What is Premenstrual Dysphoric Disorder (PMDD)?

By Teen Health Source

What is PMDD?

People who get periods know how much the week before your period starts can suck! You might deal with a rollercoaster of emotions 0r other annoyances like acne and headaches. These symptoms, collectively known as premenstrual syndrome (PMS), shouldn’t be debilitating enough to impact your life at school, work, home, or your relationships. If that’s the case, there’s no shame in seeking help!

While doctors and other people in your life may write off what you’re experiencing as “typical period troubles,” that doesn’t make your concern or pain any less valid. If the symptoms before your period are especially difficult to manage, it could be due to premenstrual dysphoric disorder (PMDD), a more severe form of PMS.

Both PMDD and PMS symptoms begin about 7-10 days before your period and last for the first few days of it, but PMDD comes with more emotional and behavioural disruptions. For example, someone with PMS may feel quite low in the days leading up to their period and cry a lot more than usual, but someone with PMDD would become so sad that they’re bedridden and experiencing suicidal thoughts. While the exact cause of PMDD isn’t fully understood yet, it may be due to how your period’s hormonal changes can cause a deficiency of serotonin, a chemical in your brain and intestines that affects mood. Those who have mood disorders like depression, a family history of PMDD, or who smoke cigarettes a lot are more likely to develop it.

 

How do I know if I have it?

Common symptoms include:

• Sadness, hopelessness, feelings of worthlessness
• Anxiety or “feeling on edge”
• Mood swings
• Becoming tearful suddenly or frequently
• Increased self-criticism & rejection sensitivity
• Increased irritability
• Conflict with parents, friends, coworkers, and/or romantic partners
• Less interest in usual hobbies and activities
• Fatigue and lack of energy
• Overeating and/or binge eating
• Concentration issues
• Trouble falling asleep or oversleeping
• Physical symptoms of PMS: breast swelling/tenderness, headaches, joint/muscle aches, weight gain, and bloating

PMDD can resemble thyroid disorders, depression, and anxiety, but if you think you have symptoms of it, it’s worth looking into. This might mean seeking out a second opinion if you feel like you’re not being taken seriously when you first mention this to a doctor, other medical professional, or a parent/guardian.

The criteria for diagnosis is as follows:

• Must have 5 or more symptoms present during at least two cycles
• Symptoms happen only during what’s called the luteal phase (the days leading up to your period), but go away in the follicular phase (the week after your period)
• Symptoms must cause distress and/or affect your ability to function in work, social, or other settings
• Symptoms are not tied to or made worse by another condition

To receive a diagnosis, your doctor will recommend that you track your mental health and physical symptoms daily over the course of several months. Tracking how you feel for several months without receiving treatment can be difficult, so consider using a journal, an app that you can set reminders, or the resource we highlight below to make it easier to remember. It’s important to track this way because there are no lab tests (ex: blood, hormone, saliva) that can give you a diagnosis of PMDD. Lab tests can only rule out physical conditions like hormonal imbalances. Additionally, PMDD is directly tied to your menstrual cycle, so making note of when the symptoms happen is especially helpful for diagnosis. 

The International Association of Premenstrual Disorders (IAPMD) has created a free downloadable sheet called the Daily Record of Severity of Problems (DRSP). Every day for one month, you check off what symptoms you’re experiencing (i.e.: irritability, increased appetite) and rate how severe each one is. Because you’ll have to do symptom tracking for at least two cycles, print out two sheets. You can find the DRSP here: https://www.iapmd.org/shop/p/iapmd-pmds-symptom-tracker

 

How do I treat it?

While PMDD can’t be cured, there are plenty of options for treating it, remember to talk to your doctor or a physician before starting any new medication or supplement:

• Antidepressants known as selective serotonin re-uptake inhibitors (SSRIs) can help with emotional symptoms, fatigue, and sleep issues. You can either take them all month, or only during the window between ovulation (when your ovary releases an egg) and the first day of your period.
• Birth control pills with a shortened pill-free window (or none at all) can make your PMDD symptoms less intense.
• Calcium, magnesium, B6 supplements, and herbal remedies like chasteberry, which can be purchased over-the-counter, may also help. 
• Increasing lean protein (i.e. chicken breast, tofu eggs) and complex carbohydrates (i.e. brown rice, quinoa, oats) in your diet will stabilize your blood sugar and boost the release of tryptophan, a building block for the mood-regulating chemical serotonin. This reduces irritability and mood swings. Limit eating foods high in refined sugar and salt when you have premenstrual symptoms, as they tend to cause blood sugar spikes that lead to worsened fatigue and mood problems. If you decide to cut back on refined sugar, honey and maple syrup are solid sweetener choices, for cutting back on salt opt for fresh produce and meat instead of processed or canned versions.
• Reduce caffeine, alcohol, and nicotine intake in the days leading up to your period because these can make anxiety, irritability, and sleep issues worse.
• Regular exercise and stress management techniques like meditation and yoga can counter mood symptoms by releasing endorphins, pain-relieving and mood-boosting chemicals found in your body.

We strongly advise you to follow the directions of your doctor, especially when taking antidepressants, supplements, and birth control pills. All of these can have an adjustment period and serious side effects!

Further Reading

• IAPMD PMDs Symptom Tracker
• Evelyn – Cycle Tracking for PMDD diagnosis: why it matters
• Teen Health Source – Dealing with PMS Symptoms

If you have questions about this topic, feel free to contact one of our peer educators. [Link]

Last Updated: January 2026