Premenstrual Dysphoric Disorder (PMDD): How to Cope with Severe PMS

Reviewed by Tatiana Rivera Cruz, LICSW, a clinical social worker/therapist at ADHD Advisor who specializes in anxiety, depression, grief, couples counseling, family conflict, trauma, and PTSD

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a more severe and less common form of premenstrual syndrome (PMS). While the two conditions have often been grouped together, PMDD is now recognized as a distinct condition, having been added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. Research on PMDD has been somewhat limited, but this recent recognition has led to improvements in our understanding of this complex and chronic condition.

As many as 80 percent of women of childbearing age experience physical or emotional symptoms in the week or two before their period. These can range from bloating, cramping, tiredness, and food cravings to anger, restlessness, and depression. For some women, these symptoms can be debilitating, bringing significant distress and mood changes, and interfering with your work, relationships, and ability to function in daily life. You may have trouble concentrating, difficulty sleeping, and feel anxious, out of control, or even so sad and despairing that you have thoughts of suicide. These symptoms usually then fade within a few days of menstruation.

Since PMDD is frequently misunderstood, it can make symptoms even more frustrating and difficult to manage. A common response from family and loved ones can often be to just “snap out of it.” Even those closest to you may not recognize that the symptoms you’re experiencing are real, and rush to be judgmental or critical.

It’s important to remember that you are not alone (about three to eight percent of menstruating women meet the diagnostic criteria for PMDD) and you are not “crazy” or overreacting. No matter how severe your symptoms, there are ways to ease your suffering, improve your quality of life, and get the necessary support to better cope with this condition.

Causes of PMDD

PMDD is thought to arise from fluctuations in hormone levels, which often begins about 10 to 14 days before your menstrual cycle, and eases up within a few days of the start of your period. During your menstrual cycle, the tissues in your body become sensitive to changes in hormone levels, which may have an effect on neurotransmitters in the brain that influence mood. While the reasons why some women have more marked symptoms of PMS or PMDD is not definitive, studies indicate that some women may be hypersensitive to cyclical changes in estrogen and serotonin functioning.

Significant exposure to stress may also be related to the development of PMDD. A cross-sectional study of approximately 4,000 women suggests that a history of trauma could be associated with the onset of PMDD.

Signs and symptoms

The symptoms of PMS and PMDD have some similarities, such as fatigue, irritability, changes in appetite, and difficulty concentrating. These can vary from person to person, but PMDD is usually composed of a combination of physical, behavioral, and mental health components.

Physical symptoms may include bloating, cramping, headaches, backaches, or other types of body aches. You may also have symptoms of anxiety and depression, such as anger, mood swings, difficulty sleeping, low energy, hopelessness, and recurrent crying. Since women report feelings of depression more often than men, hormonal fluctuations are likely contributors to PMDD and other premenstrual conditions.

[Read: Depression in Women]

Although there is a considerable degree of overlap between the symptoms of PMS and PMDD, the manifestations of PMDD are of much greater intensity. It can make you feel like a completely different person during this time, like you’re on an emotional rollercoaster. You may be unable to manage your work responsibilities, family obligations, social activities, or even simply get through the day. Your food cravings may be out of control, and you may also feel irrational, panicky, or even suicidal.

PMDD diagnosis

It’s important to obtain an accurate diagnosis in order to determine the proper treatment for premenstrual dysphoric disorder. But obtaining a definitive diagnosis of either PMS or PMDD is not always straightforward.

There is currently no single test that can determine if you have PMDD, so your doctor will take a medical history and conduct a physical examination. To diagnose PMDD, your symptoms must be present in the 5 to 7 days before your menstrual period begins.

A complete blood count (CBC) may be used as a screening tool to rule out other conditions that can cause fatigue, such as anemia. Thyroid function tests may be also performed to check for either underactive or overactive thyroid glands, which can mimic the symptoms of PMS and PMDD.

Keeping a diary of your symptoms for at least two full menstrual cycles can be helpful for diagnostic purposes. Your doctor will probably request that you record both your physical symptoms and your mood during this time.

PMDD treatment

While PMDD is usually treated by a mental health professional, such as a psychiatrist or therapist, visiting a gynecologist may also be necessary to help with symptoms related to your menstrual cycle.

The treatments for PMDD are primarily aimed at symptom relief and improving your daily functioning. This encompasses a variety of different approaches including cognitive behavioral therapy, medications, exercise, relaxation techniques, and dietary supplements.

Therapy

Cognitive-Behavioral Therapy (CBT) is a form of talk therapy that helps you reframe negative thoughts, feelings, behaviors. CBT can help change your perception of how you experience PMS and PMDD, including the physical pain and discomfort.

