The Ultimate Guide to PMDD - Allbodies

The Ultimate Guide to PMDD

The Ultimate Guide to PMDD

Think of it as the 64 oz. Big Gulp version of the 12 oz. can of PMS.


You may be used to having sore boobs, an achy vulva, and a slightly less forgiving mood when your period is on its way. But for some people, an encroaching period can be totally debilitating and result in severe depression, heightened anxiety, and serious mood swings.  Welcome to PMDD. PMDD is a premenstrual disorder that causes cyclical, severe physical and mental discomfort, including severe depression. The severity of the symptoms are what differentiate it from PMS.  And the fact that it is cyclical is what differentiates it from other disorders.

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According to a 2009 study published in the Journal of Women’s Health, roughly 5% of people with a uterus have PMDD during their childbearing years. It wasn’t until 2013 that PMDD was added to the Diagnostic and Statistical Manual of Mental Disorders (basically, the “end-all-be-all” volume that psychiatrists and psychologists use to diagnose patients), but before then, PMDD was a contested phenomenon with some health experts questioning its existence altogether. In an article from the October 2002 Monitor on Psychology titled, “Is PMDD Real?” Joan Chrisler, PhD opines that PMDD and PMS are “culture bound syndromes.” Basically meaning, first-world probs. So this, coupled with the fact that our health system too often overlooks pain of female-presenting bodies (for example, they are more likely to experience delays in emergency care) is likely why you’re a stranger to PMDD.


Unfortunately, there is no known cause for PMDD though it is thought that PMDD may be an abnormal reaction to the hormonal changes that happen during each menstrual cycle. PMDD also includes severe depression, so another possible cause for PMDD may be a lowering of serotonin levels. 


Common symptoms of PMDD include:


  • Severe depression in the two weeks leading up to a period
  • Suicidal thoughts or actions
  • Fatigue
  • Bloating
  • Increased agitation and irritation
  • Changes in sleeping patterns
  • Increase or decrease in appetite


If these symptoms are interfering with your everyday life, see your healthcare provider. PMS is like a toothache. PMDD is a root canal without numbing… every month. It’s severe, regular, and disruptive – it needs to be diagnosed and treated for relief to take place. 


To start, know you aren’t crazy, and you don’t need to suffer! PMDD can be downright draining, and when we’re struggling physically this often takes an even deeper emotional toll. It’s important to be honest and open with your healthcare provider about the severity of your symptoms – they can’t get you the help you need if they don’t know how awful you’re really feeling. We recommend getting some different treatment perspectives from different modalities when it comes to PMDD so that you can have some options.

Lifestyle changes, and in some cases, medication, can be very helpful.  If the medication route is the right choice for you, the FDA has approved the birth control pill Yaz to treat PMDD. In some cases, antidepressants may be recommended to support serotonin levels- one factor that is thought to contribute to PMDD.


But there are lots of non-medication routes you can take as well. Check out this article on how to fight PMDD like a warrior.


Remember, one of the differentiating factors of PMDD is that it is cyclical. It’s also PRE-menstrual, so once menstruation begins, the symptoms should start to dissipate with regular bleeding.    



PMDD is a more severe and disabling form of premenstrual syndrome. Whether we are speaking of PMS or PMDD, they are both due to hormonal imbalance, often of estrogen dominance or progesterone deficiency. Unfortunately, if these hormonal imbalances are not treated effectively, they can go on and become issues for fertility later in life. Since some may be prescribed birth control when young, the effects of not having a natural menses every month can effect fertility in the long term. (A pill bleed is not a ‘real’ bleed– it’s a fabricated menstrual cycle from the removal of progestins in the birth control pill) PMDD is also treated with medications that can suppress gonadotropic hormones (LH & FSH), so long term use can be detrimental for fertility later in life.

-Dr. Autuma Shah


Good news for anyone wanting to hop on the baby train: getting your eggo preggo relieves PMDD! No period while pregnant = No PMDD.  


While there’s rarely just one factor that plays into our desire to get down, because most people with PMDD experience depression and lethargy, they may not be down for sex leading up to their period. That’s not a hard and fast rule though, and other people may want the relief that sexual intimacy can bring, both mentally and physically. A gentle reminder to do what you need to do for you, whether that’s sex with a partner, or sex, party of one! Being honest with where you are at, and communication with sexual partner/s when needed is key here! Get more tips on sex with PMDD here!

This article was created for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

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