What is PMDD? The disorder that feels like PMS — but way worse

Premenstrual dysphoric disorder is characterized by extreme emotional or behavioral changes before a woman's period.
A woman sitting on bathroom floor
Premenstrual dysphoric disorder is essentially severe PMS, doctors say.Michael Poehlman / Getty Images

Many women are familiar with the telltale bloating, fatigue and moodiness that signal premenstrual syndrome, or PMS.

But for about 5% of women of childbearing age, those symptoms are more severe, even causing disruptions in their relationships and work lives in the days leading up to their period — a sign they may be suffering not from PMS, but premenstrual dysphoric disorder (PMDD).

"It's a continuum," said Dr. Jacqueline Thielen, an internist who specializes in women's health at the Mayo Clinic in Jacksonville, Florida. "The symptoms are pretty much the same, but (with PMDD) they're amplified. And you're having many symptoms, typically five or more. It's really difficult to get things done during that time. It's the intensity and the amount of symptoms that discern the difference."

And yes, you can blame hormones.

"It's not that the hormones are abnormal," said Dr. Cybill Esguerra, an OB-GYN and assistant professor of gynecology and obstetrics at the Johns Hopkins University of Medicine in Lutherville, Maryland. "If you looked at hormone levels in women who have PMS or PMDD, they're not higher or lower than they are in women who don't. It's just that (women who do have it) are more sensitive to the hormone fluctuations, for whatever reason."

What are the symptoms of PMDD?

Since PMDD is essentially a more severe version of PMS, the two disorders share symptoms. Physically, women may experience bloating, weight gain, breast tenderness, fatigue and headaches. Emotional and behavioral symptoms include anxiety, depressed mood, trouble concentrating, insomnia and social withdrawal.

However, with PMDD, at least one of the following symptoms typically stands out, according to the U.S. Department of Health and Human Services Office on Women's Health:

  • sadness or hopelessness
  • anxiety or tension
  • extreme moodiness
  • marked irritability or anger

That means it can be difficult for women to know if what they're experiencing is indeed PMDD or another disorder, such as depression or anxiety. The difference is that, with PMDD, women are only experiencing these symptoms in the days leading up to their periods.

"You should feel back to your normal self after the second or third day of your period," Thielen said.

What is PMDD treatment?

Just like with PMS, many women find relief from diet and lifestyle changes, including exercise and cutting back on caffeine, sugar and alcohol.

Of course, when you're fatigued, dealing with cramps and craving sweets, that's all easier said than done. That's why Thielen recommends women track their symptoms (on paper or an app like Clue or Flo), so they know what to expect each cycle and can get a head start on those healthy behaviors before their symptoms appear.

"You have to anticipate," she said. "You know it's coming so you have to do preparation. I'm not saying it's easy."

Esguerra echoed the importance of tracking symptoms, adding that it can help expedite a diagnosis and save women doctor's visits, too.

"If you're going to see a doctor for the first time, start your symptom log before you go in — that saves you two months," she said, explaining that without a symptom log, the doctor will probably ask the patient to track her symptoms before prescribing any treatment.

While exercise and healthy eating are helpful, many women who have PMDD may find they need medication. Both Esguerra and Thielen say antidepressants, or SSRIs, are hugely helpful for women who have PMDD. Women can take antidepressants daily, or their doctors may suggest they only take the medication around the time they have symptoms.

Birth control is another option. Oral contraceptives may help by decreasing the range and duration of the hormonal fluctuations that cause the symptoms, Esguerra explained.

Research has also suggested that some vitamins and herbal remedies may be helpful for both PMS and PMDD, including B-6, magnesium and vitex-agnus castus, or chasteberry, although women should talk to their doctors before trying any supplements.

Risk factors

Women who have a family history of PMDD are more likely to develop PMDD themselves.

Having an underlying mood disorder or a history of trauma — as well as just experiencing everyday stress — are also risk factors.

Don't suffer in silence

Thielen wants women to know that no matter what their experience is, whether it's PMS or PMDD, if they're suffering from symptoms, they should talk to their doctors.

"I’ve watched women over the years sort of suck it up and move on, but there are ways to improve — maybe not always alleviate all the symptoms — but there are ways to improve quality of your experience," she said.

"If you are having any kind of symptoms that are bothersome, always ask your provider and share what’s going on," Thielen added. "There may be assistance you don't really know about."