What is PMDD?
PMDD (Premenstrual Dysphoric Disorder) is a cyclical hormone-based mood disorder.
PMDD is a severe negative reaction in the brain that is directly connected to the natural hormonal fluctuations of the menstrual cycle and is triggered when ovulation occurs.
Ovulation
→ What it is: The release of an egg from the ovary.
→ When it happens: Around the middle of the menstrual cycle (typically day 14 in a 28-day cycle).
→ What it marks: The end of the follicular phase and the beginning of the luteal phase.
📌 Think of ovulation as the event, and the luteal phase as the aftermath that prepares your body for either pregnancy or menstruation.
PMDD (Premenstrual Dysphoric Disorder) has symptoms that arise during the luteal, or premenstrual phase of the menstrual cycle and subside within a few days of menstruation due to the brain's sensitivity to the natural rise and fall of progesterone and estrogen.
Luteal Phase (Premenstrual Phase of the Menstrual Cycle)
→ What it is: The phase that follows ovulation.
→ When it happens: From ovulation and ends when menstruation starts (typically lasting 12 to 14 days on days 15–28 of your 28-day cycle).
→ What happens: The body produces progesterone to support a possible pregnancy. If there's no pregnancy, hormone levels drop, triggering the menstrual period.
📌 Think of ovulation as the event, and the luteal phase as the aftermath that prepares your body for either pregnancy or menstruation.
Although individuals with PMDD have normal hormone levels and typical hormonal fluctuations, their brains react abnormally to these fluctuations for reasons that are not yet fully understood.
Researchers have, however, established that this extreme brain response is triggered by estrogen and progesterone's normal rise and fall.
While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance. It’s important to recognize the real issue to address the symptoms effectively. Research has consistently shown that hormone levels—and their primary metabolites—are within normal ranges in individuals with PMDD. This means there is no evidence that PMDD is the result of a traditional “hormone imbalance.”
PMDD Symptoms
For those living with PMDD, severe symptoms like anger, irritability, depression, and anxiety can feel overwhelming and often interfere with daily life.
These symptoms present exclusively during the luteal phase, or premenstrual phase, the 1–2 weeks before menstruation, and can resemble a severe mood disorder. However, the key distinction is that they consistently resolve shortly after the period begins, indicating a cyclical hormonal pattern rather than a persistent mental health condition.
PMDD can lead to severe emotional symptoms, including suicidal thoughts and behaviors.
Studies show that up to 34% of those with PMDD have reported past suicide attempts.
🔴 PMDD affects each person differently; symptoms can range from mild to moderate to severely life-disrupting.
PMDD does not cause heavy periods, cramps, or period pain, though symptoms such as premenstrual cramping, bloating, and breast tenderness are common.
PMDD can worsen during reproductive events (first period, pregnancy, giving birth, miscarriaage, menopause).
PMDD Causes
While the underlying biological causes of PMDD are still under investigation, current research suggests it may result from a combination of several contributing factors.
While the exact biological causes of PMDD are still being studied, research points to several contributing factors. Regardless of the phase of their menstrual cycle, individuals with PMDD have been found to exhibit:
→ Unique patterns in the expression of genes responsive to ovarian hormones
→ Distinct differences in brain activity and neural network function
→ Higher rates of exposure to traumatic life events and chronic stress
In the luteal phase, those with PMDD have:
→ Altered serotonin function in the brain
→ Abnormal responses to normal cyclical changes in the metabolites of progesterone (allopregnanolone) in the brain
🔴 PMDD affects each person differently; symptoms can range from mild to moderate to severely life-disrupting.
In 2017, researchers at the National Institutes of Health (NIH) found that those with PMDD are more sensitive to changes in the sex hormones estrogen and progesterone. They found that this might be due to a molecular mechanism in their genes. Researchers compared white blood cells in women with PMDD and those without and confirmed that women with PMDD had differences in the genes that process sex hormones.
💭 I think I have PMDD.
Many people live with undiagnosed PMDD for years. Naming it can bring relief, but also uncertainty. It’s a learning curve, but you’re not alone; we’re here to help.
