What is Premenstrual Dysphoric Disorder by Robyn Tamanaha, LMFT

Premenstrual Dysphoric Disorder (PMDD) affects approximately 1.5% to 5.8% of menstruating women; however, the actual prevalence might be higher due to frequent underdiagnosis.

What does it look like?

A woman who is experiencing PMDD will notice a change in her mood that occurs a week before her menses. Symptoms will gradually improve a few days after the start of her menses, and will either begin to diminish or subside entirely a week after menstruation. 

If you are curious whether you may be experiencing PMDD, ask yourself if you experience the following a week prior to menstruation:

1. Frequent mood shifts? Suddenly feelings of sadness? Sensitivity to rejection?

2. Frequent irritability or bouts of anger? Conflicts with other people?

3. Feelings of hopelessness or self-criticism? 

4. Feelings of anxiety or tension? 

In addition to the above, do you notice the following behavioral shifts a week prior to menstruation:

1. Less interest in work, school, friends, hobbies

2. Trouble concentrating

3. Lethargy, easily fatigued, or lack of energy

4. Change in appetite or craving specific foods

5. Trouble falling or staying asleep, or sleeping too much

6. Sense of being overwhelmed or out of control

7. Physical changes, such as breast tenderness or swelling, muscle joint pain, bloating, or weight gain

Diagnosis of PMDD requires the presence of at least 5 symptoms, with at least one from the mood-related list and at least one from the behavioral list. This experience is very distressing and can make it difficult to function in major areas of her life such as work, school, planned social activities, or relationships. Proper diagnosis can be made through consultation with a knowledgeable therapist who will assess the symptoms' recurrence for at least two consecutive menstrual cycles. This evaluation helps differentiate PMDD from other episodic disorders like Bipolar Disorder or Major Depressive Disorder.

What causes it?

PMDD can occur anytime after a woman has had her first menstrual cycle. It's estimated that there might be a 30%-80% heritability, but it is unknown if it's the PMDD symptoms or other heritable traits. Some individuals with PMDD have reported reduced levels of ALLO, a critical progesterone metabolite, and rapid withdrawal from ovarian hormones.

Can it be treated with therapy? 

Fortunately, PMDD can be treated effectively through therapy with a knowledgeable professional. Treatments typically involve a combination of Cognitive Behavioral Therapy, mindfulness techniques, emotion management skills, and strategies for fostering healthy relationships.

You don’t have to do this alone. I treat Premenstrual Dysphoric Disorder (PMDD) and other mood spectrum disorders. If you are interested in receiving therapy with me, let’s schedule a free 15-minute phone consultation.

I can provide in person and video therapy. My office is located in Irvine, which is near Newport Beach, Orange, Fountain Valley, Costa Mesa, Anaheim, Huntington Beach, Mission Viejo, Laguna Niguel, Aliso Viejo, Laguna Hills, Tustin, Seal Beach, and beyond. I provide video therapy to individuals who live in California, including Orange County, San Diego, Los Angeles, Santa Barbara, San Francisco, at more. I work with OCD, anxiety, depression, bipolar disorder, and Asian American & Pacific Islanders.

Disclaimer: This information is being provided to you for educational and informational purposes only. The topics being discussed are meant as a self-help tool for you own use. It is not psychotherapy or counseling. This information is to be used based on your own judgment. If you need to speak with a professional, you should find one local to you and contact them directly.

References: 

American Psychiatric Association Publishing. (2022). Premenstrual Dysphoric Disorder. In Diagnostic and statistical manual of mental disorders: FITFH edition, text revision: DSM-5-TR (p. 197).

MGH Center for Women’s Mental Health. (2020, May 7). The etiology of premenstrual dysphoric disorder: 5 interwoven pieces. MGH Center for Women’s Mental Health. https://womensmentalhealth.org/posts/etiology-premenstrual-dysphoric-disorder/

IAPMD. (2023). Facts & figures. IAPMD. https://iapmd.org/facts-and-figures