Premenstrual dysphoric disorder (PMDD) is a condition that affects some reproductive-age women during their menstrual cycle and differs from premenstrual syndrome (PMS) in both the type and severity of symptoms. While PMS encompasses a range of physical and emotional symptoms that you may experience before menstruation, PMDD symptoms are more severe and can significantly impact daily life. PMDD is a complex and often misunderstood medical condition that can make it difficult to work, socialize, and maintain healthy relationships.
Fortunately, there are treatments that can help manage the physical and mental health symptoms of PMDD, making this stressful time of the month easier to navigate.
Our psychiatrists offer evidence-based mental health treatments and the latest psychiatric medication options through convenient online visits across California or in-person at our locations in the Los Angeles area. Schedule your appointment today.
What Is PMDD?
PMDD is a type of severe and chronic mental health disorder included in the DSM-TR-5 that’s characterized by a range of emotional and physical symptoms that occur during the luteal phase — the period between menstruation and ovulation. This disorder affects about 1.6% to 3.2% of women worldwide, with some experts believing this is an underestimate due to underdiagnoses.1 Symptoms of PMDD appear during the week before menstruation and end within a few days after your period starts, and can be so severe that they disrupt daily responsibilities.
To meet diagnostic criteria for PMDD, individuals must experience at least five symptoms during most menstrual cycles, with at least one being a core mood symptom.
Core mood symptoms of PMDD
As previously mentioned, you must experience at least one core mood symptom to be diagnosed with PMDD. The four core mood symptoms of PMDD include:
- Depressed mood: This can be feelings of sadness, loneliness, or low self-worth.
- Anxious mood: You may experience tension and feel on-edge with racing thoughts.
- Affective lability: In other words, you experience mood swings, sadness, or increased rejection-sensitivity.
- Irritability or anger: Characterized by being easily annoyed or lashing out at interpersonal conflicts that are usually more easy to manage.
Additional symptoms of PMDD
In addition to identifying with at least one core symptom, you must also experience at least four others. These four other symptoms can be from the core symptoms, or from these additional symptoms:
- Anhedonia: This is the name for a loss of interest in activities that once brought joy.
- Attention and concentration struggles
- Lethardy: Unusually low energy or being easily fatigued.
- Appetite changes: This can either be overeating or unusual food cravings.
- Feelings of overwhelm
- Physical PMDD symptoms
Physical symptoms of PMDD
The DSM-5 includes physical symptoms as part of PMDD diagnostic criteria. Common physical symptoms to watch out for if you think you have PMDD include:
- Bloating.
- Breast tenderness and breast, joint, abdominal, and muscle pain.
- Appetite changes and food cravings.
- Headaches or muscle tension.
- Fatigue, low energy, or insomnia.
- Gastrointestinal issues such as nausea, diarrhea, or constipation.
- Skin changes like increased acne or skin sensitivity.
PMDD symptoms often overlap with those of PMS. However, PMDD symptoms are typically more severe, debilitating, and disruptive to daily life, affecting work, relationships, and overall well-being.
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What Causes PMDD?
The exact cause of PMDD remains unclear, but recent studies suggest it’s linked to an unusual sensitivity to normal hormonal changes during the menstrual cycle.2 Fluctuations in estrogen and progesterone levels — particularly in the luteal phase — appear to disrupt brain neurotransmitters like serotonin, which regulates mood and physical symptoms.
This disruption may lead to a temporary serotonin deficiency, contributing to PMDD’s emotional and physical symptoms. Research also points to genetic factors and inflammation as potential contributors, explaining why treatments for PMDD often target serotonin levels.
Is there a link between depression and PMDD?
Recent research supports a strong link between PMDD and depression.4 PMDD is a severe premenstrual condition causing intense mood symptoms — intense sadness, hopelessness, and irritability — in the week or two before menstruation. While PMDD is classified as a depressive disorder in the DSM-5-TR and shares symptoms with major depressive disorder (MDD), it’s distinguished by its clinical pattern tied to hormonal shifts in the luteal phase of the menstrual cycle.
Studies — including those from the past few years — show women with PMDD often experience clinical-levels of anxiety or depression during luteal phase episodes.5 Research also indicates both PMDD and mood disorders involve disruptions in serotonin neurotransmission, though PMDD’s mechanism is specifically tied to abnormal sensitivity to hormonal fluctuations.5 Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are highly effective for PMDD and can even be taken intermittently during the luteal phase — working much faster than they do for depression — suggesting related but distinct mechanisms. The key differentiator remains PMDD’s cyclical pattern: symptoms reliably resolve after menstruation begins, unlike ongoing depression.
