At a glance
- Premenstrual dysphoric disorder is a chronic, cyclical mood disorder that affects 5 percent of women
- Hormone fluctuations and increased sensitivity to these changes are natural causes of PMDD
- You’re not alone — there are multiple treatments to explore with your primary care provider or OB/GYN
“This is normal and just what it means to be a woman.”
“I’m just being dramatic — it’s not really that bad.”
Far too many women have told themselves something like this during the week leading up to their period
Premenstrual syndrome (PMS) symptoms — like changes in mood, cramping or lack of interest in normal activities — are common for most menstruating people. But others face something more severe: premenstrual dysphoric disorder (PMDD)
Understanding PMDD starts with knowing it exists
Premenstrual dysphoric disorder is a chronic mood disorder that occurs roughly one to two weeks prior to the start of each period. It gets better within a few days of the period starting
Those with PMDD will likely have typical PMS symptoms, such as bloating or muscle aches, but their mood-related symptoms are significantly worse
Roughly 5 percent of menstruating women have PMDD. However, those numbers don’t account for the many more who are undiagnosed
“We need to remember that we’re not alone. … A woman doesn’t have to feel like something is wrong with them. If you’re missing school, work or activities that you enjoy, seek help.”
There’s such a stigma around having a period, explains Jess Keesee, MD, FACOG (they/them), an OB/GYN at MultiCare Capital Women’s Health
Society often tells people that periods are “gross” or abnormal. This leads women to not talk about their periods, or assume that whatever they’re experiencing is the same for everyone
Combine that with the stigma often associated with seeking mental health care — as well as a lack of education about menstrual-related conditions — and it’s not surprising that PMDD often goes overlooked and untreated
“I try to reduce those stigmas for people by reassuring them that their symptoms don’t mean something is wrong with them,” Dr. Keesee says. “This is a fairly common condition, and it’s OK to seek treatment and help for it.”
When we as a community normalize conversations around things like PMDD, it helps people realize they don’t have to live with a debilitating condition, they add
What are the signs & causes of PMDD?
The exact cause of PMDD isn’t clear. A leading belief is that some people are naturally more sensitive to the hormone fluctuations that occur during the luteal phase of the cycle, explains Harjeet Sekhon, MD, FACOG (she/her), an OB/GYN at MultiCare Women’s Center – Northshore
The luteal phase occurs after ovulation and ends when your period starts. It lasts about two weeks. Estrogen, which can affect the body’s serotonin levels, and progesterone, a natural brain-calming hormone, both naturally fluctuate during this phase
People with underlying or preexisting mental health conditions, such as depression, anxiety or gender dysphoria, may also be at greater risk of developing PMDD, Dr. Keesee adds
Some evidence shows that women who watched their mothers deal with intense or emotionally draining periods are more aware of these symptoms and experience increased sensitivity to them, Dr. Sekhon explains. A genetic connection hasn’t been proven, though
PMDD is most common in women of reproductive age (20 to 40). It can escalate during perimenopause, when hormones are likely to surge up and down, Dr. Sekhon adds. Most women with PMDD experience a natural improvement once in menopause or during pregnancy
The most common symptoms of PMDD include mild to severe:
- Mood swings
- Anger and irritability
- Feelings of hopelessness
- Anxiety
- Feeling out of control
- Difficulty concentrating
- Lethargy
- Changes in appetite
- Difficulty performing daily activities
- Suicidal thoughts
Symptoms vary person to person, but if they’re interfering with your daily life or relationships, talk with your primary care provider or OB/GYN
“We need to remember that we’re not alone. Most women have some type of symptom, so being aware and being able to find someone to get through it with, and be heard by, is so important,” Dr. Sekhon says. “A woman doesn’t have to feel like something is wrong with them. If you’re missing school, work or activities that you enjoy, seek help.”
PMDD is complex, but treatment and relief are possible
If your monthly experience sounds like PMDD, schedule an appointment with your primary care provider or OB/GYN. Also, start tracking your cycle and symptoms as soon as possible
“We need to see those cycles and symptoms for at least two full months before we can move forward with any treatment plan,” Dr. Keesee explains. “If you’re having symptoms all month long or after your period, we’ll need to look at other mood disorders, so it’s important to know when those symptoms are happening.”
Relief is possible, but you’ll have to be patient, says Dr. Sekhon. After tracking your cycle and symptoms for at least two months, then beginning treatment, it will likely take a few months to feel any improvement
The most common options for your first level of treatment include:
Selective serotonin reuptake inhibitors (SSRIs):Medications like sertraline (Zoloft) or fluoxetine (Prozac) can be prescribed to be taken during the luteal phase of your cycle
SSRIs often provide more immediate improvement than other treatment options, Dr. Keesee says. They must be taken each month, though, or symptoms are likely to return
For people already prescribed SSRIs for a preexisting mental health condition, your prescriber can explore dosing options to better meet your needs during the luteal phase, Dr. Sekhon adds
Ready to explore your PMDD treatment options?Find a Doctor
Hormonal oral contraceptives:The combined hormonal birth control pill (estrogen and progesterone) can help keep hormone levels consistent throughout the cycle and reduce PMDD symptoms, Dr. Sekhon explains. You’ll need to take them for at least two to three months to notice effectiveness
Hormonal birth control suppresses the ovaries. It can be especially effective when the placebo week is skipped each month, which keeps that suppression consistent, Dr. Keesee adds
Cognitive behavioral therapy:This form of therapy helps you reframe negative and emotional thought patterns and instead focus on problem-solving, relaxation and stress management, Dr. Sekhon says
Therapy can be beneficial by itself, but it can also provide short- and long-term benefits when combined with SSRIs, Dr. Keesee adds
Holistic options:Many women with PMDD have found symptom relief by exploring other high-benefit, low-risk options like acupuncture, increased physical activity during the luteal phase, or over-the-counter supplements and pain relievers like calcium or Midol
While one or a combination of these options will work for many people, a small percentage may need to explore more extensive treatments like medical menopause or surgery, Dr. Keesee says
Medical menopause requires an injection that shuts down the ovaries. It’s often combined with hormone replacement therapy (HRT). Most providers won’t recommend continuing this treatment for longer than two years, but it can help determine whether surgery to remove the ovaries would be effective, Dr. Keesee adds
An oophorectomy is the surgical removal of one or both ovaries. You’ll likely want to discuss the pros and cons with your health care provider, including the impact on your overall health and the need for HRT
It may take a lot of trial and error to find what works best for you, which can be very frustrating, Dr. Keesee says, but many people feel it’s worth it
“There are patients who have struggled for so long and have tried so many things, and when we get success, it’s so gratifying,” they say. “We want to help everyone find that.”
What’s next
- Does PMDD sound like your monthly experience? Schedule an appointment
- Find support for all your women’s health needs at MultiCare
- Polycystic ovarian syndrome — another commonly misunderstood condition explained
Behavioral Health
Women’s Health
About the Author
Samantha Malott
Samantha Malott is a content manager at MultiCare and uses her love for storytelling to shine a light on the high-quality care our teams provide and the excellent community organizations we’re so proud to partner with
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