS) symptoms, such as fatigue, bloating, and breast tenderness. PMDD also causes severe anxiety, depression, and mood swings. Some people with PMDD may even experience suicidal thoughts. Hormonal birth control pills and antidepressant medications can help to manage the symptoms. 

How Common Is PMDD?

PMDD affects about 1 in 20 women of childbearing age in the United States. Other estimates have found that this number is closer to 1 in 12 women. PMDD does not impact those who do not menstruate.

PMDD by Ethnicity

The risk of PMDD may vary by ethnicity, but further research is needed. One study found that Black women in the United States were significantly less likely to be diagnosed with PMDD than White women. Of the study participants, 2.9% of the Black women had PMDD, and 4.4% of the White women had PMDD.

Another study found women of color born in the United States were more likely to experience PMDD than those who immigrated to the country. Researchers concluded that the more time women of ethnic minority spent in the United States, the higher their risk of PMDD. The study authors believe this was due to stressors, such as discrimination and poverty. 

PMDD by Age & Sex

PMDD affects individuals who menstruate. Women of reproductive age, from menarche to menopause, may be at risk of PMDD. Individuals with PMDD experience symptoms for an average of 6.4 days.

Most individuals who menstruate experience some discomfort before their periods:

  • Nine in 10 women in the United States report discomfort before their periods.One in 3 women in the United States experiences PMS symptoms.One in 12 women in the United States has PMDD.

Causes of PMDD and Risk Factors

For most people with PMDD, the exact cause is unknown. Healthcare providers believe decreasing levels of the hormones estrogen and progesterone before the menstrual period may play a role. The brain’s chemical serotonin may also be involved. Serotonin helps to regulate moods and fluctuates throughout the menstrual cycle. 

Known risk factors of PMDD include:

  • History of anxiety
  • History of depression
  • History of seasonal affective disorder (SAD)
  • History of traumatic events
  • Family history of PMDD

Other factors that may be linked to an increased risk of PMDD include:

  • Thyroid disorders
  • Obesity
  • Smoking
  • Alcohol or substance abuse
  • Lack of physical exercise

Screening and Early Detection

If you and your healthcare provider suspect you are experiencing PMDD, the first step is to undergo a physical exam and review your medical history. Your provider will likely perform a pelvic exam and thyroid testing to rule out other possible causes for your symptoms. 

Your healthcare provider will also refer you to a mental health provider for a psychiatric evaluation to test for other mental health conditions such as anxiety or depression. 

PMDD Symptoms

Diagnosis of PMDD is primarily based on your symptoms. Common symptoms of PMDD include:

  • Anxiety
  • Panic attacks
  • Irritability
  • Anger
  • Depression
  • Suicidal thoughts
  • Fatigue
  • Intense food cravings
  • Mood swings
  • Headaches
  • Insomnia

Diagnosis

To be diagnosed with PMDD, your symptoms must be evaluated using the DSM-5 criteria for PMDD:

  • You have experienced at least five symptoms before your periods for the last year.Your symptoms occur in the final week before your period (menstruation).Your symptoms start to improve within a few days after menstruation begins.

Your healthcare provider may ask you to fill out a questionnaire about your symptoms, including how long they last and how severe they are. 

Summary

PMDD is a severe form of PMS that causes discomfort, anxiety, depression, and mood swings one to two weeks before your period. It’s estimated that 1 in 12 women in the United States experience PMDD. The condition can affect anyone who menstruates. Possible risk factors of PMDD include a history of anxiety, depression, seasonal affective disorder, or a history of traumatic events. The exact cause of PMDD is unknown. Diagnosis depends on your symptoms and when they occur. 

PMDD Assessment Scale

Commonly used PMDD assessment scales include:

Frequently Asked Questions

  • How do I know if I have PMDD?
  • PMDD is a chronic condition that causes severe anxiety, depression, or mood swings in the weeks leading up to your period. If you suspect you may be experiencing PMDD, see your healthcare provider immediately.
  • What is the treatment for PMDD?
  • Those with PMDD often require treatment. Your healthcare provider may recommend hormonal birth control pills, antidepressant medications, or both.

PMDD is a chronic condition that causes severe anxiety, depression, or mood swings in the weeks leading up to your period. If you suspect you may be experiencing PMDD, see your healthcare provider immediately.

Those with PMDD often require treatment. Your healthcare provider may recommend hormonal birth control pills, antidepressant medications, or both.