CBT has been shown to be effective for other mood and anxiety disorders, as well as physical pain. Learning new cognitive strategies from a skilled therapist can be an important treatment option and help you better manage symptoms.

Medications

• Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are most often recommended to treat PMDD. Intermittent dosing at different times during the menstrual cycle may ease your symptoms of irritability and mood swings. Longer durations may be necessary to reduce feelings of depression and some of the physical discomfort.
• Research on the effectiveness of hormonal treatments, including oral contraceptives, is limited, so it has not been very widely used to treat PMDD.
• You can also take over-the-counter pain medications, such as ibuprofen to help with pain relief for cramps, backache, headache, and other uncomfortable physical symptoms.

Alternative treatments for PMDD

Complementary medical approaches, along with lifestyle changes, can also help you to manage symptoms of PMDD.

Exercise. Understandably, it can be extremely difficult to find the motivation to exercise when you’re feeling exhausted, depressed, or dealing with physical discomfort. Life with PMDD can seem so completely overwhelming at times, it’s tempting to curl up on the sofa and count down the hours. But any kind of physical activity that you can handle may elevate your mood and alleviate some of the physical pain from PMDD.

If you enjoy being outdoors, begin with a short walk in a pleasant, scenic environment. On the days when you’re feeling up to it, choose more vigorous exercises, such as brisk walking, running, or biking. At home, practicing yoga or even just some light stretching may also be of some benefit in easing pain and boosting your mood.

Acupuncture. Research has shown that acupuncture may be beneficial for pain conditions, and can also have a role in the treatment of PMS and PMDD. Acupuncture may also be helpful for reducing depression, although further studies are needed to draw more firm conclusions.

Dietary supplements. While it’s always better to get the vitamins and nutrients you need from a healthy, balanced diet, there is some evidence that taking calcium supplements may be beneficial for symptoms of PMS and PMDD.

• Vitamin B6 and magnesium may also help with relieving cramps.
• Other supplements, such as omega-3 fatty acids and gingko biloba, can be helpful in easing cramps and other symptoms.
• Consult with your doctor or nutritionist before adding supplements to your diet.

How to improve your life with PMDD

Aside from the treatment guidelines described above, there are other strategies that can ease the impact of PMDD symptoms and make your life a little easier. There is no “magic formula” for improvement in daily living with PMDD, but incremental steps can set you on the right path.

First and foremost, be kind to yourself, and focus on taking small steps to make each day more manageable. Be prepared to try out different approaches to find the ones that are most suitable and effective for you.

Tip 1: Track your menstrual cycle

Similar to the diary or calendar you may have prepared for your doctor, it’s important to continue tracking your menstrual cycle on a regular basis. This type of data can help you follow the patterns in your cycle to better understand how PMDD affects your mind and body. It can also guide you in scheduling activities at times when you are most productive and more likely to be able to keep appointments.

This record-keeping method can be useful for planning social engagements, as well as work commitments and other crucial events in your life. There are many “period tracking” apps on offer, which enable you to track your daily symptoms. Some are free of charge, others can translate the data into graphs for you and your doctor to review.

Tip 2: Manage stress

We don’t always think about relaxation when we’re caught up in the immense challenges of living with PMDD. Nevertheless, when you’re feeling anxious or depressed, try to focus on self-care, and looking after your emotional wellbeing.

Stress management is one of the key strategies for dealing with the symptoms of PMDD. There are numerous ways to achieve a state of deep relaxation in order to stay in the present moment, and restore the proper mind-body equilibrium.

Most relaxation techniques are right at your fingertips, such as deep breathing exercises, meditation, taking a warm bath, getting a massage, listening to soft music, or aromatherapy. Guided imagery and visualization, where you imagine a peaceful scene to calm your mind and body, is another effective option for relaxation.

[Read: Relaxation Techniques for Stress Relief]

Try using HelpGuide’s free guided meditations to soothe your mind and reduce stress. Experiment with different relaxation techniques to find those that best fit your needs.

Tip 3: Rest and recharge your body

Don’t overlook the importance of getting enough sleep and eating healthfully. It’s often easier said than done, but your body needs nourishment and rest in order to function properly, and bolster your resilience while you deal with PMDD.

Tips for better sleep with PMDD

Aim to get at least 7 to 8 hours of quality sleep each night. That may not always be possible since sleep disturbances are common with PMDD. However, there are steps you can take to improve the quality of your rest at night:

• Maintain a consistent sleep schedule of going to bed and waking up about the same time each day.
• Ensuring your bedroom is quiet, dark, and comfortable can help you in falling asleep more quickly, and waking up less frequently during the night.
• If necessary, try taking pain relievers to ease the physical symptoms of PMDD.
• Your doctor may also recommend the use of sleeping pills or sleep aids when your symptoms are at their worst.

