How to Identify the Symptoms of Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (sometimes known as PMDD) is a more severe version of PMS (premenstrual syndrome), which affects 1 in 20 in the run-up to their period. It is caused by a severe reaction to the change of levels of hormones oestrogen and progesterone which happens during the menstrual cycle. [1] While everyone who menstruates will get PMS at some point, PMDD is more serious, and can impact day-to-day life. [2] Seeking a diagnosis can help you cope with this condition and help you understand why you feel the way you do.

Steps

  1. To be diagnosed with PMDD, you must have five or more of the following symptoms before your menstrual period, one of which must be a core emotional symptom that stands out: [3] [4]
    • Emotional or mood changes (core emotional)
    • Irritability or anger (core emotional)
    • Anxiety or tension (core emotional)
    • Feeling depressed (core emotional)
    • Loss of interest in typical activities
    • Lack of energy
    • Difficulty concentrating or brain fog
    • Changes in appetite
    • Difficulty sleeping
    • Feeling overwhelmed
    • Physical symptoms, such as bloating, weight gain, headaches, muscle or joint pain, or breast tenderness
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Part 1
Part 1 of 4:

Identifying Physical Symptoms

  1. Before your period, you may experience aches in your muscles or joints. [5] This includes pain in your knees, hands, wrists, or feet. [6] This pain may make it harder to move.
    • Although you might want to stay in bed when you have such pain, this is not a good approach as it can cause yourself to stiffen up, making the pain worse. [7]
    • Joint pain can have many causes, such as arthritis. [8]
  2. [9] You may also feel a dull pain around your breast or armpit area. This can be caused by the increase of oestrogen up to two weeks before your period. [10] The pain isn't usually that severe, but pay special attention if you think it is. Other causes can be weight gain, stress, injury to the breast, wearing a bra that doesn't fit, or breast cysts. [11]
    • Breast pain or tenderness is not a known sign of breast cancer. Unless you exhibit other symptoms of breast cancer, there is no need to worry. [12] [13]
    • This will usually be in both breasts, but it can also be in just one. [14]
  3. [15] This may mean feeling more tired and sleeping more, or finding it difficult to sleep. You may feel more tired or drowsy during the day, which can also be caused by depression around this time. [16]
    • Other things that can disrupt your sleep pattern are caffeine and alcohol, an uncomfortable bed, mental illness, recreational drugs, or jet lag. [18]

    Did you know? It is estimated that 70% of people with premenstrual dysphoric disorder experience insomnia (inability to sleep), and 80% experience tiredness or hypersomnia. [17]

  4. Around your period, you are more likely to feel more bloated, meaning your stomach may feel more stretched and puffy than usual. [19] [20] You may also experience gas, gurgling sounds from your stomach, or burping more than usual. [21]
    • Other causes of bloating include irritable bowel syndrome, flatulence, food intolerance, constipation, or swallowing excess air (usually through talking or eating too fast). [22]
  5. [23] You may have a loss in appetite, be more hungry than usual, or find yourself craving specific foods. As a result, you may end up binge eating, or skipping meals. [24]
  6. [25] Headaches are a common symptom of both PMS and PMDD, and are usually known to be particularly worse before your period. They are also more likely to return the next day. Other causes can be menopause, the contraceptive pill, or pregnancy. [26]
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Part 2
Part 2 of 4:

Identifying Emotional Symptoms

  1. [27] Your mood may rapidly change, meaning you may experience a wide variety of emotions in a relatively small amount of time. You may experience feelings of tearfulness, or increased fear of rejection before your period. [28] You may also experience impulsiveness. This may result in reckless behaviours such as leaving a job or relationship.
    • This can also be a symptom of a mental illness, such as depression, bipolar disorder, or schizophrenia. [29]
  2. Take into account any anxiety or tension you may have been experiencing. [30] You may be feeling more nervous or 'on edge' than usual. You may experience symptoms such as feeling dizzy, faster heartbeat, being unable to relax, tearfulness, dreading the future, or problems concentrating. [31]
    • There is some overlap of symptoms with generalised anxiety disorder and PMDD, such as irritability, insomnia, headaches, tiredness, and muscle aches. [32]
  3. [33] This low mood may mean you lose interest in some activities. You may have increased feelings of worthlessness or hopelessness. In some cases, it can cause suicidal thoughts. [34] You may also feel more tearful or guilt-ridden, have less self-esteem at this time of month, struggle with decision making, lack motivation, or self-harm. [35]
    • These can also be a symptom of a depressive disorder, pay attention to when you get symptoms.

