If you feel irritated, weepy, and moody just before you get your period, you may assume that you have premenstrual syndrome (PMS) and you may be resigned to having such symptoms every month.

But there is a condition that is related to PMS calledPremenstrual Dysphoric Disorder(PMDD). Much less common, it not only causes physical symptoms but behavioral and psychological ones as well.

PMDD Symptoms

PMDD can cause extreme mood shifts at certain times each month.1It may actually interfere with your daily life, says Christopher M. Zahn, MD, vice president for practice activities at the American College of Obstetricians and Gynecologists (ACOG).

The symptoms of PMDD can include sharp mood swings, irritability, feelings of hopelessness, andbob bet体育 . When you have PMDD, you also can have problems concentrating, changes in appetite, difficulty sleeping, and bloating.

The symptoms of PMDD are more severe than the symptoms of premenstrual syndrome, Dr. Zahn says. About 3% to 5% of women have PMDD.2

“PMDD is a severe type of PMS that, although rare, can be very harmful for those who live with it,” he says.

The symptoms of PMDD usually appear in the 7 to 10 days before menstruation begins, Dr. Zahn says. The symptoms can be unpredictable: some months, you may feel worse than others.

“But there will be some consistency to the presence of symptoms,” Dr. Zahn says. A PMDD diagnosis is confirmed by a pattern of symptoms that appear at least three months in a row.

Besides the physical symptoms of PMDD, you can experience emotional symptoms like rejection sensitivity, says Eric Reed, MD, medical director of the mood disorder intensive outpatient program at University Hospitals Cleveland Medical Center in Ohio.

“For instance, you may find yourselfpicking fights with your partner,” he says. “You can feel like you are being ignored by your partner and if you are feeling this way, it can be very hard to take.”

What is unique to PMDD is that the symptoms are so closely tied to a woman’s menstrual cycle, Dr. Reed says: “There is a very rapid element to it. You can be fine one day and screaming at your partner the next day. It is frustrating for the person experiencing it because it happens so quickly.”

Of all the symptoms of PMDD, the most defining ones are related to mood, says Nichelle Haynes, DO, a psychiatrist at Reproductive Psychiatry Clinic of Austin, Texas.

“Besides irritability and mood swings, PMDD can stir up feelings of anger and hopelessness,” she says. “It can make a person feel on edge.”

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Could You Have PMDD?

Take our quiz to see if your symptoms align with those experienced by sufferers of Premenstrual Dysphoric Disorder.

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Depression before getting a period

Pervasivedepression和焦虑是常见的经前综合症的症状PMDD. It may be that the same hormonal changes that trigger a menstrual period can make the symptoms of PMDD worse.1

“Since PMS and PMDD have symptoms that overlap with the symptoms of depression, it is important to talk to your obstetrician/gynecologist to confirm that your symptoms are actually from PMS or PMDD,” Dr. Zahn says. Your symptoms of depression also could come from another cause, such as chronic fatigue syndrome or even irritable bowel syndrome, he says.

The big difference between depression and PMDD is the timing of the symptoms, Dr. Haynes says.

“The timing of PMDD distinguishes it from major depressive disorder,” she explains. “With PMDD, you will have few to no symptoms outside of the two-week window before your period.”

When do PMDD symptoms start

The symptoms of PMDD can begin during the teenage years, Dr. Zahn says: “It is estimated that 1 in 4 children will develop a mood disorder by their late adolescence. PMDD is one of those disorders.”

While it can be typical for PMDD symptoms to begin during a woman’s 20s, she may not know that she has PMDD right away.

“The symptoms worsen over time,” Dr. Haynes says. “And really, symptoms can occur at any point after a woman begins to menstruate.”

If a person is wondering whether they may have PMDD, it is important to talk with the doctor about it.

PMDD Diagnostic Criteria

About 5% of women will meet the criteria for a diagnosis of PMDD, says Dr. Reed.

“The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has very strict criteria for diagnosing PMDD,” he says. “There have to be two or three mood symptoms and two or three physical symptoms. And it has to be verified that during two menstrual cycles, symptoms come on a few days before your period and go away when your period starts.”

Also, to be diagnosed with PMDD, a woman must have at least one of these symptoms stand out: anxiety or tension, sadness or hopelessness, extreme moodiness, or pronounced irritability or anger. And the symptoms need to occur only during the weeks before a period and stop within a few days after the period starts, Dr. Haynes says.

