What Causes Premenstrual Dysphoric Disorder (PMDD)?

Medically Reviewed by Jabeen Begum, MD on March 06, 2024
5 min read

Premenstrual dysphoric disorder (PMDD) is a health problem similar to premenstrual syndrome (PMS), but it’s more serious.


It's likely that you’ve had some type of PMS since you started your period. Doctors believe that as many as three-quarters of women who get periods have some signs of PMS, whether it’s food cravingscramps, tender breasts, moodiness, or fatigue.

But PMDD is different. It causes emotional and physical symptoms similar to PMS, but people with PMDD find their symptoms draining. Your PMDD symptoms could interfere with your daily life, including work, school, social life, and relationships.

The symptoms of PMDD usually show up the week before your period starts and last until a few days after it begins. Most of the time, they’re severe and exhausting, and they can get in the way of your daily activities.

Symptoms of PMDD include:

Psychological PMDD symptoms

  • Mood swings
  • Depression or feelings of hopelessness
  • Thoughts of suicide
  • Intense anger and conflict with other people
  • Tension, anxiety, and irritability
  • No interest in your usual activities
  • Trouble concentrating
  • Feeling out of control
  • Sleep problems
  • Nervousness
  • Fatigue
  • Confusion
  • Forgetfulness
  • Poor self-image
  • Paranoia
  • Emotional sensitivity
  • Crying

Other PMDD symptoms

  • Appetite changes
  • Cramps and bloating
  • Breast tenderness
  • Headaches
  • Joint or muscle pain
  • Hot flashes
  • Constipation
  • Nausea
  • Vomiting
  • Pressure in your pelvis
  • Backache
  • Acne
  • Skin inflammation and itching
  • Flare-ups of other skin conditions
  • Dizziness
  • Fainting
  • Easy bruising
  • A fast-beating or fluttering heart (heart palpitations)
  • Muscle spasms
  • Swelling in your ankles, hands, and feet
  • Weight gain
  • Peeing less than usual
  • Allergies
  • Infections
  • Vision changes
  • Eye infection
  • Less coordination
  • Lower sex drive
  • Food cravings

Researchers don’t know the exact cause of PMDD. Most think it may be an abnormal reaction to hormone changes related to your menstrual cycle.

PMDD affects up to 10% of women or people assigned female at birth (AFAB) of childbearing age. Many people with PMDD may also have anxiety or depression.

Studies show a link between PMDD and low levels of serotonin, a chemical in your brain that helps transmit nerve signals. Certain brain cells that use serotonin also control mood, attention, sleep, and pain. Hormonal changes may cause a decrease in serotonin, leading to PMDD symptoms.

Other risk factors for PMDD include:

  • Anxiety or depression
  • PMS
  • A family history of PMS, PMDD, or mood disorders
  • A history of trauma, abuse, or other stressful life events

If you have any of the classic PMDD symptoms, see your doctor. They’ll check your medical history and give you a thorough exam. The doctor will do some tests to find out how you’re feeling emotionally and mentally.

Before they diagnose you with PMDD, the doctor will make sure that emotional problems, such as depression or panic disorder, aren’t causing your symptoms. They’ll also rule out other medical or gynecological conditions, such as endometriosisfibroidsmenopause, and hormone problems.

Your doctor can diagnose you with PMDD if:

  • You have at least five of the symptoms listed above.
  • Your symptoms start 7-10 days before you get your period.
  • Your symptoms go away shortly after you start bleeding.

If you’re dealing with these issues daily and they don’t get better when your period starts, it’s unlikely that you have PMDD.

If you’re trans or nonbinary

People who are trans or nonbinary can get PMDD. If you've had a poor experience with doctors in the past, you may have trouble opening up to them about your symptoms. Look for a doctor who's knowledgeable in treating trans and nonbinary patients.


Researchers have found a possible link between ADHD and PMDD. Some women with ADHD have worse symptoms in the week leading up to their period, which causes challenges in treatment. A boost in ADHD medicine during this time could help improve ADHD and mood symptoms, but more research is needed.

Many of the things you do to manage PMS can also ease your PMDD symptoms.

Common treatments include:

Birth control for PMDD

Birth control pills could ease your PMDD symptoms by shortening or stopping your periods, but there's no guarantee. Some people say the pill makes their symptoms worse. Talk to your doctor about a 3-month trial to see if it works for you.

PMDD medications

Some over-the-counter pain relievers such as aspirinibuprofen, and nonsteroidal anti-inflammatory drugs (NSAIDs) may ease symptoms such as headache, breast tenderness, backache, and cramping. Diuretics, also called “water pills,” can help with fluid retention and bloating.

Vitamins and supplements

For some, about 1,200 milligrams a day of dietary and supplemental calcium may help with symptoms. Vitamin B6, magnesium, and L-tryptophan also may work, but consult your doctor before taking any supplements.

Some studies suggest that chasteberry (Vitex agnus-castus) is good for PMDD, but there isn’t enough research to be sure. The FDA doesn't control herbal supplements, so talk with your doctor before trying one.

Talk therapy and relaxation techniques

Talking to a therapist may also help you find new ways to manage PMDD. Relaxation therapy, meditation, reflexology, and yoga might also provide you relief, but they haven’t been widely studied.

Without treatment, PMDD can trigger depression and even suicide. It can also take a serious toll on your relationships and career. Call the Suicide and Crisis Lifeline at 988 if you're having suicidal thoughts or are concerned about a loved one. It's free, anonymous, and available around the clock.

It's important to take care of yourself when you have PMDD. Here are some tips for living with the condition:

  • Get support. Join a peer support group for people living with PMDD. The International Association for Premenstrual Disorders (IAPMD) has more information about online support.
  • Create a self-care box. This is a box of things that help you feel better, such as a book you really like, notes of support, or a notebook and pen to jot down your thoughts.

If your loved one has PMDD, here are some ways you can support them and yourself:

  • Take it seriously. Understand that PMDD is a real condition with serious effects. Avoid dismissing your loved one's problems as common issues.
  • Be understanding. Learn about PMDD to understand what they're going through. Ask them about their personal experiences with the condition.
  • Ask how you can offer support. Discuss what support your loved one needs, whether emotional or practical.
  • Be patient. Understand that they may act differently during PMDD episodes. Be patient and wait until symptoms pass before addressing any issues.
  • Comfort them. Offer comfort by assuring them that their symptoms will pass, and you're there to support them.
  • Plan around their monthly cycle. PMDD symptoms and plan activities or support around them.
  • Support them to get help. Encourage them to get professional help and support them through the process.
  • Take care of yourself. Set boundaries, share caregiving duties, and talk to others about your feelings to maintain your own mental health.

PMDD is like a more severe version of the typical PMS that many people have before their periods. While PMS might cause symptoms such as mood swings or fatigue, PMDD can be much more intense. It can disrupt your daily life, making it hard to work, study, or maintain relationships.

Symptoms include mood swings, depression, anger, anxiety, fatigue, and physical discomfort such as cramps and headaches. Treatment options range from medications such as antidepressants to lifestyle changes such as diet, exercise, and stress management. Some herbal supplements and alternative therapies may also offer relief, but you should talk to your doctor before trying them.