Premenstrual Dysphoric Disorder (PMDD)

Premenstrual symptoms

What Is Premenstrual Dysphoric Disorder?

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of premenstrual syndrome (PMS). Many women experience fleeting physical and psychological changes around the time of their menstruation. In fact, at least 75% of women with regular menstrual cycles report unpleasant physical or psychological symptoms premenstrual. For most women, symptoms are mild but for a certain group of women, these symptoms can be disabling. PMDD causes severe, debilitating symptoms that interfere with a woman’s ability to function. The main symptoms that distinguish PMDD from other mood disorders or menstrual conditions is when symptoms start and how long they last.

Symptoms of PMDD:

Symptoms of PMDD can emerge 1-2 weeks preceding menses and typically resolve with the onset of menses. Diagnosis of PMDD occurs when over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:

  • Depressed mood
  • Anger or irritability
  • Trouble concentrating
  • Lack of interest in activities once enjoyed
  • Moodiness
  • Increased appetite
  • Insomnia or the need for more sleep
  • Feeling overwhelmed or out of control
  • Other physical symptoms, the most common being belly bloating, breast tenderness, and headache
  • Symptoms that disturb your ability to function in social, work, or other situations
  • Symptoms that are not related to, or exaggerated by, another medical condition

Confirming the Diagnosis of PMDD

The best way to confirm the diagnosis of PMDD is discussion with your General Practitioner and charting of symptoms. Women with PMDD will experience symptom-free intervals between menses and ovulation (luteal phase). Several well-validated scales for the recording of premenstrual symptoms include:

  • Calendar of Premenstrual Experiences (COPE)
  • Daily Record of Severity of Problems (DRSP)

How common is it?

PMDD is a medical illness that impacts only 3% to 8% of women usually emerging during a woman’s 20’s. These symptoms may worsen over time; for example, it has been observed that some women may experience worsening premenstrual symptoms as they enter menopause. Less commonly, PMDD may begin during adolescence, with case reports suggesting that successful treatment options in adolescents with PMDD are like those used for adult women. The major risk factors for PMDD include psychiatric history of a mood or anxiety disorder, family history of premenstrual mood dysregulation and are aged in their late 20’s to mid-30’s.

What is the treatment for PMDD?

The psychological treatment of choice for Premenstrual Dysphoric Disorder is Cognitive Behaviour Therapy (CBT), aimed at symptom management. Another beneficial treatment option is Acceptance and Commitment Therapy (ACT), which helps an individual learn to live a meaningful life alongside their symptoms – if symptoms persist. A number of medical treatment options may be complimentary to psychological therapy, which can be discussed with your GP.



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