Related: Understanding and Supporting Depression in Women
How To Treat PMDD
Treating PMDD often involves a combination of approaches aimed at alleviating both the emotional and somatic symptoms experienced when a woman is menstruating. It’s essential to work closely with a psychiatrist or other mental health care professional, to find a treatment plan that can relieve symptoms of PMDD.
Selective serotonin reuptake inhibitors (SSRIs)
SSRIs, are a class of antidepressant medications that can effectively reduce the emotional symptoms associated with PMDD, including depression, irritability, and mood swings. These medications are often taken daily or during the luteal phase to target the specific symptoms related to PMDD and work by increasing serotonin levels in the brain, which helps regulate mood. It’s essential to work with a healthcare provider to find the right dosage and monitor for any potential side effects.
Hormonal birth control
For some individuals, hormonal birth control methods — such as oral contraceptives, patches, or hormonal intrauterine devices — can be beneficial in managing PMDD symptoms. These methods can regulate hormone levels and reduce the severity of emotional and physical symptoms. However, not all individuals may respond well to hormonal birth control, and it’s essential to discuss the options and potential side effects with a healthcare provider.
Pain management
Over-the-counter pain relievers such as ibuprofen can help manage physical symptoms like joint or muscle pain and headaches. It’s crucial to follow the recommended dosage and consult with a healthcare provider if pain persists or worsens.
Related: Perinatal Mood and Anxiety Disorders
TMS Therapy for PMDD
Many people who struggle with PMDD do not respond to antidepressants or other traditional treatments. For these individuals, you should know that antidepressants and birth control aren’t your only options to reduce premenstrual symptoms.
Transcranial Magnetic Stimulation (TMS) therapy stands out as an alternative treatment for PMDD that has shown promising results in managing severe emotional symptoms. TMS is a drug-free, non-invasive, and FDA-cleared treatment that is twice as effective as medication for depression. TMS can be used as a stand-alone therapy, or in combination with medications and talk therapy.
During TMS treatment, patients recline in a treatment chair and remain awake and alert. A TMS magnet is positioned over the patient’s head to deliver gentle pulses to specific areas of the brain. Each treatment session lasts about 20 minutes, after which patients can immediately return back to their daily routines.
TMS therapy is an important alternative for individuals who cannot tolerate or do not respond well to traditional medications or other treatment options. Most patients notice symptom improvement with TMS after two weeks of treatment, or eight to 10 sessions.
Related: TMS and Pregnancy
How Neuro Wellness Spa Can Provide Treatment for PMDD
If you’re struggling with PMDD, remember that you’re not alone, and there’s hope for managing your symptoms effectively. With advancing treatment options like those offered at Neuro Wellness Spa, you have more resources at your disposal than ever before. Whether you’re considering traditional approaches like psychiatry, psychotherapy, or more innovative treatments like TMS therapy, there are multiple avenues to explore in your journey toward better health. We encourage you to seek professional help if you’re experiencing severe premenstrual symptoms, as a proper diagnosis and personalized treatment plan can make a substantial difference in your life.
At Neuro Wellness Spa, our team of mental health experts understands the unique challenges of PMDD and is ready to support you. By combining medical interventions with lifestyle adjustments and building a strong support system, you can find relief and regain control over your life. Take the first step towards managing your PMDD symptoms more effectively — contact Neuro Wellness Spa to learn how we can help you live life on your own terms.
References
- New data shows prevalence of Premenstrual Dysphoric Disorder |. (2024, January 30). https://www.ox.ac.uk/news/2024-01-30-new-data-shows-prevalence-premenstrual-dysphoric-disorder
- Https://www.hopkinsmedicine.org/-/media/images/Johns-Hopkins-medicine-logo-horizontal-full-color.svg. (2025, February 10). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd
- Tiranini, L., & Nappi, R. E. (2022). Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome. Faculty Reviews, 11. https://doi.org/10.12703/r/11-11
- Menstrually Related Mood Disorders – Center for Women’s Mood Disorders. (2019, June 4). Center for Women’s Mood Disorders. https://www.med.unc.edu/psych/wmd/resources/mood-disorders/menstrually-related/