Premenstrual Dysmorphic Disorder (PMDD)

We’re all familiar with Premenstrual Syndrome (PMS). It’s become a familiar topic in women’s health and culture. Sometimes we joke about it, and sometimes we bond by talking about our shared experiences with other women.

But for some of us, PMS is more than a monthly nuisance. While 1 in 3 women will complain of suffering from PMS at some point in their lives, only about 1 in 20 (3-5%) will have symptoms so acute that they will have a severe negative impact on their lives. If you fall within this category, you might have something called premenstrual dysmorphic disorder (PMDD).

What is PMDD?

Premenstrual dysmorphic disorder (PMDD) is more than mere PMS. In fact, PMDD is actually classified in the Diagnostic and Statistical Manual of Mental Disorders as a mental illness, whereas PMS is not. PMDD and PMS share many symptoms, but their severity is significantly different.

If you develop PMDD, you will most likely notice the onset of symptoms in your late 20s and early 30s. The biggest distinguishing factor between PMDD and PMS is that PMDD often causes extreme changes to your mood during specific points in your menstrual cycle.

When exploring whether or not you suffer from PMDD, a doctor looks at 11 different symptoms. Of these symptoms, you must be suffering from at least 5 of them to be diagnosed with the disorder. These symptoms are:

  • Depressed mood*
  • Mood swings*
  • Irritability*
  • Decreased interest in usual activities
  • Difficulty concentrating
  • Lack of energy
  • Marked change in appetite
  • Insomnia or hypersomnia
  • Feeling overwhelmed
  • Physical symptoms such as bloating and breast tenderness
  • Tension*

*You must also be experiencing one or more of these symptoms to be diagnosed with PMDD

These disruptions in mood can be accompanied by more common PMS symptoms, but they are significant enough to affect relationships and interfere with your work or daily obligations. Symptoms occur 1 to 2 weeks before you menstruate and cease once your period starts.

If you notice changes to how you feel physically during this time frame but don’t experience extreme emotional lows, you may still be suffering from PMS.

What Causes PMDD?

Though the exact cause of PMDD is unknown, most doctors now agree that genetics plays a large factor in whether or not you’ll end up with the disorder. You’re much more likely to develop PMDD if your mother also experienced severe premenstrual symptoms.

But exactly why some women experience PMDD while others do not is debated. Studies show that the hormone levels in sufferers of PMDD aren’t that different from women without PMDD. So if hormone imbalances aren’t the cause, what is?

Apparently, it’s not about how much hormones you have, but how sensitive you are to these hormones. Women with PMDD react more strongly to the hormones released by their menstrual cycles. In turn, this can affect the structure of their brains. PMDD sufferers tend to have fewer neurotransmitters for serotonin – also known as the “happy chemical” because it triggers feelings of joy and wellbeing in us.

How to Treat PMDD

PMDD shares a lot of physical symptoms with PMS. As a result, some of the treatments between the two are the same. Here are a few of the options you can explore.

1. Change your menstrual products

Some evidence suggests that a change to your menstrual products could help. Traditional tampons can increase cramping while normal pads might irritate those with sensitive skin.

Organic products may minimize negative symptoms. Period panties, reusable pads, and menstrual cups are also excellent options for those looking for a way to switch up their routine and fight their negative premenstrual symptoms. Can’t decide what’s right for you? Don’t worry; we’ve broken down many of the different alternative products available.

2. Alter your diet

You might find that changing your diet in the weeks before your period can bring you emotional comfort and provide you with the energy your body craves. The worst of your PMDD symptoms occur during the luteal phase in the week or two before your period.

Drinking more water and avoiding coffee and alcohol can help you stay hydrated, which in turn decreases the negative physical effects of your PMDD. Foods like dark chocolate, red meat, and spinach are packed with iron and will keep you remain energized. Nutrient-rich comfort foods nurture both your body and your mind.

3. Try alternative and natural treatments

If you’d like to try out a few homeopathic remedies for PMDD before visiting your doctor, there are many alternative treatments out there that might be right for you. For example, regular exercise can increase your serotonin production – that “happy chemical” that can be lacking in those suffering from PMDD.