PMDD and bipolar disorder

Like PMDD,bob app官网下载 is a cyclic mood disorder. Sometimes, PMDD and bipolar disorder can occur together. Or PMDD may be misdiagnosed as bipolar disorder, says Dr. Reed.

“The person may get worried that other people think they are crazy,” he says. “And in some cases, women with PMDD may be diagnosed withborderline personality disorder.”

If a woman thinks she might have PMDD, it is important for her to seek help from someone who is experienced at diagnosing and treating mental health disorders and PMDD, says Kristin Yeung Lasseter, MD, founder and president of the Reproductive Psychiatry Clinic of Austin and a board member of the International Society of Reproductive Psychiatry.

“A woman could be incorrectly diagnosed with PMDD when she really has another mental health disorder, such as depression or anxiety, that is being aggravated by hormone changes,” Dr. Lasseter says.

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Extreme PMDD symptoms

With PMDD, there can be very significant impairment, Dr. Reed says.

“A woman may feel almost suicidal when she has PMDD,” he says. “It is common to miss work due to the depression.”

These extreme symptoms can absolutely be disabling, Dr. Zahn says. He advises a woman to tell her OB/GYN if she is having symptoms that can point to PMDD.

“OB/GYNs are trained to support people who feel that their symptoms are severely disabling their quality of life,” he says.

Why some women get PMDD but others don’t


“我们知道reproduct的周期性ive hormones means that after ovulation, there is a change in the hormones,” she says. “Some people are more sensitive to this change. It appears that those with PMDD have an increased sensitivity to the high levels of progesterone present after ovulation.”

Progesterone is intended to help someone get and stay pregnant, but if a fertilized egg is not implanted in the endometrial layer of the uterus, levels of this hormone decline. When the high levels of progesterone drop, a woman’s symptoms also fade, Dr. Haynes says.

While reproductive hormones are involved in both PMDD and PMS, the levels of these hormones are the same among women with and without PMS. It may just be that some women are more sensitive to the normal hormone fluctuations of the menstrual cycle.2

“We don’t always know who these people will be until they experience symptoms,” Dr. Haynes says.

“PMDD is not believed to be caused by abnormal hormone levels,” Dr. Lasseter says. “It is specifically the change in hormone levels that lead to symptoms.”

And even then, she explains, research suggests that women with PMDD may be more sensitive to changing hormone levels than other women.

Tracking Symptoms of PMDD

You can track your symptoms with a printable tracker or witha digital trackeroffered by the International Association for Premenstrual Disorders. The app is free and you can track and journal your symptoms.

Treating PMDD Symptoms

Treatments for PMDD can include relaxation therapy, massage therapy, or hormone birth control methods, says Dr. Zahn. “Some people may also benefit from antidepressants or anti-anxiety medications,” he says.

The class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) can be effective as a treatment for PMDD, says Dr. Reed. “There are a lot of theories about why these may work,” he says. “After ovulation, there is a huge surge of progesterone.”

“We know that progesterone impacts the neurotransmitters, including serotonin, and this may be one of the reasons that adding a short course of SSRIs improves symptoms,” Dr. Haynes says. “An SSRI could be taken during the symptomatic period each month.”

Be sure to check with your health care provider about what medication schedule is best for you.

There also is some evidence that certain foods known to be mood boosters may help PMDD. Two common spices—turmeric and saffron—may actually help you manage the mood symptoms of PMDD. More research is needed before definitive recommendations can be made.

Saffron may have mood-boosting power, research suggests. It may help to regulate the brain chemicals that are responsible for maintaining your mood—serotonin in particular. Saffron also could help reduce some of the physical symptoms of PMDD.3,4And a substance in turmeric called curcumin may help regulate one’s mood.5

Some experts recommend herbal remedies and nutritional supplements. For instance, consuming 1,200 milligrams of calcium each day might reduce PMDD symptoms, some experts feel, and herbal remedies may also be prescribed. However, the U.S. Food and Drug Administration does not regulate herbal supplements. Before trying one of these, consult your doctor.6

When does PMDD end?

PMDD is driven by changes in hormone levels that occur during the menstrual cycle, says Dr. Lasseter.

“不出所料,经前不悦症症状停止一次改变我n reproductive hormone levels stop,” she says. “This is typically once a person has stopped having menstrual cycles for 12 months or more.”

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Last Updated: Jan 12, 2022