Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects 3-8% of the female population.

This disorder is characterized by debilitating physical, emotional, and behavioral symptoms that can significantly impact daily life and relationships.

In this article, we will discuss the causes, symptoms, and treatment options for PMDD, as well as the importance of support networks and self-care practices in managing this condition.

PMDD vs. PMS: What's the Difference?

Premenstrual Syndrome (PMS)

  • Affects approximately 75% of the female population

  • Symptoms include mood swings, cravings, bloating, breast tenderness, and general discomfort

  • Typically occurs a few days to a week before the period starts

Premenstrual Dysphoric Disorder (PMDD)

  • A more severe form of PMS that affects 3-8% of the female population

  • Symptoms are more intense and longer-lasting than PMS, often starting 7-14 days before the period begins

  • Can cause significant disruptions to daily life, including career and relationships

Causes of PMDD

Hormonal fluctuations

PMDD is tied to fluctuations in reproductive hormone levels, specifically estrogen and progesterone.

Some women may have a genetic predisposition to PMDD, making them more sensitive to hormonal changes.

    Inflammation and high levels of estrogen

    Inflammation and high estrogen levels are often linked to PMDD.

    Focusing on gut health, blood sugar stabilization, and liver detoxification can help address these underlying issues.

      Allopregnanolone and GABA

      Allopregnanolone, a byproduct of progesterone, typically has a calming effect on the brain by interacting with GABA receptors.

      In some women with PMDD, allopregnanolone may not interact properly with GABA receptors, leading to increased anxiety, moodiness, irritability, and anger.

        Histamine intolerance

        Histamines can contribute to inflammation and may affect GABA receptors in the brain.

        Women with histamine intolerance or mast cell activation syndrome (MCAS) may experience more severe PMDD symptoms.

          Genetic sensitivity

          Some research suggests that women with PMDD have a genetic sensitivity that causes an abnormal response to normal hormone levels.

          Environmental factors, lifestyle choices, and overall health can also influence the severity of PMDD symptoms.

            Symptoms of PMDD

            Diagnostic criteria

            According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), at least five of the following 11 symptoms (including at least one of the first four listed) should be present for a PMDD diagnosis:
            • Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
            • Marked anxiety, tension, feelings of being "keyed up" or "on edge"
            • Marked affective lability (e.g., mood swings)
            • Persistent and marked anger or irritability or increased interpersonal conflicts
            • Decreased interest in usual activities (e.g., work, school, friends, and hobbies)
            • Subjective sense of difficulty in concentrating
            • Lethargy, easy fatigability, or marked lack of energy
            • Marked change in appetite, overeating, or specific food cravings
            • Hypersomnia or insomnia
            • A subjective sense of being overwhelmed or out of control
            • Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain

            These symptoms must be present for at least a week before the person's period and resolve when the period starts

            Mood-related symptoms

            • Depression

            • Hopelessness

            • Feelings of low self-worth

            • Tearfulness

            • Anger (especially extreme bursts of anger that feel uncontrollable)

            • Anxiety

            • Irritability

            • Fearfulness

            • Feeling completely overwhelmed

            • Lack of interest in usual joyful activities

            • Suicidal thoughts

            Physical and cognitive symptoms

            • Insomnia or excessive sleepiness

            • Extreme fatigue

            • Food cravings (that often result in binge eating)

            • Breast tenderness

            • Headaches or migraines

            • General lack of energy

            • Joint pain

            • Weight gain

            • Trouble concentrating

            • Cramps

            • Bloating

            Diagnosing PMDD

            Symptom diary

            To receive an official PMDD diagnosis, a woman should track her symptoms for several months to determine if they appear cyclically.

            A healthcare provider may use this information to rule out other possible causes of symptoms.

              Evaluation by a healthcare professional

              A doctor may consider the DSM-5 criteria and the patient's symptom diary when making a diagnosis.

              Additional tests and evaluations may be performed to exclude other medical conditions.

                Treatment Options for PMDD

                Conventional treatments

                Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, may be prescribed to address mood-related symptoms.

                Hormonal contraceptives may be recommended to regulate the hormonal cycle and prevent ovulation.

                  Natural approaches

                  • Balancing blood sugar

                  • Reducing inflammation

                  • Prioritizing sleep and managing stress

                  • Supporting gut health, as histamine problems often stem from gut dysbiosis

                  • Encouraging proper liver detoxification

                  • Eliminating histamine-rich foods from the diet

                  • Taking natural antihistamines like vitamin C and quercetin

                  • Supplementing with magnesium and vitamin B6

                  The Importance of Support Networks and Self-Care

                  Building a support network

                  Connecting with others who understand the challenges of PMDD can provide emotional support and practical advice.

                  Support groups, online forums, and social media communities can offer a safe space to share experiences and learn from others.

                    Self-care practices

                    Implementing a self-care routine can help manage PMDD symptoms and improve overall well-being.

                    Examples of self-care practices include regular exercise, mindfulness techniques, journaling, and seeking professional counseling or therapy.


                      PMDD is a challenging condition that can significantly impact a person's daily life and relationships. By understanding the causes, symptoms, and treatment options, individuals with PMDD can take proactive steps to manage their condition and improve their quality of life. It is crucial to work closely with healthcare professionals to create a tailored treatment plan that addresses both the physical and emotional aspects of PMDD.

                      In addition to seeking medical treatment, building a strong support network and prioritizing self-care practices can play a significant role in managing PMDD symptoms. By connecting with others who share similar experiences and learning from their insights, individuals with PMDD can find comfort, encouragement, and hope.

                      Ultimately, raising awareness and understanding of PMDD will not only help those directly affected by the disorder but also contribute to a more supportive and empathetic society. By promoting open conversations and destigmatizing mental health issues, we can foster a culture of compassion and support for all individuals living with PMDD and other mental health conditions.

                      Remember, if you or someone you know is struggling with PMDD, it is essential to seek professional help and explore the available treatment options. Early intervention and ongoing support can make a significant difference in managing this challenging condition and living a fulfilling life despite its challenges.