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Let’s Talk about PMDD

Coping with premenstrual dysphoric disorder


Women with premenstrual dysphoric disorder (PMDD) often face prejudice, incur higher health care costs than those with mild to moderate PMS, and require specific medical treatment. Women with PMDD have poorer health-related quality of life and are more likely to report suicidal ideation compared to women without PMS.

Casting off PMDD into the bucket labelled “women’s issues we all deal with” or dismissing these women’s experiences as “just that time of the month” does a disservice to those whose relationships, career, and quality of life suffer with their condition.

PMDD—the facts

  • PMDD is a severe form of PMS that affects between 1.8 and 5.8 percent of menstruating women per year.
  • This condition comprises cognitive, physical, and affective symptoms that arise during the luteal phase of the menstrual cycle, which spans from ovulation to the onset of menses.
  • The intensity of these symptoms causes significant distress and interference in their daily lives, negatively affecting their relationships and productivity at home and work.


Diagnosing PMDD

Just like PMS, PMDD symptoms only occur in the luteal phase of the menstrual cycle and resolve within a few days of the onset of menses. But unlike PMS, PMDD is classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The DSM-5 requires that four criteria be met for the diagnosis of PMDD.

PMDD diagnostic criteria

Criterion A

At least five of the following 11 symptoms must be present, including at least one symptom listed #1-4:

  1. depressed mood, feelings of hopelessness, or self-deprecating thoughts
  2. anxiety, tension, or feeling “on edge”
  3. severe mood swings
  4. persistent and severe anger, irritability, or increased interpersonal conflicts
  5. decreased interest in usual activities
  6. difficulty concentrating
  7. lethargy or easy fatigue
  8. change in appetite, overeating, or specific food cravings
  9. oversleeping or insomnia
  10. feeling overwhelmed or out of control
  11. other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain

Criterion B 

Symptom severity significantly impacts social, sexual, workplace, or academic functioning.

Criterion C

Symptoms must be related to the menstrual cycle and not be menstrual exacerbations of other conditions, such as major depressive disorder, anxiety, panic disorder, dysthymic disorder, and personality disorder.

Criterion D 

Criterion A, B, and C must be confirmed by daily ratings for at least two consecutive symptomatic menstrual cycles.

If you’re wondering if your PMS is severe enough to be classified as PMDD, a good place to start is by journalling which symptoms you have and when you experience them in relation to your menstrual cycle. Look up the Daily Record of Severity of Problems for a validated tool used to document symptoms and diagnose PMDD.


Consult your health care practitioner

Developing a keen sense of your own body is always valuable, but remember to consult your health care practitioner for an official diagnosis. Bring your symptom journal to your appointment for a discussion about taking next steps.

Lab testing and imaging can be helpful to rule out other potential causes of your symptoms. For instance, migraines, anemia, endometriosis, and hypothyroidism may cause similar symptoms to PMS and PMDD and require different treatment.


Interpersonal relationships

The impairment to interpersonal relationships in the luteal phase for women with PMDD is comparable to the severity experienced by those with clinical depression.

Research has shown that education about the condition can mitigate prejudice against those with PMDD. One trial showed that people who were educated about PMDD perceived sufferers to have more warmth, less depression, and more competence than did those who were not familiar with the condition.

Encouraging your partner, friends, and family to read about PMDD from reputable sources may lead to better understanding of your condition. Open communication may also help lighten the burden and foster empathy. When you’re feeling well, encourage your friends to ask how PMDD affects your life. (See sidebar: Communication tips.)


Gender roles

A challenging social norm to navigate is the gendered expectation that women should be kind, nurturing, and self-sacrificing. PMDD can make women have angry outbursts, feel too fatigued to make dinner for weeks on end, and retreat from social time with their partner and children. This flies in the face of the ideal woman/wife/mother!

If you have PMDD, you might face criticism from your partner and feelings of guilt and inadequacy on your part. Practise self-compassion and remind yourself that this isn’t coming from “you.”

Regardless of whether or not you perform traditionally feminine roles in the home, it’s a good idea to communicate with your partner about the allocation of responsibilities. Intentionally lighten your load in your luteal phase and take on more tasks in your follicular phase when you’re feeling like yourself.

Communication tips

  • Ask HR for flexibility in scheduling, deadlines, and presentations.
  • Save important conversations with your partner for your follicular phase.
  • Ask your partner what their boundaries are for dealing with your outbursts.
  • Talk about your needs.
  • Consider couples therapy to assist with unmet needs and problem solving.
  • Tell your kids in advance that you’ll be needing alone time; give it a name like “grumpy mummy” time.

Mental health resources

  • Cognitive behavioural therapy has been shown to reduce the burden of PMDD, while addressing stress management and coping styles.
  • Psychoeducational self-help programs have been shown to assist women in managing mild to moderate PMS.

Natural premenstrual supports


supplementing with 600 mg, twice per day, has been shown to be superior to placebo for improving emotional and physical PMDD symptoms

chaste tree berry / vitex

oral administration has been found to be superior to placebo for both emotional and somatic symptoms of PMDD

bright light therapy

early morning and evening sessions may mitigate PMDD symptoms

magnesium and vitamin B6

supplementing in combination may be more effective than placebo for reducing PMS score


an extract taken orally may be as effective as mefenamic acid (an NSAID) for reducing physical symptoms of PMS, and more effective for reducing emotional symptoms of PMS


essential oil used in aromatherapy massage may be more effective for reducing physical and mental symptoms of PMS than massage alone


essential oil inhalation may help improve bloating, pain, and the emotional symptoms of PMS

damask rose

essential oil, whether applied topically or inhaled, has been shown to reduce menstrual headache, fatigue, and bloating



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