Premenstrual dysphoric disorder (PMDD): get to know Super PMS

Irritability, crying and cramps: these are some of the manifestations felt by several women during the menstrual cycle. About 75% of them suffer from the well-known PMS.

PMS stands for Premenstrual Tension, a condition caused by hormonal changes that occur during the menstrual cycle. The condition is considered normal and can usually be relieved with a balanced diet and hot water compresses.

However, when adding the letter “D” to the acronym, the problem can be much more serious. Have you heard of TDPM?

PMDD is the acronym for Premenstrual Dysphoric Disorder, a serious condition that can affect some women, also known as “Super PMS”.

Do you want to know more about it? Continue reading the text!


What is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a severe form of the known premenstrual tension (PMD). In general, the problem occurs in the days before menstruation and its symptoms end after the blood flow starts.

It affects about 3% to 8% of women and is classified as a mood disorder, with physical and mainly emotional changes and symptoms.

The most common manifestations of the disorder are strong depressive feelings, high anxiety , great irritability and emotional instability. During this time, women may also experience physical effects, such as excessive fatigue , pain in the breasts and head.

Thus, they are often unable to perform daily activities, even needing to be away from work during crisis days.

Unlike PMS, which presents general changes in the body, but generally does not cause great harm to women, PMDD can cause problems in their relationships, whether they are family, social, professional or even with themselves.

This, because it is common that, in these days, the woman is extremely sensitized, thus increasing the risk of conflicts and discussions.

It is worth mentioning that to be considered PMDD it is important that the symptoms are presented, at least, in 2 consecutive menstrual cycles.

In addition, there are some symptoms that should generally be present for the diagnosis, which can be done by a gynecologist or psychiatrist, such as: emotional instability; depressive feelings; increased irritability and high anxiety.

Is TDPM an intense PMS?

-Yeah . Premenstrual dysphoric disorder (PMDD) is a severe and intensified version of the traditional premenstrual tension (PMD). In general, it is possible to say that the big difference between the two conditions is in the intensity and form of symptom manifestation.

In PMS, the symptoms are, in general, predominantly physical, such as headaches, swelling of the body, pain in the breasts and cramps, and there may be mild irritability. However, the condition does not usually significantly affect the person’s life, interfering in their interpersonal relationships, for example.

It is also worth remembering that the T of the acronym TPM is “ premenstrual tension ”, that is, it is not considered a disorder and, therefore, it usually does not need specific treatment.

Simple changes in habits such as a more balanced diet and the practice of physical exercises are usually effective and sufficient for the relief of symptoms.

In the case of PMDD, the problem is in fact a disorder, and it is manifested mainly in psychological symptoms, which can include depressive conditions and great emotional instability.

This causes significant psychological and physical suffering for the woman, which can damage her relationships at work, school or even with the people who live at home.

Does premenstrual dysphoric disorder have ICD?

-Yeah . TDPM is present in the CID – International Statistical Classification of Diseases and Health-Related Problems.

The ICD is a tool developed by the World Health Organization and aims to monitor the incidence and prevalence of different diseases in the world, in addition to standardizing the nomenclature of pathologies.

Through it, an overview of the population’s health situation is revealed.

In ICD-10, premenstrual dysphoric disorder is listed under code N94.3 , however, it is called Premenstrual syndrome.

In the DSM.V (Diagnostic and Statistical Manual of Mental Disorders), a document with criteria and information on the diagnosis of diseases, it is found by code 625.4 , in the category of depressive disorders.

Causes: what leads to TDPM?

Currently, the specific causes of the development of PMDD have not yet been proven. The problem is believed to be related to common hormonal changes in the menstrual cycle.

Both progesterone and estrogen (female hormones) fluctuate greatly, with falls at some times and increases at others.

During the first day before ovulation, estrogen spikes usually occur, during which the symptoms of PMDD occur. When menstruation occurs, estrogen levels decrease, reducing the manifestations of the problem.

One of the possibilities studied is that these changes strongly interfere with the levels of neurotransmitters (substances that act in the regulation of mood) in the brains of some women, causing the symptoms of PMDD.

Do you have risk factors?

As with the causes of PMDD, the risk factors are not completely known.

However, some studies believe that there is a genetic predisposition in people suffering from PMDD, that is, a characteristic inherited from the mother that influences the development of the problem.

Women who have already presented depressive, anxious or personality disorders may also be more prone to the disorder.

What are the symptoms? When do they start showing up?

