PMDD 101: treatment, symptoms, and support

Top things to know

• PMDD is a severe form of PMS that causes intense mood symptoms and can interfere with work, school, relationships, and daily activities

• Symptoms usually appear in the luteal phase—one to two weeks before the period—and improve within a few days after the period starts

• Tracking your symptoms every day for at least two menstrual cycles can help confirm a PMDD diagnosis, and several treatments are available to help manage symptoms 

• Track your mood, physical changes, and other cycle details in the Clue app to better understand your patterns and prepare for conversations with your healthcare provider 

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) (1). Along with PMS symptoms—such as headaches, breast tenderness, and bloating—people with PMDD experience intense mood symptoms (2). PMDD symptoms often develop about one to two weeks before the period, during the luteal phase (1). This is the part of the menstrual cycle that begins after an egg is released from an ovary (ovulation) and ends when the next period starts (3). 

Symptoms can disrupt work, school, relationships, and daily activities (3). They usually improve within a few days after the period begins and become mild or go away during the following week (4). 

The exact cause of PMDD is not fully understood. However, research suggests that the brain may respond differently to normal changes in the hormones progesterone and estrogen during the menstrual cycle (5).  

Who does PMDD affect? 

An estimated 1.6% (roughly 1 in 60) of people with menstrual cycles have PMDD (6). This estimate comes from studies that confirmed this condition through daily symptom tracking. 

Other studies have reported rates as high as 7.7% (about 1 in 13), but those estimates included possible cases that had not been confirmed through tracking (6). PMDD can also go undiagnosed, so its exact prevalence remains difficult to determine (6). 

Anyone who ovulates can experience PMDD, including women, transgender men, and non-binary people (7). 

Researchers don’t fully understand why some people develop PMDD, but a few factors seem to be associated with having this condition (3).

They include: 

Family history and genetics

Having a close family member with PMDD or severe premenstrual symptoms may increase the likelihood of developing it (3). Research suggests that genetics may contribute, but no single gene has been shown to cause PMDD (3). 

Depression or anxiety

People with current or past history of depression or anxiety are more likely to also have PMDD, though researchers are still working to fully understand the connection (8,9). For people who have both PMDD and an anxiety disorder, mood symptoms may continue after the period begins (8). With PMDD alone, symptoms usually improve within a few days after a period starts (4).   

Trauma

A history of trauma, including childhood abuse, has been associated with PMDD (10). Researchers think this may happen partly because trauma can also increase the risk of depression, which is itself linked to PMDD (10). But these findings do not prove that trauma directly causes PMDD (10). 

High stress

People with PMDD tend to have higher stress levels than people without it, especially during the luteal phase (11). It’s not yet clear whether stress worsens PMDD symptoms, whether PMDD makes stress harder to manage, or both (11). 

Smoking

Research has found a link between smoking and higher odds of having PMDD (12). But it’s not clear whether smoking contributes to PMDD or whether other factors help explain the connection (12).

These factors are linked to a higher risk of developing PMDD, but having one or more does not mean you will develop the condition. 

What are the symptoms of PMDD?

PMDD can cause emotional, behavioral, and physical symptoms, and they vary from person to person (13). 

PMDD symptoms are divided into categories, and they include (13): 

Mood symptoms

• Strong mood swings, sudden sadness or tearfulness, or increased sensitivity to rejection

• Intense irritability or anger, or more conflict with other people

• Feeling very depressed, hopeless, or critical of yourself

• Intense anxiety or tension, or feeling on edge

Additional symptoms

• Losing interest in work, school, hobbies, friends, or other usual activities

• Trouble concentrating

• Low energy or extreme tiredness

• Changes in appetite, overeating, or food cravings

• Sleeping much more than usual or having trouble sleeping

• Feeling overwhelmed or out of control

• Physical symptoms, such as breast tenderness or swelling, joint or muscle pain, bloating, or weight gain 

Some people with PMDD also have thoughts of suicide (14).

If you are thinking about suicide or are worried that you may hurt yourself, seek help right away. If you are in the US, call or text 988 to reach the Suicide & Crisis Lifeline.

Outside the United States, contact a local crisis line or emergency service.

How does PMDD get diagnosed?

A healthcare provider makes a PMDD diagnosis by considering your symptoms, their timing, and how they affect you (4). They may also review your health history, mental health, and medications to rule out other possible causes (4). 

Healthcare providers often use criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) to diagnose PMDD (4,13).

These criteria include (4,13): 

• Timing: Symptoms must be present during the final week before your period, begin to improve a few days after it starts, and become mild or disappear during the following week. This pattern must occur during most menstrual cycles over the past year. 

• Number and type of symptoms: You must have at least 5 of the 11 possible PMDD symptom categories. At least one must be a core mood symptom, and at least one must come from the additional symptom list.

• Impact on your life: Symptoms must cause significant distress or interfere with work, school, relationships, or social activities. Mild discomfort alone does not meet the criteria.

• Ruling out other causes: Your healthcare provider will check whether another condition, medication, or substance could explain your symptoms. They will also consider whether an existing condition, such as depression or anxiety, is getting worse before your period. This is called premenstrual exacerbation and is different from PMDD, although PMDD can occur alongside another condition.

• Daily symptom tracking: To confirm the diagnosis, you must record your symptoms every day during at least two symptomatic menstrual cycles. A healthcare provider may make a provisional diagnosis before tracking is complete and may recommend tracking for longer if the pattern remains unclear.

