Premenstrual Dysphoric Disorder: Causes, Symptoms, and Treatment
Medically reviewed by Sumiran Racherla, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Premenstrual Dysphoric Disorder?
An obstetrician-gynecologist (ob-gyn), a doctor for women's health, usually treats premenstrual dysphoric disorder (PMDD). A mental health professional may also help. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is premenstrual dysphoric disorder?
Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before her period. PMDD is a severe type of premenstrual syndrome (PMS). Its symptoms are more severe than those of PMS.
PMS is a group of physical or emotional symptoms that most often start about 5 to 11 days before a period. Less than 5% of women of childbearing age get the more severe form, PMDD.
Symptoms
Symptoms happen during the week just before menstrual bleeding. They most often get better within a few days after the period starts. PMDD symptoms include at least one mood-related symptom.
- Sadness or hopelessness, and sometimes thoughts of suicide.
- Mood swings, sometimes with crying.
- Irritability or anger that affects other people.
- Anxiety.
- Panic attacks.
- A feeling of being out of control.
- Low energy or tiredness.
- Problems sleeping.
- Trouble concentrating.
- Food cravings or binge eating.
- Bloating, breast tenderness, headaches, and joint or muscle pain.
Some women with PMDD have suicidal thoughts.
Causes and who gets it
The causes of PMS and PMDD have not been found. Hormone changes during the menstrual cycle may play a role. PMDD affects a small number of women during the years when they have periods.
Many women with PMDD have anxiety or depression, which can be severe. Alcohol or illegal drug use and thyroid disorders may also play a role. So may being overweight, having a mother with PMDD, and a lack of exercise.
How doctors diagnose it
No physical exam or lab tests can diagnose PMDD. Doctors check for other conditions with a full history, a physical exam with a pelvic exam, thyroid testing, and a mental health evaluation.
Keeping a calendar or diary of symptoms can help you spot the most troublesome symptoms and when they happen. This may help your provider diagnose PMDD and pick the best treatment.
Treatment
A healthy lifestyle is the first step to managing PMDD.
- Eat healthy foods with whole grains, vegetables, and fruit, and little or no salt, sugar, alcohol, and caffeine.
- Get regular aerobic exercise throughout the month.
- If you have trouble sleeping, try changing your sleep habits before taking medicines for sleep.
The first medicine option is most often an SSRI, a kind of antidepressant. You can take it in the second part of your cycle until your period starts, or for the whole month. SSRIs can help treat PMDD in some women.
Cognitive behavioral therapy (CBT), a type of talk therapy, may be used with or instead of antidepressants. CBT involves about 10 visits with a mental health professional over several weeks to months.
Birth control pills may also help. Types taken without a break are most effective. With them, you may not get a monthly period. Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, cramps, and breast tenderness.
Medicines that suppress the ovaries, such as Depo-Lupron, are also used. Their side effects are similar to those women have in menopause.
When to see a doctor
Contact your provider if symptoms do not improve with self-treatment. Also contact your provider if symptoms interfere with your daily life.
If you are thinking about harming yourself, call or text 988 (the Suicide and Crisis Lifeline) right away. If someone has tried to end their life, call 911 right away and do not leave the person alone.
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. Either can talk through your symptom diary, do a physical exam, and check for other conditions, such as a thyroid problem. They can also refer you to a mental health professional when needed.
Common questions
What is the difference between PMS and PMDD?
PMDD is a more severe form of PMS. Its symptoms are often more severe and harder to live with. PMDD also includes at least one mood-related symptom.
Can a blood test diagnose PMDD?
No, no physical exam or lab test can diagnose PMDD. A symptom diary may help your provider diagnose it.
Can PMDD be treated?
Yes, most women with PMDD find that treatment helps. A healthy lifestyle is the first step. The first medicine option is most often an SSRI.
When do PMDD symptoms start and stop?
Symptoms happen during the week just before menstrual bleeding. They most often get better within a few days after the period starts.
Sources
- MedlinePlus - Premenstrual dysphoric disorder
- American College of Obstetricians and Gynecologists - Premenstrual Syndrome (PMS)
- Office on Women's Health - Premenstrual syndrome (PMS)
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
