Understanding The Silent Battle Of PMDD
Women's Health

Understanding The Silent Battle Of PMDD

For many women, the severity of our menstrual cycle can make us feel foreign in our own bodies.

From physical symptoms like bloating and fatigue to emotional waves brought on by mood swings and irritability, 3 out of 4 menstruating women have experienced some form of premenstrual syndrome (PMS) in their lifetime. However, what separates normal PMS from a more debilitating variation of these conditions lies in the severity and impact of these symptoms and how it impairs a woman’s ability to function in their daily life — and such is the case of Premenstrual Dysphoric Disorder (PMDD).


Premenstrual Dysphoric Disorder (PMDD) is a severe type of premenstrual syndrome (PMS) that brings about a variety of emotional and physical symptoms during the week or two before menstruation. It is often recognized as 'severe PMS’ and typically occurs during the luteal phase of the menstrual cycle, which spans from ovulation to the onset of the period.

“PMS and PMDD are very similar but also very different,” says Dr. Ashanda Saint Jean, an associate professor of obstetrics and gynecology at New York Medical College.

“In terms of PMS syndrome, it is characterized by both physical and behavioral symptoms that occur prior to the onset of menstruation,” she tells xoNecole. “Whereas PMDD is the severity of the symptoms, which then can be characterized by depression, anxiety, mood changes, and sometimes even suicidal ideation. It's the severity of the symptoms which then require medicinal therapy.”


One of the main distinctions between PMDD and PMS is how it impairs or disrupts the daily functions and quality of life of the women who experience this condition. “Some of the signs of PMDD can be depression, irritability, and anxiety,” Dr. Saint Jean explains. “You can have the severity in the form of breast pain, bloating, swelling, headaches, but once you have your period, these symptoms usually remit or stop occurring.”

While symptoms of PMDD may vary on an individual basis, they typically show up with PMS symptoms and can be broken up into two categories:


  • Mood swings
  • Experiencing sadness or tearfulness
  • Fatigue or decreased energy levels
  • Crying spells
  • Less interest in activities you normally enjoy
  • Feeling hopeless
  • Suicidal feelings
  • Feeling angry or irritable
  • Feeling anxious, tense, or ‘keyed up’


  • Breast tenderness or swelling
  • Bloating sensation
  • Changes in appetite, including overeating or specific food cravings
  • Sleep disturbances
  • Muscle and joint pain
  • Headaches
  • Increased anger or conflicts with others
  • Strong emotional response to perceived rejection by others

Although the specific causes of PMDD are yet to be fully understood, research suggests that there is a connection between PMDD and heightened sensitivity to the typical hormonal fluctuations that take place throughout the menstrual cycle.

“It's your body's response to estrogen. There’s a cycle to how your brain sends out signals and that influences your ovaries to produce hormones,” she says, “It’s hypersensitive sensitivity to the elevation of the hormones that can make the body and mind experience symptoms of PMDD.”


Women who suspect to have symptoms of PMDD can begin their self-screening by taking the International Association for Premenstrual Disorders (IAPMD)’s online screening assessment. Your medical provider will then look for five or more PMDD symptoms, including one mood-related symptom to determine the diagnosis.

Because PMDD is diagnosed based on recurring symptoms, it’s helpful to keep track of your symptoms for at least two full menstrual cycles by using a journal, notebook, or tracking app.

“One's agency is very important and our patients know their bodies,” Dr. Saint Jean says. “It can be something that you may suspect that you have, but I will always advise patients to then have that conversation with their provider (gynecologist or primary care physician).”

“If you’re having any of these symptoms, it’s always a good idea to bring them to the forefront and discuss with your provider and see together how you can arrive at the appropriate diagnosis for you,” she continues.


Once a diagnosis is made, there are a variety of treatment options that can be prescribed. Many patients may require a mood stabilizer such as a Selective Serotonin Reuptake Inhibitor (SSRI), which is a category of medication that increases the levels of serotonin in the brain. Dr. Saint Jean also shares that there is the option of continuous oral contraception, which “increases the intervals of your menstrual cycle,” and allows you to have fewer periods throughout the year.

In all, treatment solely depends on the severity of your symptoms is the advice from your medical provider.

“Not everyone requires to be on an SSRI, but it is helpful for some, especially some patients who have suicidal ideation,” she shares. There are also a variety of lifestyle changes, exercise, and dietary modifications that can aid in decreasing these symptoms. “You may crave salt and sugar, which then can contribute to bloating and water retention; so we advise you to stay away from sugary and salty foods prior to menstruation.”

Struggling with PMDD can feel like a silent battle when you’re experiencing it alone or never knew there was a name for the symptoms that you endure. Thankfully, with the proper tracking and advisory from your primary care physician, PMDD doesn’t have to be something that you suffer through unsupported or untreated — and with these tools, relief could be closer than you think.

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