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