Premenstrual Dysphoric Disorder (PMDD)


It’s common for women to experience physical, emotional and behavioral changes attributable to different phases of their menstrual cycles. But for some women, these changes are severe and recurring. These changes, called premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), typically begin after ovulation and gradually worsen until the start of menstruation.


PMDD and depression share many of the same symptoms. The most common symptoms of PMDD include:

Depressed mood
Anxiety or tension
Decreased interest or pleasure in activities
Difficulty concentrating
Low energy
Change in appetite
Changes in sleep (either sleeping too much or too little)
Feeling overwhelmed
Joint or muscle pain
Breast tenderness

It’s common for women to experience some emotional and physical symptoms prior to their monthly period. But for 3% to 4% of women, those symptoms are severe enough to interfere with their daily activities and relationships. It appears that these women have an abnormal response to the normal hormone changes associated with the menstrual cycle. Research is underway to discover what makes some women more susceptible to PMDD. Possible risk factors include:

A vulnerability to the effects of hormones on mood
A history of depression or mood disorders
Individual differences in the brain
Women with PMDD are at greater risk of developing depression, including postpartum depression, underscoring the importance of prompt diagnosis and treatment. If you are experiencing the symptoms of PMDD, speak with your healthcare provider right away.


To determine the connection between symptoms you may be experiencing and your menstrual cycle, it’s important to keep a record of your symptoms over an entire month. Use a calendar to record when you experience symptoms. It will be a helpful tool for you and your healthcare provider to use to determine a course of treatment.


The good news is, there are many proven options for treating PMDD. Together, you and your healthcare provider can develop a comprehensive treatment plan that addresses your symptoms.

Antidepressant medications can be highly effective in relieving premenstrual symptoms. There are many safe, effective and well-tolerated antidepressants to choose from. Some studies suggest that taking antidepressants only during the last half of the premenstrual cycle may yield the most benefit. Read more about antidepressants here, then talk with your healthcare provider about whether an antidepressant might be right for you.

Herbal remedies, dietary supplements and alternative medicine
Unfortunately, very little scientific evidence supports alternative treatments for depression, and because these remedies are not regulated, there is no standardized information about ingredients or dosing instructions. Some supplements or remedies may have a negative interaction with antidepressants or other medications you may be taking. Be sure to talk to your healthcare provider before taking any herbal or dietary supplements.

Either alone or in combination with medications, psychotherapy, sometimes called “talk therapy,” has been shown to be effective in helping patients manage the symptoms of depressive conditions like PMDD. Two approaches, Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) are particularly effective in the treatment of depression. These are treatment options worth discussing with your healthcare provider.

In addition to pursuing medication and psychotherapy as strategies to treat your symptoms, there are a number of actions you can take on your own to feel better. The Take Care of Yourself section of this website contains useful information about incorporating the following self-care strategies into your treatment plan:

The symptoms of PMDD can be a drain on your energy and enthusiasm. A good support system is important for overcoming PMDD. Consider asking for extra help with housekeeping and childcare during difficult times of the month. And keep to a reasonable schedule. Remember: you don’t have to do it all yourself.

For improving both physical health and mood, there’s no substitute for physical activity. Most experts suggest striving for 30 minutes of physical activity, three times a week, but as little as 10 minutes a day has been shown to be beneficial. Happily, the activity doesn’t have to be strenuous to make a difference. A brisk walk is all it takes.

Stress management
Stress can make the symptoms of PMDD even worse. The demands of everyday life can seem overwhelming when you’re suffering from PMDD. Relaxation techniques like deep breathing, deep muscle relaxation, biofeedback, yoga, meditation and massage can be useful in reducing symptoms. Spending time with others, and making time to participate in activities you enjoy are also good practices. Read more about stress and stress-relievers here, and talk to your healthcare provider about establishing a plan to keep stress in check.

Getting enough good quality sleep is important for promoting good physical health, and essential for managing the symptoms of PMDD. Take time to learn about establishing good sleep habits, and make sleep a priority.

Eating a well-balanced diet and following a regular eating schedule are important ways you can care for yourself. Consuming less refined sugar, caffeine, alcohol and chocolate may also help, as may taking a calcium supplement. In addition to the nutrition advice available on this website, which is focused on controlling the symptoms of depression, your healthcare provider may make specific recommendations about foods to eat or avoid, as well as vitamin and mineral supplements to take.

More information about depression in women at different life stages:

Depression during pregnancy
Postpartum depression
Depression during menopause