Understanding how to get diagnosed with PMDD starts with tracking your symptoms daily (4). 

Record when your period starts and ends, any emotional and physical symptoms, their severity, and how they affect your relationships and activities.

Continue tracking even on days when your symptoms are mild or absent. This helps your provider see whether symptoms follow the pattern required for PMDD (4).

How to prepare for your healthcare provider visit

Start by seeing a primary care provider, general practitioner (GP), or gynecologist (15). They can begin the evaluation and refer you to other specialists, such as a mental health provider if needed (16). PMDD care may include healthcare providers from more than one specialty (16).

Because PMDD symptoms rise and fall with the menstrual cycle, it can be difficult to remember or explain exactly when they occur and how severe they become (4). Daily tracking gives you a record to refer to during your medical appointment. 

Talking about intense mood changes or asking to be evaluated for PMDD may also feel difficult (15). Preparing for the appointment can help you explain your concerns more clearly.  

Before your medical appointment:

• Prepare examples. Explain how your symptoms affect your work, school, relationships, sleep, or ability to complete your daily activities.

• Gather your records. Use your notes or Clue tracking data to help you describe when symptoms begin, when they improve, and how severe they become. You can also make a list of your medications and health conditions.

• Write down your questions. You might ask whether your symptoms could be PMDD, whether another condition could explain them, and what the next steps are.

• Consider bringing support. A trusted friend or family member can offer emotional support, take notes, and help you remember what was discussed. With your permission, they may also describe changes they have noticed.

During the visit, state your main concern directly. You could say: 

"My mood symptoms get significantly worse before my period. They interfere with my daily life, and I’d like to be evaluated for PMDD."

Finding a provider who listens to your concerns and works with you to find answers is also important. If you feel dismissed or unsure about the plan, advocate for yourself, ask for a clearer explanation, request a referral, or seek a second opinion.

What treatments are available for PMDD? 

Several treatments can help manage PMDD symptoms. The best approach depends on your symptoms, health history, birth control needs, and plans for pregnancy. 

Some people benefit from combining medication, therapy, and supportive lifestyle habits (17). 

PMDD treatment options include (17):

• Antidepressants for PMDD

Usually selective serotonin reuptake inhibitors (SSRIs) (17). They are considered a first-line treatment for mood symptoms (17). 

• Cognitive behavioral therapy (CBT)

This can help you develop ways to manage difficult thoughts, emotions, stress, and the effect of PMDD on your quality of life (4). 

• Hormonal birth control pills

Research suggests that some hormone birth control pills for PMDD containing drospirenone may help reduce symptoms for some people (17). 

• Supportive habits

Regular exercise, including yoga, which may help relieve PMS symptoms, consistent sleep, and stress-management practices, may support overall well-being and help some people manage symptoms (18).

The evidence for these approaches is more limited than it is for first-line treatments such as SSRIs.

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Medicines such as ibuprofen may help relieve premenstrual pain and other physical symptoms, but they do not treat the core mood symptoms of PMDD (19).

Gonadotropin-releasing hormone (GnRH) agonists: These temporarily stop ovulation and ovarian hormone changes (17).

Because they can cause menopause-like symptoms and other side effects, specialists generally reserve this option for severe symptoms that have not improved with other treatments (17,20).  Considering hormonal options to help manage your cycle? Read our detailed guide on How Hormonal Birth Control Affects PMDD & PMS.

Using Clue to track PMDD symptoms

Using the Clue app to track PMDD symptoms can help you see how your experiences change throughout your cycle (21).

Track every day for at least two menstrual cycles, including days when symptoms are mild or absent. This creates a more complete record and may make patterns easier to recognize and discuss with your healthcare provider (22). 

Tracking may also help you anticipate when symptoms are likely to occur so you can plan for work, daily responsibilities, self-care, and extra support.

With Clue Plus, you can get more detailed insights about your cycle. It has extra features like predictions, pattern analysis, daily notes, and custom tags that can help you better understand how your mood, sleep, energy, and physical symptoms change throughout your cycle. 

FAQs

How fast do antidepressants work for PMDD?

SSRIs, the antidepressants most often used for PMDD, can relieve symptoms faster than they typically do when used for depression (23,24). Improvement may begin within a few days (23). In one small study, symptoms started to improve within hours, with most of the response occurring within two days (24). How quickly treatment works varies from person to person.

Can I take SSRIs only during the luteal phase?

Yes. A healthcare provider may prescribe an SSRI to be taken only during the luteal phase. This usually means starting around ovulation or about two weeks before your expected period and stopping when bleeding begins (23). Research shows that both luteal-phase and daily dosing of SSRIs can reduce PMDD symptoms (23,25). The best schedule depends on your symptoms, other health conditions, possible side effects, and personal preferences. 

Will birth control stop PMDD symptoms?

Some birth control pills may relieve PMDD symptoms, but they don’t work for everyone (17). The pill with the most supporting evidence combines drospirenone and ethinyl estradiol and includes 24 active pills followed by four inactive pills (17). A healthcare provider can help you consider the possible benefits and side effects. 

How do I avoid withdrawal symptoms when stopping?

When you take an SSRI every day, do not stop it suddenly or change the dose unless your healthcare provider tells you to (26). Your provider can help you lower the dose slowly, which can reduce the risk of withdrawal symptoms (27). 

People who take an SSRI only during the luteal phase usually stop when their period begins, and studies have not found significant short-term withdrawal symptoms with this schedule (23). Contact your provider if you develop new symptoms after lowering or stopping your medication.