Other alternative treatments include acupuncture and massages that utilize aromatherapy and essential oils. CBD oil is also quickly emerging as a viable treatment for depression and anxiety. Medical professionals don’t completely understand why CBD helps people in these areas, but some suggest that it positively impacts the serotonin receptors in the brain. These are the same receptors that are less numerous in patients suffering from PMDD.

Spending time in nature also provides us with significant emotional and physical benefits. In fact, there’s a whole branch of medical study known as Environmental Psychology devoted to these effects. Psychological studies have shown that spending time in nature combats depression, relieves stress, and helps us regulate our emotions – all of which can be impacted by PMDD.

4. Get a prescription

Because PMDD is so severe that it’s considered a mental illness, homeopathic and natural remedies may not cut it. That’s why doctors prescribe medications to treat PMDD. You can use hormonal birth control to control your cycles by limiting the hormonal fluctuations you otherwise experience every month.

Hormone sensitivity can impact your ability to absorb and transmit serotonin. Thus, selective serotonin reuptake inhibitors (SSRIs) – a type of antidepressant – are especially useful in combatting the symptoms of PMDD. These drugs can reduce your adverse emotional states, give you more energy, help you sleep better, and dial down the food cravings in the week or two before your period.

If you find that the emotional impact of your PMS symptoms is wreaking havoc on your personal and professional life, you might have PMDD. Please set up an appointment with your OBGYN; there are practical and effective treatments out there that could greatly improve your quality of life.


What are the 11 symptoms of PMDD?

There are 11 symptoms doctors look for when deciding whether or not you have PMDD. If you have PMDD, you will suffer from at least 5 of the below symptoms. Please note that at least one of these 5 symptoms must include either depressed mood, mood swings, irritability, or tension.
The 11 symptoms are:
1. Depressed mood                    
2. Mood swings
3. Irritability
4. Decreased interest in usual activities
5. Difficulty concentrating
6. Lack of energy
7. Marked change in appetite
8. Insomnia or hypersomnia
9. Feeling overwhelmed
10. Physical symptoms such as bloating and breast tenderness
11. Tension

Is PMDD a mental illness?

Unlike PMS, PMDD is listed as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders. This is because it can have a severe impact on the mental health of those who suffer from it. It’s also considered an endocrine – or hormone-related – disorder. So, while it may most negatively affect the emotional health of those who suffer from it, it’s also very much a physical condition.

How do you treat PMDD?

If you’re diagnosed with PMDD, your doctor may prescribe you antidepressant medication and/or a hormonal birth control. Antidepressants (more specifically, SSRIs) increase the production of serotonin in your brain, which can in turn help fight the disruptions in mood caused by your PMDD. Hormonal birth control gives you and your doctor more control over your hormones and menstrual cycles. Herbal remedies and supplements like chasteberry might also help. Finally, lifestyle changes can give you a better handle over your emotional health. Yoga, meditation, and exercise are all linked to decreasing anxiety and fighting depression.

Does PMDD get worse with age?

Most women begin to experience PMDD symptoms in their late 20s and early 30s. But some medical professionals believe that PMDD symptoms worsen with age. Stress can also aggravate the condition. If you notice a growing severity in your symptoms over time, contact your doctor. Activities like yoga, meditation, and massage can also decrease stress levels and assist in minimizing the detrimental effects of your PMDD.

Can a hysterectomy cure PMDD?

Before answering this question, it’s important to note that there are different types of hysterectomies. The sex hormones partially responsible for PMDD are tied to the ovaries. Most hysterectomies remove the uterus and, sometimes, the cervix. But most leave the ovaries in place. This is because without our ovaries and sex hormones, we are much more likely to develop osteoporosis, heart disease, and neurological diseases. Hormone therapy can replace some of these hormones, but these then can cause your PMDD to return. The risks associated with removing the ovaries make this type of surgery an undersirable cure for PMDD.

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