PMDD: A Severe Form of PMS

What is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual syndrome, or PMS, refers to the changes in a woman's mood along with certain physical symptoms relating to her menstrual cycle that are significant enough to affect her quality of life.

Most experts agree that while PMS can cause significant distress, some women seem to have even more severe cyclical symptoms that may actually lead to physical or mental loss of function. These women are considered to suffer from premenstrual dysphoric disorder (PMDD), an unusually severe form of PMS.

The symptoms of PMDD generally begin the week before menstruation and end a few days after menstruation has begun. Women with PMDD may experience drastic mood swings, anger, depression, irritability, tension, sleep and appetite changes, fatigue, and physical problems such as pain or bloating. PMDD affects an estimated 3% to 8% of women of reproductive age.

The cause of PMDD (and PMS) is not certain but appears related to hormonal changes that accompany the menstrual cycle. Some evidence suggests a connection between PMDD and the levels of serotonin, a neurotransmitter (a chemical in the body that helps the brain transmit information).

PMDD seems to be more common in women who have experienced depression. And conversely, a woman with PMDD is at an increased risk for the development of depression.

Diagnosis of PMDD

To establish a diagnosis of PMDD, your doctor will perform a thorough physical examination to rule out any gynecological problems that could be causing your symptoms. Sometimes a psychiatric evaluation is included in the diagnostic process, since some emotional disorders such as panic and anxiety disorders may produce symptoms similar to those of PMDD.

While PMS is most often treated with over-the-counter pain medications (such as ibuprofen), PMDD may require treatment with antidepressant medications of the SSRI (selective serotonin reuptake inhibitor) type. Fluoxetine (Sarafem, Prozac) and sertraline (Zoloft) are common SSRI antidepressants that have been shown to provide relief for women with PMDD. Your doctor may recommend that these medications be taken continuously or only at certain times during the menstrual cycle.

While regular fitness has been shown to provide relief for PMS, it remains unclear whether exercising can improve the symptoms of PMDD. Sometimes prevention of ovulation by taking birth control pills is recommended to control the symptoms of PMDD.

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Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care


"Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder"