Almost every one of us has experienced discomfort associated with impending menstruation. According to a Femvie study, up to 80% of women experience symptoms of premenstrual syndrome (PMS) to some extent. The most common symptoms include bloating, fatigue, drowsiness, mood swings, acne, and painful or tender breasts.
For some women, however, the period before menstruation is much more than just a few unpleasant days; they suffer from premenstrual dysphoric disorder (PMDD).
What is premenstrual dysphoric disorder?
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome. It is a set of physical and psychological symptoms that are linked to the menstrual cycle.
While PMS can cause discomfort or mood swings, PMDD significantly disrupts a woman's daily functioning. It can make work, study, social life, and relationships difficult. (1) In some cases, it can also be associated with suicidal thoughts or intense episodes of anxiety and depression.
Premenstrual dysphoric disorder affects approximately 3–8% of women of reproductive age, but the actual number may be higher due to diagnostic difficulties. (2)
Symptoms of PMDD
PMDD symptoms usually appear between ovulation and the start of menstruation and subside with the onset of menstruation or within a few days after it begins. While emotional symptoms are key, physical symptoms typical of premenstrual syndrome may also appear. However, each woman may experience PMDD slightly differently.
PMDD symptoms may include (3, 4):
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significant mood swings
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irritability, anger, or agitation
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feelings of tension, anxiety, or nervousness
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panic attacks
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feelings of sadness or despair
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thoughts of self-harm or suicidal feelings*
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loss of interest in daily activities and relationships
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difficulty with thinking or concentrating
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fatigue or lack of energy
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food cravings or binge eating
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sleep problems
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feeling out of control
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physical discomforts such as cramps, bloating, breast tenderness, headaches, joint or muscle pain
*In some cases, thoughts of self-harm or suicide may also occur. If you experience these, do not hesitate to seek professional help – you are not alone.
Why do menstrual symptoms sometimes appear, but menstruation doesn't?
What causes PMDD?
The exact causes of premenstrual dysphoric disorder are not yet fully understood. Experts believe that it may be related to an increased sensitivity to the natural fluctuations of estrogen and progesterone hormones during the menstrual cycle. (5) According to some research, genetic predisposition may also play a role. (6)
Some factors have been shown to increase the risk of developing PMDD, including:
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cigarette smoking
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past trauma or chronic stress
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existing anxiety disorders
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obesity
Why is diagnosis problematic?
Diagnosing PMDD can be difficult. Due to overlapping symptoms, PMDD is often confused with common premenstrual syndrome (PMS) or other mental illnesses, such as depression, anxiety disorders, or bipolar disorder. This can lead to misdiagnosis and delayed appropriate treatment.
Currently, there is no laboratory test that unequivocally confirms PMDD. For a PMDD diagnosis, it is crucial to keep a calendar or symptom diary for at least two consecutive menstrual cycles. During these cycles, five or more symptoms should regularly appear, at least one of which must be emotional in nature. (7, 8)
Although blood tests cannot detect PMDD itself, doctors may perform tests such as thyroid function tests or other hormonal examinations to rule out other health problems that could cause similar symptoms.
Options for support and treatment for PMDD
Some lifestyle changes can be helpful for monitoring and alleviating physical and emotional symptoms throughout the cycle. For some women, these may work alone; for others, they are combined with targeted treatment. In any case, they represent a good first step, especially while waiting for a specialist examination or a referral from a general practitioner.
You might consider, for example:
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regular exercise
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a balanced diet
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vitamin and mineral supplements, especially B vitamins, magnesium, calcium, or vitamin D
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relaxation techniques and stress reduction
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reducing alcohol, caffeine, and nicotine
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practicing sleep hygiene
In cases of more severe symptoms, pharmacological treatment may be recommended. Antidepressants from the group of selective serotonin reuptake inhibitors (SSRIs) have proven most effective, or hormonal treatment may be prescribed.
PMDD has a significant impact on a woman's quality of life. If you suspect that this disorder affects you, do not hesitate to consult your doctor as soon as possible.
The sooner you track your cycle and symptoms, the easier it can be to diagnose and find effective relief. Keeping a menstrual diary or using an app can help you gain an overview of when and how difficulties appear – and it will also be valuable information for your doctor.
What else to read on the Femspace blog?
- Menstruation in the workplace: Research results and tips on how to support female employees
- What affects female libido and what role does the menstrual cycle play?
- Do we need more sleep before menstruation?
- Spotting and bleeding outside of menstruation
- How to start tracking your menstrual cycle?
- Menstrual red flags: 7 signs to watch out for
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With love
Femvie Team
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