In this article, we cover the main symptoms of PMDD, how to distinguish PMDD from PMS and how to get to a diagnosis for PMDD.
What is PMDD and when does it occur?
PMDD stands for premenstrual dysphoric disorder.
PMDD is a premenstrual and mood disorder that affects women during their reproductive years and encompasses both psychological and physical symptoms.
Symptoms of PMDD occur during the luteal phase (second half) of the menstrual cycle and are alleviated after the menstrual bleed and during the first half of the cycle (follicular phase).
Symptoms of PMDD lie at the more severe end of the continuum of premenstrual disorders.
How is PMDD different to PMS?
PMDD is considered much more severe than PMS.
PMS symptoms are typically symptoms of irritability, cravings, mood swings, cramps and tender breasts which occur in the week leading up to your period. In comparison PMDD may also have these symptoms but the mood changes extend to disrupt daily life quality including jobs, relationships and everyday tasks.
What are the symptoms of PMDD?
The common symptoms of PMDD include the following and are experienced in the second half of your cycle or luteal phase:
- Mood swings
- Suicidal thoughts
- Difficulty concentrating
- Excessive crying
- Increase in food cravings and appetite
- Feeling out of control
- Feeling of rejection
How PMDD is diagnosed
In order to be diagnosed with PMDD in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria the following must be present:
Timing of symptoms
In the majority of menstrual cycles, at least 5 symptoms must be present in the final week before the onset of menses, start to improve within a few days after the onset of menses, and become minimal or absent in the week post menses.
Symptoms of PMDD
One or more of the following symptoms must be present:
- Marked affective lability (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection).
- Marked irritability or anger or increased interpersonal conflicts.
- Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, and/or feelings of being keyed up or on edge.
- Decreased interest in usual activities.
- Subjective difficulty in concentration.
- Lethargy, easy fatigability, or marked lack of energy.
- Marked change in appetite; overeating or specific food cravings.
- Hypersomnia or insomnia.
- A sense of being overwhelmed or out of control.
- Physical symptoms such as breast tenderness or swelling; joint or muscle pain, a sensation of “bloating” or weight gain.
The symptoms are associated with clinically significant distress or interference with work, school, usual social activities, or relationships with others.
The DSM also states other psychiatric disorders must be considered, symptoms must not be due to the psychological effects of substance abuse and all other medical explanations have been excluded such as a thyroid disorder.
Blood tests cannot confirm a diagnosis as it is classified as a mood disorder.
What to do if you have PMDD
If you suspect you have PMDD or any of the symptoms are familiar to you, then the first step is to visit your GP for a diagnosis.
From there, there are many conventional and nutritional therapies that can help to address PMDD.
At FUTURE WOMAN, we encourage clients struggling with PMDD to test their hormones first and foremost in order to receive a personalised protocol of supplements and diet changes tailored to them and their unique hormone picture.
Read more about the FUTURE WOMAN approach to PMDD.
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Hantsoo, L., & Epperson, C. N. (2015). Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Current psychiatry reports, 17(11), 87. https://doi.org/10.1007/s11920-015-0628-3
Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American family physician, 94(3), 236–240.
Lanza di Scalea, T., & Pearlstein, T. (2019). Premenstrual Dysphoric Disorder. The Medical clinics of North America, 103(4), 613–628. https://doi.org/10.1016/j.mcna.2019.02.007
Reid RL. Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome) [Updated 2017 Jan 23]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Table 1, Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD) Available from: https://www.ncbi.nlm.nih.gov/books/NBK279045/table/premenstrual-syndrom.table1diag/