Most women experience some type of emotional and physical discomfort in the days leading up to their menstrual period.

But when those mental health symptoms, which could include anxiety, depression or severe mood changes, become too much and are impacting your ability to function or maintain relationships, you might have premenstrual dysphoric disorder (PMDD). At The Ohio State University Wexner Medical Center in Columbus, Ohio, we want you to know you don’t have to suffer with these distressing symptoms.

Women’s Behavioral Health at the Ohio State Wexner Medical Center provides comprehensive, evidence-based care for those experiencing stress or stress-related disorders during life events that are unique to women. If you’re struggling to manage this time in your menstrual cycle, we’re here to help.

What is premenstrual dysphoric disorder?

When you experience typical physical and emotional symptoms in the few days leading up to the start of your period, it’s called premenstrual syndrome, or PMS. Premenstrual dysphoric disorder (PMDD) is a severe, chronic form of PMS, which tends to resolve a few days after the onset of your period starting.

People with PMDD experience severe anxiety, depression or mood changes and may feel hopeless or self-deprecating.

These symptoms are so pronounced that they impact daily living and can interfere with relationships. PMDD does require medical treatment, so it’s important to talk to your doctor about possible therapies, medications or lifestyle changes that could improve your condition.

How common is premenstrual dysphoric disorder?

Roughly 10% of women of childbearing age have premenstrual dysphoric disorder.

What causes premenstrual dysphoric disorder?

We don’t know what causes premenstrual dysphoric disorder, but it could be related to the decreasing levels of estrogen and progesterone hormones you experience after ovulation and before your period starts.

Changing serotonin levels throughout your cycle could also be responsible. Serotonin is a neurotransmitter that regulates mood, sleep, digestion and other important bodily functions.

While we don’t know exactly what causes PMDD, some people are at more risk of developing the disorder than others. Risk factors for premenstrual dysphoric disorder include:

• Anxiety or depression diagnosis, including postpartum depression
• History of PMS
• Family history of PMS or PMDD
• Personal history of trauma, abuse or other stressful events

Premenstrual dysphoric disorder symptoms

Symptoms of PMDD are more severe than those of PMS. In addition to experiencing physical PMS symptoms like cramping and bloating, signs you might have premenstrual dysphoric disorder include:

• Depressed mood
• Anger or irritability
• Difficulty concentrating or confusion
• Fatigue, but unable to sleep
• Increased appetite or binge eating
• Feeling overwhelmed or tense
• Painful menstruation
• Headaches
• Hot flashes
• Decreased interest in activities

While many of these symptoms happen with other mental and behavioral health conditions, the key difference for PMDD is when symptoms begin and how long they last. Symptoms of PMDD typically start a week or so before your period and improve a few days after it starts.

How is premenstrual dysphoric disorder diagnosed?

While your providers can give you a complete physical and then a pelvic exam, and also take a complete medical history, there’s no definitive test to diagnose PMDD. Often a first step to diagnosis is having an initial psychiatric evaluation done by a mental health expert who might also have you keep a journal for a few months of the symptoms you experience and when.

To diagnose PMDD, typically the following are present:

• You’re experiencing multiple symptoms, and the onset of symptoms coincides with your menstrual cycle.
• Your symptoms are so severe that they impact your ability to function at home, work, school or social events.
• Your symptoms aren’t related to another physical or mental health condition.

What happens if premenstrual dysphoric disorder is left untreated?

Typically, PMDD is a chronic and serious condition that if left untreated could cause further pain and hardship. It often won’t go away without medical intervention or until menopause.

Premenstrual dysphoric disorder treatment

In Women’s Behavioral Health at the Ohio State Wexner Medical Center, we have various options for PMDD treatment that are safe, effective and evidence based. As an academic medical center, we’re one of the only universities in the nation conducting research around premenstrual dysphoric disorder and other women’s mental health concerns and translating it into better care.

Treatments we offer for premenstrual dysphoric disorder include:

• Antidepressants – Select serotonin reuptake inhibitors (SSRIs) can help reduce emotional symptoms and work faster on PMDD than major depressive disorder. You can take these all month long or just in the time between ovulation and menstruation.
• Birth control pills – Hormonal birth control pills can help reduce physical and emotional symptoms of PMS and PMDD.
• Nutrition supplements – Sometimes we’ll recommend calcium, vitamin B6, magnesium or other supplements.
• Psychotherapy – Working with a licensed psychotherapist to manage stressors and learn coping and calming techniques can help ease some symptoms.
• Lifestyle coaching – Maintaining a healthy weight and eating a balanced diet can also help manage symptoms of PMDD. Getting enough rest, limiting caffeine and alcohol, exercising regularly and practicing meditation or yoga are other lifestyle changes that can make a positive impact.