How a healthy diet can support you

Eating healthy foods is as equally important as getting enough sleep. While specific dietary changes have been recommended for symptoms of PMS—but may not necessarily be as effective for women with PMDD—others are part of an overall healthy eating program.

• Remember to eat three meals a day to keep your body fueled and hydrated throughout the day.
• Deep-fried, processed, and sugary foods can be inflammatory and worsen symptoms of PMS or PMDD.
• Complex carbohydrates, such as whole grains, vegetables, and fruits are less likely to worsen fatigue, mood swings, and unhealthy food cravings.
• Try limiting your salt intake, which can make bloating worse.
• Both caffeine and alcohol can worsen PMS and PMDD symptoms, so try to decrease the amount that you consume in the weeks before your period.

Tip 4: Seek out support groups and other resources

Support groups are valuable resources for connecting with other women who have PMDD. There are both in-person and online peer support groups offered free of change. Some of these groups are located on Facebook and Instagram. Being part of a cohesive group can make you feel less isolated, provide a safe space to share your experiences, and get additional coping tips that have worked for others.

If you feel more comfortable in one-on-one settings, speaking with a licensed therapist, mental health counselor, or other health professional is another means to receive ongoing support. Above all, keep in mind that there’s no reason to suffer in silence. Remember that you’re not alone, and there are many worthwhile organizations you can reach out to and rely upon. See below for links.

Tip 5: Create a “wellness toolkit”

Assembling a “wellness toolkit” may sound complicated, but it’s simply a list of tools that can help you feel more hopeful and better able to cope with daily stressors. These are just a few suggestions for ways to ease stress and boost your mood, but brainstorm other tools that may work better for you.

• Listen to your favorite music.
• Spend time with friends or family who you feel comfortable talking to.
• Take breaks from social media overload throughout the day.
• Watch an entertaining movie, video, or TV show.
• Play with pets, whether they’re your own or others’.
• Read a book for pleasure, or to learn something new.
• Find ways to connect with nature.
• Exposure to sunlight can be effective for easing depression, so find ways to get outside and soak up the rays.
• Engage in a hobby that you enjoy or taps into your creativity.
• Practice saying positive affirmations about yourself on a daily basis.

How to help a loved one with PMDD

It’s normal to feel helpless when someone you care about is struggling with PMDD. Everyone has a unique experience with this condition, and it may change as your loved one ages. Living with PMDD in adolescence and early adulthood can be particularly difficult as your loved one goes through a transitional stage of development.

As a parent of an adolescent or teen, or a close friend, relative, or significant other of a woman with PMDD, there are ways to provide support and understanding.

Learn all you can about PMDD. When you educate yourself about PMDD, you will be more informed, as well as more understanding about what your loved one is going through. This will also encourage your loved one to confide in you about her feelings and experiences with PMDD.

Be attentive to her needs and open to discussion. At the same time, respect her boundaries if she expresses resistance about talking with you. Inquire about how you can best support her, so you won’t assume you know what she needs. You also can suggest speaking to a trained professional, or contacting a support group, if that seems more appropriate.

Listen attentively. Just being a good listener is a tremendous asset to your loved one with PMDD. Let her know you are concerned, and show how much you care about her. You can say “I’m worried about you and want to help as much as possible.” Allow her the space to express how PMDD affects her life. Being validated demonstrates your compassion for her condition.

Provide patience and reassurance. If your child or partner is acting irrationally or seems totally out of control, it can take a great deal of patience and fortitude to be around them. Keep in mind that this is temporary, and not something she’s doing purposefully. Try to remain calm, and let her vent her feelings without reacting to hurtful things she might say or do. Reassure her that this will pass, and you’re there to support her every step of the way.

Work on planning and scheduling. You can assist your loved one with scheduling obligations during the most opportune times of her menstrual cycle. You can also lend your support during the most difficult days to help her complete tasks, stay organized, or run errands.

Be aware of crisis or emergency situations. Women with PMDD may be at increased risk for suicide. If your loved one has any suicidal thoughts or feelings, seek immediate help. You can also look out for other warning signs, such as extreme escalations in anxiety, aggression, or depression that are out of the ordinary.

Take care of yourself. Keep in mind that you cannot be of help to others unless you also take care of yourself. The same advice about healthy eating, adequate sleep, and stress relief applies to you. Try adding relaxation practices into your daily routine to help maintain a more positive mindset, a calmer demeanor, and prevent caregiver burnout.

Last updated or reviewed on February 21, 2024