Menstrual Disorders

PMS and Premenstrual Dysphoric Disorder

Premenstrual Dysphoria Disorder (PMDD) Diagnosis

Waking up on a cold, damp and gray overcast morning, your immediate reaction may be to turn over and pull the covers over your head. You certainly don’t have that same feel good energy that a sunny morning brings. It is harder to get out of bed. If you really stop and think about it, you may even feel down or irritable.

Maybe you actually feel this way or worse for about two weeks every month despite what the morning actually looks like.

Thinking about that feeling will start to help you understand if you or a loved one suffer from premenstrual dysphoria disorder, or PMDD.

Making the Diagnosis

There are no blood tests or imaging tests that are helpful to diagnose PMDD. The diagnosis is made based solely on your symptoms

It is important to realize that it is normal to experience some recurrent symptoms in the second half of your cycle, or the luteal phase.

This is roughly the two weeks after ovulation but before menstruation starts. If your symptoms are bothersome and cause some disruption of your daily life you likely have PMS.

However, if your symptoms are predominantly psychological, quite severe, and lead to a significant negative effect on your quality of life, you likely have PMDD.

Tracking Your Symptoms

I can't stress how important it is to accurately track your symptoms. Your symptoms are the only information your doctor has to make the correct diagnosis. You need to be detailed in your recording of how you are feeling emotionally and physically every day for two complete menstrual cycles.

A complete menstrual cycle is from the first day of your period until the first day of your next period. You will also need to record the days of your period. 

 You can use a blank calendar to keep a record of your symptoms. However, it might be helpful to use a specific symptom tracker or an app to help you record your symptoms.

Be sure to bring all of this information with you to your doctor's appointment.

 The reason why you need to prospectively record your symptoms is that just recalling your symptoms is not entirely accurate. The timing of your symptoms is necessary to differentiate between PMDD or a premenstrual exacerbation of an underlying condition such as bipolar disorder.

Your accurate symptom log will allow your doctor to make the correct diagnosis of PMDD.

Meeting the Diagnostic Criteria

Although there is still some disagreement among the experts on what symptoms need to be present to diagnose PMDD, there are some criteria that your doctor can use to make the diagnosis. The American Psychiatric Association recognizes PMDD as a clinical diagnosis and established a set of criteria to make the diagnosis.

Having a significant mood component to your symptoms is necessary for the diagnosis. This is why it is so important to keep an accurate log of your symptoms. Here are some important things to consider:

  • You must have five or more severe symptoms that occur during the time between ovulation and your period. 
  • These symptoms must go away during your period and not return for at least another couple of weeks when your next luteal phase starts.
  • These symptoms must also interfere with your work or school, your relationships with family, friends, and/or coworkers and your usual social activities.

You have to have at least one of the following symptoms to have the diagnosis of PMDD:

  • very labile moods like mood swings, increased sensitivity to rejection, and/or sudden sadness or tearfulness
  • marked irritability or anger
  • depressed mood
  • marked anxiety and tension

In addition, you may also have any one or more of the following symptoms to make a total of five or more symptoms: 

  • decreased interest in your usual activities
  • difficulty concentrating
  • lack of energy
  • overeating or food cravings
  • changes in your sleep habits
  • feeling overwhelmed or out of control
  • physical symptoms like breast tenderness or swelling, joint pain or muscle aches, feeling bloated, and or weight gain

Your Next Steps

We don’t know exactly what causes PMDD. What we do know is that the normal cyclic changes in your  menstrual cycle can trigger changes in your neurotransmitters or brain chemicals. These changes result in the symptoms of PMDD. Once you have been properly diagnosed with PMDD you can work with your doctor to determine what treatment options are best for you.

A Word From Verywell

Getting the proper diagnosis of PMDD is the first step to feeling better. Because the condition can be so isolating and can create big disruptions in your personal relationships it is a good idea to connect with other women who have PMDD. The National Association for Premenstrual Dysphoria Disorder is an excellent resource to help women connect and learn more about their condition and treatment options.

Making healthy lifestyle changes, getting the proper treatment, and support will help you to live well with PMDD.


Hantsoo L, Epperson C. Premenstrual Dysphoria Disorder: Epidemiology and Treatment. Current Psychiatry Reports. 2015;17(11)86-94

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