A PMDD diagnosis requires at least five of the following symptoms, including at least one core emotional symptom (marked with ✅).
Emotional & Mood Symptoms
→ Mood/Emotional Changes (mood swings, sadness or tearfulness, and increased sensitivity to rejection) ✅
→ Persistent irritability or anger leading to increased interpersonal conflict that may affect others ✅
→ Depressed mood, feelings of hopelessness, and a sense of worthlessness or guilt ✅
Anxiety & Tension
→ Feelings of tension, anxiety, or feeling on edge ✅
→ Feeling out of control ✅
Cognitive & Energy Changes
→ Difficulty thinking or focusing and experiencing “brain fog”
→ Fatigue and low energy
→ Lack of interest in daily activities and relationships (social, professional, educational)
Behavioral & Appetite Shifts
→ Changes in appetite, such as food cravings, overeating, or binge eating
→ Sleep disturbances (sleeping too much or sleeping too little)
Physical Symptoms
→ Bloating and Weight Gain
→ Cramping
→ Muscle and Joint Pain
→ Breast tenderness and/or swelling
All. The. Symptoms.
We’ve touched on a few symptoms already, but if it feels like you're being hit from all sides—physically, emotionally, and mentally—you're not imagining it. Here's the full list of PMDD symptoms to help you see the whole picture.
😡 Anger
🫥 Anhedonia (Inability to Feel Pleasure)
😟 Anxiety & Panic Attacks
😶🌫️ Brain Fog & Lack of Concentration
😭 Crying Spells
🔄 Cyclical Absences from Work/School
😵💫 Delusions
😞 Depression
💔 End Relationships and/or Job
😔 Feels Inadequate
🙃 Given a Bipolar Diagnosis
🫠 Glued to Sofa or Bed for 1-2 Weeks
📓 Heart-Wrenching Journals
🥺 Highly Sensitive
😴 Hypersomnia (Sleeps Too Much)
🥱 Insomnia (Sleeps Too Little)
💢 Irritability
🤯 Lacks Impulse Control (Binge Eating, etc.)
😷 Mask Wearing
🤕 Migraines, Aches, & Pains
🤫 Misophonia (Strong Reaction to Sound)
😶 Mutism (Unable or Unwilling to Speak)
😶 No Response to Texts, Voicemails, Emails
🤬 Outbursts & Making Hateful Comments
😨 Paranoia
😞 Prenatal or Postpartum Depression
😬 Recalling Cringe-Worthy Memories
🔺 Self-Harm & Suicidal (Attempts, Planning)
🔺 Thoughts of Harming Others (Homicidal)
💊 Tried Many Medications for Various Mental Health Diagnoses
🤕 Visits to the Emergency Department
Self Screen
Use IAPMD’s Premenstrual Disorders (PMDs) Self Screen to help determine if you may have PMDD or PME. It’s also possible to have both conditions, and if you’re unsure, we recommend consulting an experienced healthcare provider for a proper diagnosis.
This Self Screen was developed with a strong commitment to privacy and data protection, including HIPAA (US) and GDPR (EU) compliance.
📌 Disclaimer: This Self Screen Tool is not a diagnostic instrument for PMDD or PME and should not replace professional medical care. It is intended solely as a preliminary assessment to help identify potential concerns for further evaluation by a healthcare provider.
Symptom Tracker
PMDD cannot be diagnosed through blood, hormone, or saliva tests. While these tests may help rule out other conditions (such as thyroid disorders or hormone imbalances), they cannot confirm a diagnosis of PMDD. The only current method for diagnosing PMDD is by tracking symptoms daily throughout at least two complete menstrual cycles.
This downloadable tracker includes the Daily Record of Severity of Problems (DRSP), the gold-standard, clinically validated tool used by healthcare providers, clinicians, and researchers, alongside additional IAPMD-designed worksheets.
Please print out the tracking sheets and complete them daily to capture how symptoms change throughout your cycle. Bring the completed charts to healthcare appointments to support evaluation, diagnosis, and treatment planning.