Premenstrual dysphoric disorder, usually shortened to PMDD, is a severe premenstrual condition causing marked mood and physical symptoms in the one to two weeks before a period, which ease within a few days of the period starting. It is a recognised diagnosis in DSM-5-TR and ICD-11, not a stronger word for premenstrual tension.
Key points
- PMDD is a recognised diagnosis in DSM-5-TR and ICD-11, not a stronger word for premenstrual tension.
- The timing pattern is the key: symptoms appear in the luteal phase, the week or two before a period, and clear within days of bleeding starting.
- Diagnosis rests on daily symptom ratings kept across at least two cycles, not a one-off questionnaire.
- PMDD is often mistaken for bipolar disorder or borderline personality disorder, because all three involve rapid mood change.
- UK treatments include SSRIs, combined hormonal contraception and CBT, with hormone suppression and surgery kept for specialist services.
Symptoms
- Core mood symptoms: rapid shifts in mood, irritability or anger, low mood or hopelessness, anxiety or tension.
- Loss of interest, difficulty concentrating, low energy, changed appetite; thoughts of suicide or self-harm in severe cases.
- Physical: breast tenderness, bloating, joint or muscle pain, and headaches.
Causes and risk factors
- Unusual sensitivity to normal hormone change rather than abnormal hormone levels themselves.
- Research on allopregnanolone, a breakdown product of progesterone, and its effect on GABA-A receptors.
- Smoking, past trauma and family history are linked to higher risk, mostly in observational studies.
Treatment
- Lifestyle measures, then cognitive behavioural therapy for mood symptoms.
- SSRIs as first-line medical treatment, taken continuously or only during the luteal phase.
- Combined hormonal contraception; GnRH analogues and surgery are specialist-only, irreversible last resorts.
When to speak to a professional
- Symptoms follow a clear monthly pattern and have persisted for at least two cycles.
- You have a mental health diagnosis that does not fit the cyclical timing of your symptoms.
- Get help immediately if you have thoughts of suicide or self-harm at any point in the cycle.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.