Premenstrual Dysphoric Disorder

It is very normal for women to experience mild symptoms of discomfort around the time of menstruation. Usually, the discomfort does not prevent them from going about their usual daily activities. Some women experience stronger discomfort associated with Premenstrual Syndrome (PMS).

Premenstrual dysphoric disorder (PMDD), however, is a condition involving physical and psychological symptoms around the time of menstruation. The symptoms are like those of PMS, but more severe. PMDD causes significant distress and affects participation in normal work and social activities.

Some women do not seek treatment because of the stigma attached to premenstrual disorders. It’s important to remember that PMDD is recognized and there are effective treatments available.

How common is premenstrual dysphoric disorder?

Studies have found varying rates of PMDD. For example:

  • One study in the United States found that 1.3% of women experienced symptoms of PMDD (1).
  • A review of the research estimated that a higher percentage of the population, of around 8%, experience PMDD (2).

Symptoms of premenstrual dysphoric disorder

PMDD is a diagnosis in the category of Depressive Disorders in the DSM-5. The DSM-5 is the diagnostic manual mental health professionals use. People with PMDD experience a combination of the following mood and physical symptoms, in the majority of their menstrual cycles, in the week before their period begins:

  • Mood swings
  • Feeling irritable or angry
  • Feeling sad or depressed
  • Increased anxiety or tension
  • Reduced interest in normal activities
  • Increased difficulty concentrating
  • Feeling tired or fatigued
  • Changes in appetite
  • Changes in sleeping patterns
  • Feeling overwhelmed
  • Physical symptoms (such as tender breasts, joint or muscle pain, a sensation of ‘bloating’ or weight gain)

These symptoms usually reduce or completely go away in the week following menstruation (3).

What to do if you think you have premenstrual dysphoric disorder

If you experience distress or have difficulty going about your normal activities as a result of any of the above symptoms, consider one or more of these options:

  • Check-ups: Schedule a check-up with your physician to investigate or rule out other medical conditions that may contribute to your symptoms. Additionally, some symptoms of PMDD can be treated with medication or oral contraceptives.
  • Therapy: Research shows that psychological talking therapies, such as Cognitive Behavior Therapy, can help reduce symptoms of PMDD.
  • Self-care: Pay attention to your diet, stick to a regular sleep pattern, and exercise regularly. There is ongoing research investigating the impact of these factors, but many studies have shown that exercise can improve mood (4).
  • Relax: Schedule ‘time-out’ into your day and deliberately use it to relax. Consider doing a relaxation exercise or an activity that is pleasurable.
  • Support groups: The International Association for Premenstrual Disorders (IAPMD) can help you to locate a support group. They also offer support through an online chat service.
  • Hotlines: If you’re having thoughts of suicide or need immediate support, call the National Suicide Prevention Hotline at 1-800-273-8255. You could call the Office on Women’s Health Helpline at 1-800-994-9662.
  • Complementary therapies: There is limited evidence to support the efficacy of complementary therapies. Yet, some women do appear to benefit from this style of holistic treatment (5).

Therapy types to consider for premenstrual dysphoric disorder

Many types of therapy are considered helpful for treating symptoms of PMDD, such as:

  • Cognitive Behavioral Therapy (CBT): CBT can help change unhelpful thoughts and behaviors. Research indicates that CBT can help improve the symptoms of both PMDD and PMS (5).
  • Mindfulness Practices: Mindfulness helps people to be aware of thoughts and bodily sensations without automatically reacting to them as problematic.
  • Acceptance and Commitment Therapy (ACT): ACT involves components of both CBT and mindfulness as well as other strategies. ACT helps people take an acceptance approach and respond differently to PMDD symptoms.

What to look for in a therapist for premenstrual dysphoric disorder

When selecting a mental health professional, it can be helpful to consider the following factors:

Personal fit

One of the most important things to consider is the potential for developing a strong working relationship with your therapist. This relationship is called the therapeutic alliance, and it’s the number one indicator of treatment efficacy. Some women find that they feel more comfortable working with a female therapist for PMDD. This is not always the case, but just a factor to consider.

Qualifications and experience

Be sure that you find a licensed mental health professional. Ask your prospective therapist ahead of time whether they have training and experience working with people with premenstrual disorders.

Talk in advance

The best way to judge how you might feel about your prospective therapist is to ask for a preliminary phone call (you can do this with our vetted Zencare therapists). Most therapists will be happy to oblige. This gives you the opportunity to ask about:

  • Their qualifications
  • Their experience working with people who have mood disorders like depression, or more specifically, PMDD.
  • Any ongoing training related to PMDD
  • What type of therapy they suggest, and what that will be like
  • Their participation in insurance plans and cost of therapy

Try to speak to a few different therapists before making your mind up.

New to therapy? Learn about how to find a therapist here.


(1) The prevalence of premenstrual dysphoric disorder in a randomly selected group of urban and rural women

(2) European Medicines Agency, “Guideline on the treatment of premenstrual dysphoric disorder (PMDD)

(3) Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD)

(4) Physical Exercise for Treatment of Mood Disorders: A Critical Review

(5) Management of Premenstrual Syndrome, BJOG 2016; DOI: 10.1111/1471-0528.14260