    Seek help if you have any suicidal thoughts. If it is urgent, call a suicide hotline or emergency services.

  4. [36] You may find it harder to focus on work at school or work. You may find it harder to keep up with assignments, or get more distracted than usual. You may not know the reason behind this.
  5. [37] It may be harder to get things done, even if you want to, things may feel like too much. This may result in procastination, or avoiding difficult or lengthy tasks.
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Part 3
Part 3 of 4:

Differentiating Between Other Conditions

  1. Premenstrual dysphoric disorder follows your menstrual cycle. Symptoms of PMDD start occurring one or two weeks (usually seven to ten days [38] ) before your period starts, and usually get better when you get your period. Symptoms should be gone by the time your period has ended. [39] If your symptoms have no relation to your menstrual cycle, then it is not PMDD, but may be something else.
    • Symptoms can be worse during menarche (first period), pregnancy, miscarriage, and perimenopause. [40]
    • Keeping a diary, or using a period tracker app can help you keep track of your symptoms.
    • Knowing when you get symptoms is important, as it can be possible that you get misdiagnosed with something else. It is possible for more than one condition to coexist at the same time. Pre-menstruation can make other conditions, such as depression and bipolar disorder worse. [41]
  2. Most people who menstruate will get PMS, but only a few of them will experience PMDD. PMDD is seen as more extreme than PMS, and can interfere with your daily schedule. PMS and PMDD share a lot of symptoms, such as tiredness, irritability, mood swings and stomach pain [42] The difference lies in the intensity and frequency of the symptoms. For example, you may experience low moods in PMS, but for PMDD these low moods may cause suicidal thoughts, or cause you to withdraw from any activities. Someone with PMS will also have fewer symptoms than someone with PMDD. [43]
  3. Due to the fact they both include changes in mood, PMDD can often be mistaken for bipolar disorder. Observe when these changes are. In premenstrual dysphoric disorder, your mood swings will be in time with your menstrual cycle. Unlike bipolar disorder, PMDD does not cause manic episodes. In bipolar disorder, the mood swings can last days to weeks, and will affect all throughout the month. [44] Some people with bipolar disorder may experience hallucinations or delusions during manic episodes, which is not a part of PMDD. [45]
    • PMDD can often worsen the symptoms of mood disorders, such as bipolar disorder. [46]
  4. Keep in mind premenstrual dysphoric disorder and gender dysphoria are two separate conditions. While the term "dysphoria" is heavily associated with gender, PMDD is unrelated to gender dysphoria. Although it is possible a trans or non-binary person may experience gender dysphoria around their period, which can cause symptoms such as depression, this is unrelated to PMDD, as the cause is different. That being said, it is possible to have gender dysphoria and premenstrual dysphoric disorder at the same time.
    • If you experience distress due to the fact that you feel like you are in the wrong body, and you don't feel female, this may be a symptom of gender dysphoria. Read Identify Gender Dysphoria for further advice.
  5. [47] Chronic fatigue syndrome (sometimes known as myalgic encephalomyelitis, or ME) has some symptoms in common with PMDD, such as difficulty sleeping, over-tiredness, difficulty concentrating, headaches, and muscle and joint pain. However, CFS happens any time of the month. It can also include a sore throat, dizziness, and heart palpitations. [48]
  6. PMDD can cause depressive, and/or anxious moods, but these will be prior to getting your period, rather than throughout the whole month. Depression can have other causes, such as season (seasonal affective disorder), or recently having a baby (postnatal depression). [49] If you have symptoms of depression or anxiety for over two weeks, you should seek medical help, even if you don't think it's related to your menstrual cycle.
    • It is possible to have PMDD and depression or anxiety at the same time. PMDD may make depression or anxiety symptoms worse.
  7. Fibromyalgia and PMDD share symptoms, such as difficulty sleeping or concentrating, muscle pain, and headaches. Unlike PMDD, fibromyalgia can also cause irritable bowel syndrome (IBS), increased pain sensitivity, inability to regulate body temperature, and pins and needles. [50]
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Part 4
Part 4 of 4:

Getting a Diagnosis

  1. The only way you can know for certain if you have PMDD, is through an official diagnosis by an expert. Make an appointment with your doctor or gynaecologist to ask about any symptoms. Even if it isn't PMDD, it is worth checking with your doctor if you have a collection of these symptoms as it could indicate another health issue.
    • PMDD isn't that well-known, and can be overlooked, even by doctors. Be aware of your symptoms so that you are prepared to explain them to a medical professional. [51]
  2. [52] Keeping track of your symptoms is the key to observing any patterns. Keep a diary, or use a period tracker app, such as Clue, to take note of any symptoms. You can also use a mood chart. You may be asked to fill out a daily questionnaire. You will need to keep track of your symptoms for at least two months to know if it is a consistent problem or a one-off. [53]
    • This process can feel very slow and frustrating. Continue keeping a record of any symptoms, but make sure to take care of yourself too.
  3. Take any necessary blood tests . You may need to take blood tests. These cannot tell you if you have PMDD, but can rule out any other potential conditions. [54] You may be required to take saliva tests for the same reason. [55]
  4. Research suggests that those who have suffered through trauma such as emotional or physical abuse may be more likely to have PMDD. Evidence also suggests that increased sensitivity to hormone changes may be linked to premenstrual dysphoric disorder. Genetic variations are a known cause of this increased sensitivity. [56]
    • Keep in mind that PMDD is technically a hormone disorder, not a mental illness. It is however, listed in the DSM-5. [57]
    • Keep in mind that while you may come in expecting a diagnosis of PMDD, it may turn out that you have another health condition instead.
  5. . There are some easy ways you can treat premenstrual dysphoric disorder, such as limiting your alcohol and caffeine intake, quitting smoking, exercising, having a healthy diet, and having a regular sleep schedule. [58] Some other medications might be recommended to you by a health professional, such as antidepressants, birth control or painkillers.
    • Antidepressants help with symptoms of depression. You will most likely have a three-month trial with them first. You may be told to take them all month, or you may be told to only take them near your period. [59]
    • Painkillers can help you cope with physical pain during your period. Most painkillers, such as paracetamol or ibuprofen, can be obtained with no prescription, but it is best to ask a health professional about them first. [60]
    • Contraceptives can reduce symptoms of PMDD by controlling or stopping your cycle. The results of birth control for PMDD are mixed. Some people find they successfully reduce symptoms, while others feel they make them worse. [61]
    • In some cases, you may be able to get a GnRH analogue injection to induce a temporary menopause [62] , or get surgery if things get too bad. [63]
  6. . PMDD can be draining and can take a toll on your mental health. Practice self-care to make things easier for yourself. Talking to family and friends about your PMDD can mean they understand you better, and are able to help you during your cycle. [64]
    • It can be helpful to speak to others who have had a similar experience to you. [65]
    • Get to know your cycle. Becoming aware of when your PMDD is at its worst can help you prepare. Plan relaxing activities for those times, and don't be afraid to rearrange your schedule to make it easier for your menstrual cycle. [66]
    • Try to relax as much as possible. Treat yourself to a warm bath, spend time in nature, try yoga or meditation, or practice mindfulness. [67]
    • Take care of your physical health too. Eat a healthy diet, get sufficient exercise, and get enough sleep. [68]
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Expert Q&A

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      Tips

      • Look at organisations that provide support for PMDD. [69] Organisations such as International Association for Premenstrual Disorders [70] and National Association for Premenstrual Syndrome [71] provide information and advice about PMDD.
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      • Be honest in the diagnosis process. Don't exaggerate symptoms, or cover up any symptoms. The more honest you are, the more accurate your diagnosis will be.
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      • You can have PMDD at any age, as long as you have (or are just about to have) your period.
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      Warnings

