
Many people who menstruate experience mild physical and emotional symptoms in the week leading up to their period. This collection of symptoms, known as premenstrual syndrome (PMS), can include tender breasts, bloating, increased hunger, irritability, and crying spells.
While the intensity of PMS can vary, it usually doesn’t significantly disrupt daily life and generally requires little intervention.
However, premenstrual dysphoric disorder (PMDD) is a more severe condition. Affecting roughly 6% of those who menstruate, PMDD leads to intense emotional symptoms such as anger, anxiety, depression, and mood swings, starting one to two weeks before the period begins. These symptoms can severely interfere with daily activities, work, and relationships.Every month, many women experience the common signs of Premenstrual Syndrome (PMS), but for some, the symptoms go beyond the difficult but more common discomforts. Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS that affects a smaller percentage of women, yet it significantly impacts their quality of life. Recognizing the difference between PMS and PMDD is crucial for those suffering, as it can guide them towards seeking the right help and understanding their symptoms better.
PMDD is characterized not just by physical symptoms but powerful emotional components that can disrupt daily activities and strain personal relationships. Imagine coping with extreme mood swings, enduring deep sadness or irritability, and other emotional burdens every month. For someone with PMDD, these feelings are a harsh reality.
Understanding this disorder and knowing the available treatments can be the first step toward making life more manageable for those affected. Therapy plays an important role, offering strategies that can improve symptoms and provide a path toward healing and feeling more in control.
Understanding PMDD: A Deeper Look at Premenstrual Dysphoric Disorder
Premenstrual Dysphoric Disorder (PMDD) is a complex condition that significantly impacts the lives of those affected. Unlike typical premenstrual syndrome (PMS), PMDD causes severe and debilitating symptoms that can disrupt work, relationships, and daily activities. PMDD is characterized by emotional and physical symptoms that regularly occur during the luteal phase of the menstrual cycle, typically a week or two before menstruation.
These symptoms are more intense and can lead to feelings of deep sadness or despair, tension, and irritability, more extreme than symptoms experienced with PMS. The exact cause of PMDD is not known, but it is believed to involve the brain’s response to the normal hormonal changes related to the menstrual cycle. Increased sensitivity to the hormone progesterone and its metabolites may trigger a range of symptoms, including mood shifts and physical discomfort. Understanding this disorder is critical as it provides the basis for seeking appropriate treatment and support.
PMDD vs. PMS: Understanding the Differences
While both PMDD and PMS share certain physical and emotional symptoms, their intensity and impact differ significantly. PMS symptoms are generally milder and do not typically interfere with a woman’s daily activities. In contrast, PMDD symptoms are so severe that they affect several aspects of life, including mental health and well-being.
Women with PMDD may experience profound irritability, depression, and anxiety, which are much more severe than the typical moodiness attributed to PMS. Additionally, physical symptoms like joint and muscle pain, changes in appetite and sleep patterns, and physical exhaustion are much more pronounced in PMDD. These symptoms collectively escalate about a week before menstruation and usually subside a few days after the period begins. Recognizing the distinction between PMS and PMDD is crucial for diagnosis and treatment, as the therapeutic approaches may vary significantly between them. Understanding these differences helps individuals and healthcare providers determine the most effective treatment strategies, focusing on alleviating the severe symptoms that characterize PMDD.
Symptoms and Causes of PMDD
Premenstrual Dysphoric Disorder (PMDD) manifests through a variety of symptoms that significantly impact daily functioning. Emotional symptoms are at the forefront, with affected individuals experiencing severe mood swings, anger, irritability, and depression. Anxiety and tension are also commonly reported. Apart from these, PMDD might cause difficulty in concentrating, fatigue, and changes in appetite or sleep patterns. Physical symptoms can include breast tenderness, headaches, joint or muscle pain, and bloating. These symptoms tend to start about one to two weeks before a woman’s period and usually improve within a few days of the onset of menstruation.
Core Emotional Symptoms of PMDD
To be diagnosed with PMDD, someone must experience at least one of the following emotional symptoms:
- Mood Swings: Feeling sad, weepy, or unusually sensitive to rejection.
- Anger: Experiencing irritability, anger, or frequent conflicts in relationships.
- Depression: Feeling sad, hopeless, or overly critical of oneself.
- Anxiety: Feeling anxious, tense, or constantly on edge.
