Steps to Diagnosis
Premenstrual Dysphoric Disorder (PMDD) has only recently gained formal recognition as a diagnosable condition in medical and mental health communities. Premenstrual Exacerbation (PME) remains a research diagnosis and is not officially included in diagnostic manuals.
This lack of awareness and training means that many healthcare providers do not recognize PMDD or PME, or they may not know how to begin diagnosing and treating them. Because of this, the best place to start is by finding a provider who understands what PMDD is and has experience treating it.
Providers familiar with PMDD typically also understand PME, so focusing your questions around PMDD may yield the best results.
📌 A diagnosis of Premenstrual Dysphoric Disorder should not be made in anyone who is currently using hormonal contraceptives (which includes all hormonal contraceptive pills, patches, rings, implants, injections, and some IUDs) since hormonal contraceptives can prevent ovulation. While it is possible to have a progestogen (synthetic, progesterone-like hormone) induced mood disorder, this would be a different diagnosis from PMDD.
Screening Providers
It can be challenging to find a healthcare provider who is well-informed on symptoms, diagnosis, and treatment options for PMDD. It is not unreasonable to meet with several providers before finding one that is right for them. We encourage you to keep trying until you find someone who is compassionate and knowledgeable about PMDD, aligns with your health values, and honors your lived experience and treatment preferences.
We suggest that screening providers ahead of time by phone is often worthwhile. When calling, ask:
→ Does anyone at the practice have experience treating PMDD?
→ If yes, which providers specifically?
→ What treatments do they typically recommend?
While everyone responds differently to treatment, we recommend choosing a provider who is familiar with evidence-based, first-line treatments, such as those outlined on our treatments pages.
Prepare Ahead of Time
Track Symptoms Daily
→ Because PMDD and PME can be confused with conditions like major depression, bipolar disorder, anxiety disorders, or borderline personality disorder, daily symptom tracking with our Symptom Tracker, which is a Daily Record of Severity of Problems (DRSP) across at least two complete menstrual cycles, is required for an official PMDD diagnosis. This is a requirement of the DSM-5.
→ We understand this can be difficult, especially for those who have suffered for years. However, consistent tracking is the only recognized method for securing an accurate diagnosis.
→ Confirm that symptoms appear in the luteal phase and resolve within days of menstruation.
Collect Previous Medical Records
→ Documenting past treatment for premenstrual or related conditions can help your new provider become familiar with you.
→ Since obtaining records can take time, request them early. Most offices require you to sign a release form to send or collect your information.
📌 If needed, ask a trusted partner, friend, or family member to help you complete your daily ratings.
Moving Forward with a Medical Doctor
(Gynecologist, Psychiatrist, or Primary Care Phyisician)
When meeting with a doctor, keep these tips in mind:
→ Explain your symptoms clearly and say, “I believe I have PMDD (or PME).”
→ Show your completed daily symptom charts.
→ Share your treatment history, especially whether SSRIs or birth control pills have been effective or not.
→ While blood, saliva, or hormone tests cannot diagnose PMDD, ask about using lab tests to rule out other conditions (e.g., thyroid disorders).
→ Request a referral to a behaviorally oriented therapist if needed.
→ Provide your doctor with evidence-based guidelines for PMD treatment (you can print these from IAPMD.org).
→ If a treatment you’ve previously tried hasn’t worked, let your doctor know: “That hasn’t helped me in the past, I’d like to try something new.”
📌 If they are unwilling to explore new options, consider seeking a second opinion.
Moving Forward with a Therapist or Mental Health Provider
Most therapists are also not trained in PMDD or PME. Since treatment often includes medication, it’s important to find a therapist who can:
→ Refer to a physician for prescriptions
→ Offer coping strategies while you work toward diagnosis and management
In your first session, consider sharing:
→ “I believe I have PMDD (or PME), and I’ve been tracking my symptoms.”
→ Your daily symptom tracker
→ Your treatment history (especially if CBT, SSRIs, or birth control have helped)
→ Any non-cyclical mental health symptoms
→ Ask whether they can refer you to a medical provider for further evaluation.
📌 If their treatment suggestions don’t align with your experience, let them know.
📌 If you feel unheard, don’t hesitate to find someone else.