What to Know About Premenstrual Dysphoric Disorder (PMDD), According to Experts

Here’s an expert look at what PMDD is and how it impacts a person physically and mentally.

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Premenstrual syndrome (PMS) is well known for the pain and distress it can cause for anyone with a period. However, other premenstrual disorders are less discussed, including premenstrual dysphoric disorder (PMDD). While PMS symptoms are challenging to cope with, PMDD symptoms can be even worse. 

“PMDD is a severe form of PMS that can significantly impact a person’s emotional and physical well-being,” says Dr. Kecia Gaither, MD, an OB/GYN and director of perinatal services and maternal-fetal medicine at NYC Health + Hospitals. Read on to learn more about behavioral symptoms, risk factors, and treatment options for PMDD.

PMDD symptoms

PMDD can make daily life incredibly difficult to get through. “While patients with PMDD may certainly experience physical symptoms like bloating, fatigue, headaches, and breast tenderness, the disorder is really characterized by a dominance of affective symptoms like mood swings, irritability, depression, and anxiety,” says Dr. Meghan McGrattan, MD, an OB/GYN and gynecologic surgeon. 

According to Dr. McGrattan, PMDD’s symptoms usually occur the week ahead of menstruation until a few days after an individual’s period has started. This cyclical nature is one of the defining characteristics of PMDD, rather than a mood disorder or depressive disorder, say, with overlapping symptoms. It also can bring dread for individuals living with PMDD, anxiously waiting for the next bout of symptoms. 

“By definition, the symptoms must be so severe that they are causing significant distress or impacting someone’s ability to participate in their usual activities like work, school, and their social life,” Dr. McGrattan adds. “Many patients describe feeling like a completely different person in those two weeks and describe experiencing intrusive thoughts, emotional outbursts, or even suicidal ideation.” In some instances, individuals have told Dr. McGrattan about losing jobs as a result of their PMDD symptoms. 

If you’re experiencing suicidal thoughts or are in danger of harming yourself, this is a mental health emergency. Contact The Suicide & Crisis Lifeline 24/7 by calling or texting 988.

What causes PMDD? 

Researchers have yet to determine the exact cause of PMDD. But, according to Dr. McGrath, evidence currently suggests that it might be due to an abnormal level of sensitivity to regular hormonal changes. “Specifically, fluctuations in estrogen and progesterone during the luteal phase seem to trigger an exaggerated response in the brain’s neurotransmitter systems,” she says. She adds that some evidence also points to individuals having a genetic predisposition to this sensitivity, meaning genetics may be a risk factor for developing PMDD.

The mental health impact of PMDD

PMDD can significantly impact a person’s mental health. According to Charlie Health Group Facilitator Bree Williams, LPCA, and Contemplative Practitioner Tairesha “Sunflower” Flemister, LMSW, here are the different ways PMDD can cause or exacerbate when it comes to a person’s mental health: 

1. Anxiety and depression

Often, one disorder can cause or exacerbate another one. In the case of PMDD, a person might also experience more significant anxiety and depression symptoms. “Feelings of hopelessness, worthlessness, or excessive worry can intensify before menstruation, sometimes leading to suicidal thoughts or self-harm urges,” says Williams. “These emotions are often disproportionate to the situation and feel impossible to manage.” 

2. Brain fog

PMDD can cause brain fog, including difficulty concentrating or remembering things and mental exhaustion, says Flemister. Williams notes that this can occur in the days before their period, making work, school, and general decision making very challenging.

3. Sensitivity

According to Flemister, PMDD can cause heightened emotional sensitivity, loneliness, and self-doubt, especially when experiencing rejection or criticism. It can also make once-manageable stressors feel overwhelming. As Wiliams puts it, a small problem can appear like a catastrophic event. 

4. Emotional dysregulation 

Similarly, a person might find it challenging to regulate their emotions when living with PMDD. They can experience rapid mood shifts that include sudden irritability, anger outbursts, or feeling overwhelmingly sad without a clear cause,” says Williams. “Many individuals report feeling like a completely different person during this time.” 

5. Social withdrawal 

A person living with PMDD and the emotional dysregulation that accompanies it might withdraw from the world or experience conflicts with loved ones, explain Flemister and Williams. 

Individuals living with PMDD, whether they’ve received a PMDD diagnosis from a healthcare provider or not, can also experience guilt. A person might feel like their symptoms are causing them to withdraw, fail at maintaining relationships, and do poorly at work, says Williams. “PMDD is not a choice, and it is not a character flaw. Learning to practice self-compassion and seeking support can make a world of difference in managing this condition,” she adds. 

PMDD diagnosis and treatment

Dr. McGrath notes that another problem lies in the fact that PMDD is severely underdiagnosed. “It often gets misunderstood as ‘just severe PMS,’ or patients are dismissed entirely when they bring up these cyclical mood changes,” she says. Many of her patients have gone through multiple providers or received misdiagnoses of living with a primary mood disorder before learning they were experiencing PMDD. Dr. McGrath adds that increased awareness of PMDD in primary care settings could make a significant difference for patients. 

Williams seconds this: “PMDD is a serious and often misunderstood condition that can deeply impact mental health, emotional stability, and daily life. If you or someone you know is struggling with PMDD, know that you are not alone — there are treatments, support systems, and coping strategies that can help. Seeking professional guidance can be a life-changing step toward regaining emotional balance and improving overall well-being.” 

Therapy, lifestyle changes, and lifestyle modifications can all play a role in managing PMDD.

The first step in PMDD treatment is consulting with a healthcare provider who can accurately diagnose the condition and rule out other potential causes for the symptoms. Once diagnosed, treatment may involve a combination of lifestyle changes, medications (like birth control pills or other hormonal medications), and therapy to help manage symptoms and improve overall well-being. Early intervention can make a significant difference in managing the impact of PMDD on daily life.

How Charlie Health can help 

If you or a loved one are struggling with the mental health impacts of premenstrual dysphoric disorder (PMDD), Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for people and families dealing with serious mental health conditions, including conditions that co-occur with PMDD, like an anxiety disorder, mood disorder, or depressive disorder. With this kind of holistic treatment, managing your mental health is possible. Fill out the form below or give us a call to start your journey to healing today.