PMDD

Introduction

Premenstrual Dysphoric Disorder (PMDD) is a severe mood disorder tied to the menstrual cycle. It causes intense emotional, behavioral, and physical symptoms during the luteal (pre-menstrual) phase, significantly affecting daily functioning and quality of life for some people assigned female at birth.

Causes

Although hormone levels during the menstrual cycle are similar in those with and without PMDD, many researchers believe the condition stems from a heightened sensitivity to normal hormonal fluctuations (estrogen, progesterone). Genetic factors appear to contribute: some individuals have inherited variations making their neurobiological responses to hormone changes more reactive.

Types

PMDD does not have subtypes in the same way as mood or anxiety disorders; diagnosis is based on timing (symptoms emerge in luteal phase, resolve shortly after menstruation) and symptom profile.

Symptoms

Symptoms typically occur in the 1–2 weeks before menstruation and may include severe mood swings, irritability, anger, anxiety, depression, fatigue, changes in appetite, sleep disturbances (insomnia or hypersomnia), physical symptoms (breast tenderness, bloating, headaches), decreased interest in usual social/sexual activities, difficulty concentrating, and general functional impairment.

Treatment & Follow-Up

First-line treatment often involves medications — typically selective serotonin reuptake inhibitors (SSRIs), which may be given throughout the cycle or only during the symptomatic period. Other options include hormonal contraception (e.g., drospirenone-containing oral contraceptives), or in some cases GnRH analogs (under specialist supervision). Psychotherapy — especially cognitive-behavioral therapy — and lifestyle / self-care interventions (stress management, sleep hygiene, nutrition, exercise) can help manage symptoms. Regular follow-up is important to monitor symptom patterns, treatment response, and any side effects of medication.