Additional Symptoms to Look Out For
In addition to these core symptoms, at least one of the following symptoms must also be present, making a total of five symptoms required for a diagnosis:
- Decreased Interest in Usual Activities: Finding less pleasure in hobbies, work, or social activities.
- Trouble Concentrating: Struggling to focus or maintain attention on tasks.
- Lethargy or Lack of Energy: Feeling unusually tired or drained.
- Changes in Appetite: Experiencing overeating, reduced appetite, or specific food cravings.
- Sleep Disturbances: Having trouble falling asleep, staying asleep, or sleeping excessively.
- Feeling Overwhelmed or Out of Control: Feeling like situations are unmanageable or beyond your control.
- Physical Symptoms: Experiencing bloating, breast tenderness, or pain in muscles or joints.
For an official diagnosis of PMDD, symptoms must “turn on” before menstruation and “turn off” by the end of menstrual bleeding, typically before ovulation starts. It is also important to note that not all severe emotional changes occurring before menstruation signify PMDD. The American Psychological Association also states that individuals with other mental health conditions, such as ADHD, anxiety, bipolor disorder or depression, may experience worsening symptoms premenstrually .
The exact causes of PMDD are not well understood, but several factors are thought to contribute to its development. Hormonal changes that accompany the menstrual cycle play a significant role, particularly fluctuations in estrogen and progesterone. It is believed that women with PMDD might have an abnormal response to these hormonal changes. Additionally, genetics may predispose some women to PMDD, indicating that if your close relatives are affected, your risk might be higher. Other contributing factors include low levels of serotonin, which affects mood, attention, and pain, and stressful life events, which can exacerbate symptoms.
Effective Therapy Approaches for PMDD, Focusing on Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is particularly effective in treating PMDD by addressing the negative thought patterns and behaviors that can exacerbate the condition. In the therapy sessions, we focus on identifying the negative interpretations and automatic thoughts associated with the emotional and physical symptoms of PMDD. By challenging these negative thoughts and replacing them with more balanced ones, CBT helps reduce emotional distress and improve overall functioning.
Therapy sessions might include keeping a symptom diary to identify triggers and patterns, which can be incredibly useful for managing symptoms. Skills learned in CBT such as stress management techniques, problem-solving, and assertiveness training can significantly help in coping with PMDD. Additionally, relaxation techniques like deep breathing, progressive muscle relaxation, and guided imagery can help reduce the physical symptoms of PMDD, such as tension and pain.
Conclusion
Navigating life with Premenstrual Dysphoric Disorder can be challenging, but understanding the symptoms and finding effective treatment methods can significantly ease the burden. I am committed to providing compassionate care through tailored therapy approaches like Cognitive Behavioral Therapy, mindfulness, relaxation techniques and helping you discuss appropriate medication strategies with your OB/GYN or internist and be an effective advocate for yourself when talking to people who try to minimize your experience by saying it’s just PMS. While frontline treatment might include medical interventions like antidepressants for part of the month or birth control pills, learning self-care techniques and ways to maximize your coping strategies so you feel more in control are just as important. Together we can work on managing and reducing the emotional symptoms of PMDD and help you feel empowered to access appropriate medical interventions if you want to.
If you are struggling with PMDD, you don’t have to face it alone. As an therapist that specializes in women’s counseling for issues that can occur across the reproductive lifespan, I can help you find a treatment plan that suits your unique needs, paving the way for better mental health and improved quality of life. Reach out today, and let’s work together to achieve this.
Additional Resources For PMDD
Me vs PMDD Symptom Tracker App https://mevpmdd.com
Unsure if you have PMDD? Take this self-screening test https://iapmd.org/self-screen

I specialize in empowering women to live the life they want. If you would like to work with me, please phone me at 847 791-7722 or on the form below.
If you would like to read more about me and my areas of specialty, please visit Dr. Sarah Allen Bio. Dr. Allen’s professional license only allows her to work with clients who live in IL & FL & the UK and unfortunately does not allow her to give personalized advice via email to people who are not her clients.
Dr. Allen sees clients in person in her Northbrook, IL office or remotely via video or phone.

What Can I Read That Helps Me While I Am Waiting For My First Appointment With Sarah?
I have written five other booklets that you might find interesting: Simple Steps To Overcome Depression, Simple Steps To Overcome Emotional Eating, Guide To Pregnancy & Postpartum Issues, Simple Steps To Overcome Anxiety, and How To Stop Arguing With Your Child.
See each specific webpage to download one or many.
