What's the difference between premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS)? How is PMDD treated?

Answer From Tatnai Burnett, M.D.

Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling extension of premenstrual syndrome (PMS). Although PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt daily life and damage relationships.

In both PMDD and PMS, symptoms usually begin seven to 10 days before your period starts and continue for the first few days of your period.

Both PMDD and PMS may cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however, at least one of these emotional and behavioral symptoms stands out:

  • Sadness or hopelessness
  • Anxiety or tension
  • Extreme moodiness
  • Marked irritability or anger

The cause of PMDD isn't clear. Underlying depression and anxiety are common in both PMS and PMDD, so it's possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders.

Treatment of PMDD is directed at preventing or minimizing symptoms and may include:

  • Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem, others) and sertraline (Zoloft), may reduce emotional symptoms, fatigue, food cravings and sleep problems. You can reduce symptoms of PMDD by taking SSRIs all month or only during the interval between ovulation and the start of your period.
  • Birth control pills. Taking birth control pills with no pill-free interval or with a shortened pill-free interval may reduce PMS and PMDD symptoms.
  • Nutritional supplements. Consuming 1,200 milligrams of calcium daily may possibly reduce symptoms of PMS and PMDD. Vitamin B-6, magnesium and L-tryptophan also may help, but talk with your doctor for advice before taking any supplements.
  • Herbal remedies. Some research suggests that chasteberry (Vitex agnus-castus) may possibly reduce irritability, mood swings, breast tenderness, swelling, cramps and food cravings associated with PMDD, but more research is needed. The U.S. Food and Drug Administration doesn't regulate herbal supplements, so talk with your doctor before trying one.
  • Diet and lifestyle changes. Regular exercise often reduces premenstrual symptoms. Cutting back on caffeine, avoiding alcohol and stopping smoking may ease symptoms, too. Getting enough sleep and using relaxation techniques, such as mindfulness, meditation and yoga, also may help. Avoid stressful and emotional triggers, such as arguments over financial issues or relationship problems, whenever possible.

If you have symptoms of PMDD, talk with your doctor about testing and treatment options.

With

Tatnai Burnett, M.D.

From Mayo Clinic to your inbox

Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Dec. 07, 2022 See more Expert Answers

See also

  1. Acne
  2. Acne mistakes
  3. Acne scars: What's the best treatment?
  4. Ambien: Is dependence a concern?
  5. Antidepressant withdrawal: Is there such a thing?
  6. Antidepressants and alcohol: What's the concern?
  7. Antidepressants and weight gain: What causes it?
  8. Antidepressants: Can they stop working?
  9. Antidepressants: Side effects
  10. Antidepressants: Selecting one that's right for you
  11. Antidepressants: Which cause the fewest sexual side effects?
  12. Atypical antidepressants
  13. Bedtime routines: Not just for babies
  14. Belching, intestinal gas, gas pains and bloating
  15. Ovulation
  16. Can't sleep? Try daytime exercise
  17. Clinical depression: What does that mean?
  18. Coffee after dinner? Make it decaf
  19. Combination birth control pills
  20. Constipation
  21. Depression and anxiety: Can I have both?
  22. Depression, anxiety and exercise
  23. What is depression? A Mayo Clinic expert explains.
  24. Depression: Diagnosis is key
  25. Depression in women: Understanding the gender gap
  26. Depression (major depressive disorder)
  27. Depression: Provide support, encouragement
  28. Depression: Supporting a family member or friend
  29. Diarrhea
  30. Don't blame pizza, fries or dirt for acne
  31. Fatigue
  32. Feeling gassy and a little embarrassed?
  33. Gas and gas pains
  34. Headache
  35. Headaches and stress
  36. Insomnia
  37. Insomnia: How do I stay asleep?
  38. Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
  39. Joint pain
  40. Lack of sleep: Can it make you sick?
  41. Male depression: Understanding the issues
  42. MAOIs and diet: Is it necessary to restrict tyramine?
  43. Marijuana and depression
  44. Meditation
  45. Minipill (progestin-only birth control pill)
  46. Monoamine oxidase inhibitors (MAOIs)
  47. Muscle pain
  48. Natural remedies for depression: Are they effective?
  49. Nervous breakdown: What does it mean?
  50. Nonprescription acne treatment: Which products work best?
  51. Not tired? Don't go to bed
  52. Laxatives
  53. Pain and depression: Is there a link?
  54. Premenstrual syndrome (PMS)
  55. Prescription sleeping pills: What's right for you?
  56. Selective serotonin reuptake inhibitors (SSRIs)
  57. Serotonin and norepinephrine reuptake inhibitors (SNRIs)
  58. Skip booze for better sleep
  59. Take headache relief into your own hands
  60. Tension headache
  61. Relieving tension-type headaches
  62. Treat acne-prone skin with care
  63. Treatment-resistant depression
  64. Tricyclic antidepressants and tetracyclic antidepressants
  65. Valerian: A safe and effective herbal sleep aid?
  66. Vitamin B-12 and depression