Premenstrual Dysphoric Disorder (PMDD)

Written By Adriana Guarderas

Menstrual Cycle Phases

Before discussing Premenstrual Dysphoric Disorder (PMDD), it is essential to at least very briefly discuss the menstrual cycle phases since PMDD is affected by this cycle. Menstrual cycles usually last 28 days but can last between 25 and 35 days without causing alarm. (8) (Note: If you are concerned about the length of your menstrual cycle, don't hesitate to contact your primary care physician.)

Menstrual Phase: This is when your period starts, shedding your uterine lining and marks day one of the menstrual cycle. This phase typically lasts anywhere from three to seven days. (7)

Follicular Phase: This phase starts at the same time as the menstrual phase and typically lasts about 16 days, but the variation is relatively wide, sometimes lasting between 11 to 27 days. (11)

Ovulation Phase: This is the shortest phase of the menstrual cycle. It typically occurs in the middle of the cycle, on day 14, and lasts approximately 24 hours. (7, 11)

Luteal: In this phase, when PMDD symptoms begin to appear most prevalent and when PMS symptoms start, the body releases more hormones, like progesterone. This phase typically lasts 14 days, varying between 11 and 17 days, depending on the person and their typical cycle. (7, 11)

What is PMDD?

PMDD is a recently recognized disorder, being added to the Diagnostic Statistical Model (DSM) in 2013. (10) Approximately 3-8% of people who menstruate experience Premenstrual Dysphoric Disorder (PMDD); one study noted that the prevalence could be as high as 12%. (1, 4, 3) In the simplest terms, PMDD is a more intense and disruptive version of the more commonly known PMS (premenstrual syndrome). (4)

PMDD Symptoms and Diagnostic Criteria

In the DSM 5-TR (the latest version of the DSM), PMDD is categorized as a “Depressive Disorder” because, along with somatic, body-based symptoms, one of the most marked symptoms is increased and severe mood changes during the luteal phase of the menstrual cycle. (2) The symptoms of PMDD begin one to two weeks before menstruation starts and end a couple of days into menstruation. (6) It’s important to note that these symptoms likely wouldn’t present at other times in the menstrual cycle because that could indicate something else, such as depression or anxiety. (2) PMDD can include, but is not limited to, the following symptoms:

  • Mood swings, increased sadness, irritability, anger, hopelessness, and/or anxiety (feeling “keyed up” or “on edge”)

  • Feeling more overwhelmed than usual

  • Oversleeping or experiencing insomnia

  • Becoming easily fatigued

  • Brain fog

Other symptoms are listed in the DSM 5-TR, but these are some primary ones. These symptoms and timing during the menstrual cycle should be present in most of a person’s menstrual cycles. Often, for diagnosis, physicians will ask a client/patient to track the symptoms they experience throughout their menstrual cycle for at least two months to make an assessment; your physician may have a different approach, so please confirm with them! (2)

I think I have PMDD; what now?

  • Talk to Your Physician: Talk to your primary care physician about your symptoms, discuss your concerns, and develop a game plan. They will likely ask you to track your symptoms throughout two cycles so that they can make a formal diagnosis, if applicable. Some resources listed later in this post are PMDD tracking apps and self-screeners so you can provide your physician with as much information as possible. Please know that you can advocate for yourself if your physician does not hear you; it can sometimes be challenging to receive a formal PMDD diagnosis, so don’t give up and see if you can change providers if your current one does not work for you. (5)

  • Talk to Your Physician or Psychiatrist About Prescriptions: Selective Serotonin Reuptake Inhibitors (SSRIs) are effective in decreasing the intense symptoms of PMDD. (1, 4) Some SSRIs that have shown promising results for people who experience PMDD are fluoxetine, sertraline, and citalopram - resulting in improved mood, decreased tension, and less disruptive sleep - discuss with your prescribing physician the benefits and detractors of any potential prescription and do not take these medications without a prescription. (4)

  • Lifestyle Changes: Not the most fun, but some lifestyle changes are effective in decreasing the negative symptoms of PMDD. These lifestyle changes include reducing caffeine intake, reducing alcohol consumption, regular exercise (such as walking, strength training, etc.), and practicing good sleep hygiene. (4)

  • Psychotherapy: Going to therapy and sharing your experiences, concerns, and challenges from experiencing PMDD symptoms can be beneficial. PMDD can be exacerbated by stress, and treatment with a qualified therapist can help manage your stress levels, anxiety, and depressive symptoms. (9)

Resources

The resources below include organizations that support people with PMDD, a list of resources, and menstrual tracking apps explicitly made for tracking PMDD symptoms.



References

  1. Aateqa, H., Fariha, B., & Luba, L. (2024). Navigating unique diagnostic and therapeutic challenges in premenstrual dysphoric disorder: A case report. Cureus, 16(6) doi:https://doi.org/10.7759/cureus.63238

  2. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

  3. Babapour, F., Elyasi, F., Shahhosseini, Z., & Monirolsadate Hosseini Tabaghdehi. (2023). The prevalence of moderate–severe premenstrual syndrome and premenstrual dysphoric disorder and the related factors in high school students: A cross-sectional study. Neuropsychopharmacology Reports, 43(2), 249-254. doi:https://doi.org/10.1002/npr2.1233

  4. Battey, R. M. (2023). Premenstrual dysphoric disorder (PMDD) – an overview. South Africa Pharmaceutical Journal, 90(4), 29-32. https://www.proquest.com/scholarly-journals/premenstrual-dysphoric-disorder-pmdd-overview/docview/2889351208/se-2

  5. Chan, K., Rubtsova, A. A., & Clark, C. J. (2023). Exploring diagnosis and treatment of premenstrual dysphoric disorder in the U.S. healthcare system: A qualitative investigation. BMC Women's Health, 23, 1-9. doi:https://doi.org/10.1186/s12905-023-02334-y

  6. Johns Hopkins Medicine. (2024, April 26). Premenstrual dysphoric disorder (PMDD). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd

  7. OB-GYN, M. (2024, February 20). Understanding the four phases of the menstrual cycle. Understanding the Four Phases of the Menstrual Cycle. https://www.morelandobgyn.com/blog/4-phases-of-the-menstrual-cycle

  8. University of California San Francisco. (n.d.). Normal menstrual cycle: UCSF Center for Reproductive Health. UCSF. https://crh.ucsf.edu/about-fertility/normal-menstrual-cycle

  9. Saeideh, I. D., Mortazavi, S. S., Mohammad Arash, R. G., & Ashouri, A. (2024). Emotion-focused therapy for women with premenstrual dysphoric disorder: A randomized clinical controlled trial. BMC Psychiatry, 24, 1-11. doi:https://doi.org/10.1186/s12888-024-05681-8

  10. Schroll, J.B. and Lauritsen, M.P. (2022), Premenstrual dysphoric disorder: A controversial new diagnosis. Acta Obstet Gynecol Scand, 101, 482-483. https://doi.org/10.1111/aogs.14360

  11. Watson, S. (2023, March 13). Stages of menstrual cycle: Menstruation, ovulation, hormones, Mor. Healthline. https://www.healthline.com/health/womens-health/stages-of-menstrual-cycle#follicular

Adriana Guarderas adrianaguarderas.com
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