Think you have premenstrual dysphoric disorder (PMDD)?

My Hormonology

Think you have premenstrual dysphoric disorder (PMDD)?


Does your premenstrual phase seem much more difficult than what you see other women go through? Does pre-period irritability, anger, depression, anxiety, physical pain or trouble sleeping interfere with everyday life?

You could have premenstrual dysphoric disorder (PMDD), which is a severe form of premenstrual syndrome (PMS) that’s estimated to effect up to 8% of cycling women.

PMDD symptoms to look for

Think you may have PMDD, but aren’t sure? Here are the signs to look for:

In the one or two weeks leading up to your period do you regularly experience….

  • Extreme mood swings?
  • Depression, suicidal thoughts or the impulse to self-harm?
  • Sudden and intense anger?
  • Anxiety that makes regular daily activities more difficult?
  • Intense pain, cramping or aches?
  • Severe insomnia?

If you said “yes” to one or more of these symptoms—and these symptoms ease up after your period arrives—you could have PMDD.

PMDD is in your genes

Many—but not all—women experience premenstrual symptoms (such as mood changes, anxiety, aches and sleep issues) as a result of two estrogen dips in the second half of their cycle. However, PMDD is different because of the greater severity of premenstrual symptoms, which can make it difficult to navigate work, school, relationships and other facets of everyday life.

Unfortunately, because the condition is not yet widely known, many women assume—or are told by others—that the problems they experience are all in their imagination or that they are exaggerating their symptoms. However, a study from the National Institutes of Health reveals the truth: PMDD sufferers have an anomaly in their gene activity that triggers more sensitivity to estrogen and progesterone, which leads to more intense premenstrual symptoms.(1)

“This is a big moment for women’s health, because it establishes that women with PMDD have an intrinsic difference in their molecular apparatus for response to sex hormones—not just emotional behaviors they should be able to voluntarily control,” study co-author David Goldman, M.D. stated in a news release.(2)

Hopefully, knowing that PMDD is driven by a difference in your body’s makeup can help you feel validated that what you’re experiencing isn’t just “bad PMS”—it’s a medical condition.

How can you treat PMDD?

If you suspect you have PMDD, make an appointment with your gynecologist and discuss this with her or him. Only a qualified medical doctor can get you the appropriate diagnostic tests and interpret the results accurately to rule out other conditions and confirm a PMDD diagnosis. A gynecologist is preferred since she or he is likely to have more experience with this condition than a general practitioner.

From there, you have treatment options.

Pharmaceutical approach: Some doctors may suggest taking antidepressants or hormone birth control. Antidepressants work by leveling out your mood and hormone birth control reduces hormone fluctuations that are causing PMDD symptoms. In a 2016 study in the journal Clinical Neuropharmacology, a review of 49 studies examining these options on PMDD prove they both work effectively.(3)

Unfortunately, this doesn’t guarantee that you’ll get successful results yourself since people respond to medications differently. However, it does indicate that at least there’s a possibility that these medications could ease your symptoms since they have been shown to help some women, so they may be worth trying if your doctor recommends them.

Holistic approach: If you want to try a drug-free treatment first or you want to complement your pharmaceutical treatment with additional proven interventions, there are several avenues to explore…

Cognitive behavioral therapy: This is a short-term (often about six months) round of sessions with a therapist trained to help you identify and cope with PMDD symptoms. This gives you tools you can use to help keep your emotions more balanced, sleep more soundly and deal with other PMDD issues.

Nutritional therapy: A registered dietitian (R.D.) can suggest the kinds of foods and beverages that create more emotional balance, reduce pain and improve sleep. She or he may also recommend certain supplements, such as chromium, which balances blood sugar and was shown to improve PMDD symptoms in a 2013 study in the Journal of Dietary Supplements.(4)

Naturopathic treatment: A naturopathic doctor (N.D.) is medical practitioner who specializes in natural remedies (which is not the same as a naturopath who does not undergo the same medical training).(5) Your N.D. may not have the qualifications to administer or interpret all necessary test results, so seeing a medical doctor first is preferred. But, if you’re more comfortable with natural treatments, including supplements, acupuncture and other similar approaches, this would be a good fit for you.

Destressing: Stress has been shown again and again to exacerbate premenstrual symptoms of all intensities because of the cascade of changes stress triggers in the brain, which then impacts levels of reproductive hormones. Try to find a stress-reducing practice you enjoy—be it yoga, meditation or tai chi—and do it regularly.

I recommend trying all of these approaches to find the right treatment or combination of treatments that work for you.

If you’re thinking of putting off getting diagnostic tests and investigating treatments because it’s too much of a hassle, consider this: A 2017 study found that women with PMDD who go untreated spend the equivalent of three years of their lives suffering with symptoms—and longer if they don’t give birth since it means going through even more monthly cycles.(6)

Spread the word about PMDD

Most girls and women are still unfamiliar with PMDD, which means those struggling with difficult symptoms may not realize they have a medical condition that can be helped with treatment. Or, worse, their symptoms are dismissed by family members, friends or co-workers who tell them to just get over it, which just adds to their suffering.

If you recognize that a girl or woman you know has one or more of these symptoms, I encourage you to speak up and share this information about PMDD with her. This one revelation that someone’s emotional or physical pain is due to a medical condition with available treatments can give her the hope she needs to get help.

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