Premenstrual Dysphoric Disorder (PMDD): What to Know

About 3–8% of people who menstruate have premenstrual dysphoric disorder (PMDD). This isn’t just bad mood before your period — PMDD causes severe emotional and physical symptoms that interfere with work, relationships, or daily life and start in the week before your period.

How PMDD looks and how it's diagnosed

PMDD symptoms appear in the luteal phase (after ovulation) and improve within a few days of the period starting. Key emotional signs: intense mood swings, overwhelming irritability or anger, marked sadness or hopelessness, and anxiety. Physical and behavioral signs include breast tenderness, bloating, fatigue, changes in appetite or sleep, and trouble concentrating.

Doctors diagnose PMDD by symptom timing and severity. You’ll likely be asked to track symptoms daily for at least two cycles — a clear pattern tied to your period is important. If symptoms happen every month and cause real life problems, that points to PMDD rather than ordinary PMS.

Treatment and practical self-care

Treatment works for many people, and your provider will tailor options to your needs. First-line medical treatment is often SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine or sertraline. SSRIs can be taken daily or only during the luteal phase — your doctor will explain which approach fits you.

Hormonal options can help too. Certain combined oral contraceptives reduce cyclical symptoms for some people. For severe, treatment-resistant PMDD, providers sometimes use GnRH agonists to suppress ovarian hormones; this needs close medical supervision and often hormone add-back therapy.

Cognitive behavioral therapy (CBT) is useful for mood control and coping skills. CBT doesn’t change hormones but helps manage negative thoughts, reduce conflict, and improve daily functioning.

Simple lifestyle steps also matter: aim for regular sleep, moderate aerobic exercise (30 minutes most days), limit alcohol and caffeine, and eat balanced meals. Some people find calcium supplements (about 1,200 mg/day) ease symptoms; other supplements like magnesium or vitamin B6 may help but have mixed evidence. Talk to your clinician before starting supplements.

Keep a symptom diary or use an app to show your doctor the cycle pattern. That makes diagnosis faster and helps track what treatments actually change.

Seek help promptly if PMDD causes severe depression, thoughts of self-harm, or if daily life is seriously affected. If you feel unsafe, contact emergency services or a crisis line right away.

PMDD can feel overwhelming, but many people get meaningful relief from medication, therapy, lifestyle changes, or a mix of these. Start by tracking symptoms and booking a visit with your primary care provider or gynecologist — a clear plan is the first step toward feeling better.