Premenstrual Dysphoric Disorder (PMDD): What You Need to Know

PMDD is more than bad mood swings before your period. About 3–8% of people who menstruate meet the criteria for PMDD — symptoms are severe enough to hurt work, relationships, or daily life. If you dread the luteal phase (the week or two before your period) because of mood swings, anger, or deep sadness, this page tells you what to watch for and what to do next.

How PMDD shows up

Symptoms usually start a week to 10 days before bleeding and go away within a few days after the period begins. Key signs include:

• Major mood changes: severe irritability, anger, or depressed mood
• Marked anxiety or panic feelings
• Clear trouble concentrating and low energy
• Sleep and appetite shifts (too much or too little)
• Physical symptoms: breast tenderness, bloating, headaches

What makes PMDD different from regular PMS is the intensity and the level of life disruption. If symptoms force you to miss work or cause relationship problems, take it seriously.

Diagnosis and what to bring to your appointment

Doctors diagnose PMDD by tracking symptoms across at least two menstrual cycles. Use a daily rating app or paper calendar — note mood, sleep, cravings, and how much symptoms affect life. The Daily Record of Severity of Problems (DRSP) is a common checklist clinicians use.

When you see your provider, bring: a two-cycle symptom log, a list of current meds and supplements, and notes on family or personal mental-health history. Be blunt about suicidal thoughts or self-harm — those need immediate attention.

Treatment options and what really helps

Treatment mixes medication, therapy, and lifestyle changes. Most people get better with one or more of these:

• SSRIs (fluoxetine, sertraline, escitalopram): often first-line. They can be taken continuously or only during the luteal phase — your doctor will advise which fits you.
• Hormonal options like combined oral contraceptives (especially drospirenone-containing pills) can help stabilize hormones. Severe cases may need GnRH agonists under specialist care.
• Cognitive behavioral therapy (CBT) helps with coping, rumination, and stress—especially when mood symptoms are strong.
• Supplements and lifestyle: 1,200 mg/day calcium has some evidence of benefit. Regular sleep, exercise, cutting back caffeine and alcohol, and stress management also help.

Medication side effects are real, so discuss risks and a follow-up plan. If one treatment doesn’t work, ask about alternatives — many people need a trial-and-adjust approach.

If your symptoms include suicidal thoughts, seek help now. Call emergency services or a crisis line. For milder but recurring problems, tracking symptoms and talking with a clinician is the fastest route to relief.

Want a practical next step? Start a daily symptom log today for two cycles and book a visit with your primary care doctor or OB-GYN. That record makes diagnosis faster and treatment more likely to succeed.