Premenstrual Dysphoric Disorder: What Is It?

Premenstrual dysphoric disorder includes a series of physical and psychological symptoms days before menstruation. Learn more about them.
Premenstrual Dysphoric Disorder: What Is It?
Laura Ruiz Mitjana

Written and verified by la psicóloga Laura Ruiz Mitjana.

Last update: 18 April, 2023

Most women suffer from pain during the menstrual period (or weeks before it). How normal is this? There are women who resort to contraceptive drugs to regulate discomfort, others to anti-inflammatories, meditation, and changes in diet. However, all this hasn’t prevented the existence of what’s known as premenstrual dysphoric disorder (PMDD).

What does it consist of? It’s important to note that we must differentiate it from the pain associated with menstruation itself (dysmenorrhea) or even from premenstrual syndrome. We’ll discuss these differences throughout the article. In addition, we’ll also discuss your symptoms according to the Statistical Manual of Mental Disorders (DSM-5).

What is premenstrual dysphoric disorder?

Premenstrual dysphoric disorder (PMDD) has also been called by other names, such as severe premenstrual syndrome or severe premenstrual disorder. It’s newly included in the latest edition of the DSM-5.

It consists of a condition particular to women that involves a series of depressive symptoms, irritability, excitability, and tension. Such symptoms appear seven to ten days before the menstrual period (menstruation).

Regarding its approximate prevalence, the DSM-5 estimates that premenstrual dysphoric disorder affects 3% to 8% of women who menstruate every month regularly.

PMDD symptoms

The symptoms of premenstrual dysphoric disorder are of different types. We’ll group them into two large groups or categories: Psychological and physical.

In order to make a diagnosis of PMDD, the symptoms must cause significant distress or interfere with the woman’s life. That is, it’s not enough for them to appear in isolation.

Psychological symptoms of premenstrual dysphoric disorder

Here, we can count anhedonia (lack of enjoyment in things that used to produce pleasure) and a lack of interest in social relationships. There’s also a feeling of loss of control with sadness and hopelessness. Among other signs are the following:

  • Panic attacks and anxiety
  • Feeling overwhelmed
  • Fluctuations in mood
  • Altered or decreased concentration, as well as difficulties falling asleep or staying asleep (insomnia)
  • Crying without apparent cause and emotional lability
Menstrual cramps in premenstrual dysphoric syndrome.
Menstrual and premenstrual cramps can be intense and disabling.

Physical symptoms

As for the physical symptoms, the most frequent are the following:

  • Lack of appetite or excess of it
  • Breast tenderness with pain or swelling in the breasts
  • Headaches and muscle or joint pain
  • Abdominal distension with gas


The cause of menstrual dysphoric disorder is still not entirely clear. Yes, there’s talk of hormonal changes and alterations before and during the menstrual period. At the same time, some factors have been identified that could facilitate the appearance, such as the following:

  • Being overweight
  • A high intake of caffeine
  • Family history of premenstrual dysphoric disorder
  • Alcoholism
  • Lack of physical exercise

In addition, stress, seasonal changes, interpersonal problems, and genetic factors may also play a causal role. In this regard, in a 2000 study by López-Mato et al. postulate genetic, neurobiological, and endocrinological factors among the causes.

Although it’s not specifically about causes, we know that many times, premenstrual dysphoric disorder is accompanied by other diseases. The most common are major depression, anxiety disorder, and emotional affective disorder.

Treatment of premenstrual dysphoric disorder

Regarding treatment, there’s no specific one. At a psychological level, relaxation or breathing techniques can be applied to reduce possible symptoms of anxiety or alleviate pain. Meditation and mindfulness can also be good options.


Beyond psychotherapy, pharmacological treatment is used in order to reduce symptoms, either emotionally or physically. For example, antidepressants such as fluoxetine have been tested, according to a study by Steiner et al. (1995), as well as sertraline.

In relation to pain, anti-inflammatories are used, although always under prescription and medical recommendation. To alleviate sleep disturbances, prescribed benzodiazepines or more natural options such as melatonin or different types of herbs (passion flower) can be used.

Other interventions in premenstrual dysphoric disorder

On the other hand, nutritional supplements such as vitamin B6, magnesium, or tryptophan have been used to alleviate various symptoms of the disorder. Some changes in lifestyle also favor a reduction in symptoms:

  • Sleep hygiene.
  • Healthy and balanced diet: Vegetables, fruits and whole foods predominate. Reduce the consumption of sugars, alcoholic beverages, and caffeine.
  • Perform physical exercise on a regular basis.

Not to be confused with dysmenorrhea or PMS

We must differentiate well premenstrual dysphoric disorder from other disorders such as premenstrual syndrome or dysmenorrhea. In the case of premenstrual syndrome (PMS), according to MedlinePlus, it encompasses a series of symptoms that begin during the second half of the menstrual cycle.

Here the signs usually disappear between one and two days after the start of menstruation. One big difference between the two is that PMDD is more severe and disabling than PMS.

On the other hand, in the case of dysmenorrhea (also called painful menstruation) we’re talking about intense pain in the abdomen and significant discomfort during the menstrual period. That is, the symptoms appear during the menstruation itself and not before.

In dysmenorrhea, cramps can also appear. In addition, the prevalence is much higher than in the case of PMDD. Therefore, although the three disorders may share symptoms, they’re different.

Woman with menstrual pain disorder.
It’s important to know how to differentiate between different syndromes that share symptoms associated with menstrual pain.

A controversial disorder

We believe it’s important to note that the new appearance of premenstrual dysphoric disorder in the latest edition of the DSM-5 has generated much controversy and debate in the field of psychology and psychiatry. This has been the case because experts in the field question whether suffering from a series of symptoms before the menstrual period is pathological.

In addition, they consider its inclusion a way of turning normality pathological, which is feeling mood swings the days before the period. On the other hand, we’re talking about calling something related to a woman’s sexuality and something derived from very intense hormonal changes a mental disorder.

That is, should suffering these mood swings in the days before the period be considered normal? Or are we really talking about a mental disorder?

With this, we don’t mean to downplay the symptoms. The reality is that they exist in many women. We’re talking more about a question of nomenclatures and everything that this entails.

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  • American Psychiatric Association -APA- (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid. Panamericana.
  • Amigo, I. (2012). Manual de Psicología de la Salud. Madrid: Pirámide.
  • Amigo Vázquez, I., Fenrández Rodríguez, C. y Pérez Álvarez, M. (2009). Manual de Psicología de la Salud. Madrid: Pirámide.
  • López-Mato, A. et al. (2000). Trastorno disfórico premenstrual. Rev Chil Neuro-Psiquiatr, 38: 187-195.
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  • Steiner, M., Korzekwa, M. & Lamont, J. et al. (1997). Intermittent fluoxetine dosing in the treatment of women with premenstrual dysphoria. Psychopharm Bull, 33(4): 771-4.

Los contenidos de esta publicación se redactan solo con fines informativos. En ningún momento pueden servir para facilitar o sustituir diagnósticos, tratamientos o recomentaciones provenientes de un profesional. Consulta con tu especialista de confianza ante cualquier duda y busca su aprobación antes de iniciar o someterse a cualquier procedimiento.