      • If you have any suicidal thoughts, seek professional help. Call emergency services if you plan to go through with it.
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      • Make sure to discuss all treatments with a health professional first, and consider the pros and cons of each option.
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      References

      1. ↑ https://iapmd.org/about-pmdd
      2. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
      3. ↑ https://iapmd.org/about-pmdd
      4. ↑ https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
      5. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
      6. ↑ https://www.nhs.uk/conditions/joint-pain/
      7. ↑ https://www.uclh.nhs.uk/MSK/Pages/Jointandmusclepain.aspx
      8. ↑ https://www.nhs.uk/conditions/joint-pain/
      9. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
      1. ↑ https://www.nhs.uk/conditions/breast-pain/
      2. ↑ https://www.thewomens.org.au/health-information/breast-health/breast-soreness
      3. ↑ https://www.thewomens.org.au/health-information/breast-health/breast-soreness
      4. ↑ https://www.nhs.uk/conditions/breast-pain/
      5. ↑ https://www.nhs.uk/conditions/breast-pain/
      6. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
      7. ↑ https://www.sleepfoundation.org/insomnia/pms-and-insomnia
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      15. ↑ https://www.medicalnewstoday.com/articles/323317
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      19. ↑ https://iapmd.org/about-pmdd
      20. ↑ https://www.medicinenet.com/mood_swings/symptoms.htm
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      22. ↑ https://www.nhs.uk/conditions/stress-anxiety-depression/understanding-panic/
      23. ↑ https://www.nhs.uk/conditions/generalised-anxiety-disorder/symptoms/
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      25. ↑ https://iapmd.org/about-pmdd
      26. ↑ https://www.nhs.uk/conditions/clinical-depression/symptoms/
      27. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
      28. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
      29. ↑ https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
      30. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
      31. ↑ https://iapmd.org/about-pmdd
      32. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/getting-a-pmdd-diagnosis/
      33. ↑ https://www.nhs.uk/conditions/pre-menstrual-syndrome/
      34. ↑ https://iapmd.org/about-pmdd
      35. ↑ https://www.nhs.uk/conditions/bipolar-disorder/
      36. ↑ https://www.nhs.uk/conditions/bipolar-disorder/symptoms/
      37. ↑ https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
      38. ↑ https://womensmentalhealth.org/specialty-clinics/pms-and-pmdd/
      39. ↑ https://www.nhs.uk/conditions/chronic-fatigue-syndrome-cfs/symptoms/
      40. ↑ https://www.nhs.uk/conditions/clinical-depression/symptoms/
      41. ↑ https://www.nhs.uk/conditions/fibromyalgia/symptoms/
      42. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/getting-a-pmdd-diagnosis/
      43. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/getting-a-pmdd-diagnosis/
      44. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/getting-a-pmdd-diagnosis/
      45. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/getting-a-pmdd-diagnosis/
      46. ↑ https://iapmd.org/about-pmdd
      47. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
      48. ↑ https://iapmd.org/about-pmdd
      49. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/pmdd-treatments/
      50. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/pmdd-treatments/#antidepressants
      51. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/pmdd-treatments/#PainkillersOrAntiInflammatoryDrugs
      52. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/pmdd-treatments/#CombinedOralContraceptives
      53. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/pmdd-treatments/#GnRHAnalogueInjections
      54. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/pmdd-treatments/#surgery
      55. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/self-care-for-pmdd/#collapse12584
      56. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/self-care-for-pmdd/#collapse3cb45
      57. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/self-care-for-pmdd/#collapse3d89f
      58. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/self-care-for-pmdd/#collapsee33fb
      59. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/self-care-for-pmdd/#collapse83822
      60. ↑ https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/self-care-for-pmdd/#collapsef1d8b
      61. ↑ https://iapmd.org/
      62. ↑ http://www.pms.org.uk/

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