Premenstrual Dysphoric Disorder (PMDD)

PMDD stands for premenstrual dysphoric disorder. It is a kind of PMD (premenstrual disorder), i.e., a disorder that happens in the luteal phase of the menstrual cycle that improves with the onset of your period.

A PMDD diagnosis* is given when you meet five of the following 11 symptoms, and you must have at at least one of the first four bolded symptoms:

  1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
  2. Marked anxiety, tension, feelings of being “keyed up” or “on edge”
  3. Marked affective lability
  4. Persistent and marked anger or irritability or increased interpersonal conflicts
  5. Decreased interest in usual activities (eg., work, school, friends, and hobbies)
  6. Subjective sense of difficulty in concentrating
  7. Lethargy, easy fatigability, or marked lack of energy
  8. Marked change in appetite, overeating, or specific food cravings
  9. Hypersomnia or insomnia
  10. A subjective sense of being overwhelmed or out of control
  11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.

The other aspects of this diagnosis include:

  • symptoms are so severe that they interfere significantly with social, occupational, sexual, or scholastic functioning.
  • symptoms are related to the menstrual cycle — they occur in the second half of the cycle and go away  when your period starts.
  • these criteria must be met for at least two consecutive menstrual cycles. 

the outline of a brain in black and white with splotches of paint on the right side and math on the left. There is a magenta rectangle with the acronym PMDD in white on top of the brain.

We don’t fully understand PMDD; however, we’re coming to understand that post-ovulatory progesterone production has a paradoxical impact on the brain and creates the symptoms experienced in PMDD.

Please seek out care if you are experiencing the symptoms listed above. PMDD can really get in the way of life and relationships. It’s also important to tease out whether it is PMDD or a different mental health diagnosis that gets worse before your period. This is called PME or a premenstrual exacerbation. This will allow you to get the appropriate care for you.


*Diagnostic criteria from Stat Pearls 2022