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Premenstrual dysphoric disorder
Other Resources UpToDate PubMed

Premenstrual dysphoric disorder

Contributors: Shea A. Nagle MPH, Abhijeet Waghray MD, Mitchell Linder MD
Other Resources UpToDate PubMed


Premenstrual dysphoric disorder (PMDD) is characterized by cognitive-affective and physical symptoms in the week or two before menses that resolve during menstruation. These symptoms are severe and can cause serious distress in patients. Common symptoms include depressed mood, anxiety, emotional dysregulation, fatigue, and impaired concentration in addition to physical symptoms including breast tenderness, pain, and weight gain.

Individuals with PMDD report mood changes and negative affect during the luteal phase of their menstrual cycle. It is currently hypothesized that PMDD is caused by exposure to progesterone during the luteal phase, which may contribute to abnormal serotonergic activity in the brain. Some evidence suggests that women with PMDD have increased sensitivity to allopregnanolone, a progesterone metabolite, which may alter GABA receptors in the brain. A study using functional MRI demonstrated hypoactivation in the right dorsolateral prefrontal cortex, which is thought to be important for emotional regulation, in women with PMDD.

PMDD may occur any time after menarche. Risk factors include stress, history of trauma, seasonal changes, and family history of PMDD. The 1-year prevalence of PMDD is estimated to be between 1.8% and 5.8% of menstruating people. PMDD may also be associated with increased suicidal ideation and suicide attempts.

Patients with this disorder may have an increased risk of various general medical conditions.

Related topic: premenstrual syndrome


F32.81 – Premenstrual dysphoric disorder

596004 – Premenstrual dysphoric disorder

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Differential Diagnosis & Pitfalls

  • Premenstrual syndrome – Distinguished by fewer and less severe symptoms.
  • Primary dysmenorrhea – Painful menses with cramping.
  • Secondary dysmenorrhea – Painful menses due to Endometriosis, adenomyosis, or Uterine fibroids.
  • Mood disorder – Including Bipolar disorders, Major depressive disorder, and dysthymia; will present differently in history; may coexist with PMDD.
  • Migraine headache – Some individuals may experience migraines around the time of menses, which may have a variety of physical and cognitive-affective symptoms.
  • Gender dysphoria – Transmasculine individuals may experience heightened dysphoria and mood symptoms around and during menses, but these feelings generally persist after menses and are usually associated with other manifestations of gender dysphoria.
  • Substance use or intoxication – Can be associated with changes in mood and emotional regulation.
  • Medication side effects – Some individuals using hormones or other medications may experience mood changes.

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Last Reviewed:02/06/2020
Last Updated:09/17/2020
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Premenstrual dysphoric disorder
A medical illustration showing key findings of Premenstrual dysphoric disorder : Fatigue, Irritability, Sleep disturbance, Myalgia, Breast tenderness
Copyright © 2024 VisualDx®. All rights reserved.