Symptoms of PMDD usually occur during the days leading up to the menstrual cycle, usually between 3 and 10 days. In general, the manifestations disappear after the blood flow starts, returning only in the days before the next bleeding.

Unlike PMS, the symptoms of the disorder tend to affect emotional issues more intensely than physical ones.

In addition, in order to be considered PMDD, a woman must generally have at least 5 of the symptoms and, among them, at least 1 being: emotional instability; depressive feelings; increased irritability and high anxiety.

However, it is essential to consult with a professional for the correct and safe diagnosis. Among the main manifestations that can occur are:

Emotional instability

Emotional instability is one of the symptoms of PMDD. It is common for women who suffer from the disorder to experience sudden mood swings, which can occur in a matter of minutes.

In this way, a woman who is happy, for example, may suddenly experience depressive symptoms, along with other sensations such as irritability and anxiety.

Depressive feelings

Feelings of intense sadness, self-deprecation, hopelessness and loss of interest in usual activities are among the symptoms that can appear with the problem.

Depressive mood is one of the main characteristics of PMDD, when the woman manifests a cyclical depression , that is, it starts and ends in a period, occurring for only a few days.

It is worth mentioning that, in PMDD, these feelings usually occur only in the days before menstruation, disappearing after the blood flow starts.

It is important not to confuse the manifestation of depressive feelings caused by the dysfunction with an existing depression, only intensified during the menstrual cycle. That is why it is essential to consult a doctor who will evaluate and diagnose the correct clinical picture.

Increased irritability

During the days of manifestation of PMDD, it is common for the patient’s sensitivity to be increased and she feels that she has “exalted nerves” at all times.

Thus, the feeling of irritability is increased significantly and persistently, with greater chances of conflicts and difficulties in relationships and living with other people during the period.

High anxiety

It is possible to observe the increased levels of anxiety in those who suffer from the disorder, which can cause intense symptoms.

The patient may feel very agitated and with high levels of tension, common features of anxiety attacks. In addition, problems like panic attacks can also occur.

Difficulty concentrating

Difficulty concentrating can occur in cases of PMDD.

For those who suffer from the disorder, ordinary daily activities can be impaired, either at home or at work, since the woman is unable to allocate sufficient focus and attention to the tasks.

Increased sensitivity to rejections

Just as a depressive mood and intense anxiety can manifest, general feelings can be sensitized during the days before menstruation.

In this way, it can be more difficult to deal with criticism and reprimands, since statements that normally would not affect the woman in a significant way can, on these days, cause a great emotional impact.


Constantly tired body and the feeling of physical and emotional exhaustion can be common for PMDD sufferers.

Thus, there may be a feeling of intense fatigue and a great lack of energy that, even when resting, do not pass.

Change in appetite

Lack or excess of appetite are common features of the problem. The intense desire for specific foods, such as sweets, for example, can occur, even if the person is not hungry.

On the other hand, the absence of hunger can also be manifested, in which there is no desire to eat.

Difficulty sleeping (too little or too much)

Changes in sleep patterns can often be noticed by people with PMDD. The insomnia , ie, lack of sleep resulting in difficulty sleeping, is one of the most common symptoms.

In addition, there may also be cases of hypersomnia, that is, when there is excessive sleep, which can lead to drowsiness during the day and, even if there is rest, sleep does not pass.

In this case, it is also common for the woman to have a very long sleep at night.

Test: how is the diagnosis of Premenstrual dysphoric disorder made?

There is no specific laboratory test for the identification of PMDD. In general, the diagnosis is made based on the patients’ reports, taking into account the symptoms and their history.

It is common for the professional to ask the patient to make notes in a diary, putting all her symptoms and sensations during 2 consecutive menstrual cycles, so that the problem can be proven.

The investigation of possible already existing cases of the disorder in the family can also be evaluated, since the problem has a genetic predisposition as a risk factor.

What is the treatment?

The treatment of PMDD may vary according to the intensity of the symptoms of each woman. In general, it consists primarily of natural and non-pharmacological resources, such as physical exercise, improved nutrition and administration of vitamin supplements.

These actions aim to increase the levels of serotonin in the body, one of the hormones responsible for well-being.

In addition, in many cases it is necessary to administer medication, usually antidepressants. Psychotherapy sessions are also recommended, as they can help women understand their emotions.

Specifically, some of the resources that can be applied in the treatment of PMDD are:


Maintaining a healthy diet is indicated for all people, regardless of whether they suffer from PMDD or not. However, for those who suffer from the problem, eating balanced meals can be even more beneficial.

This is because eating healthy and nutrient-rich foods can help treat symptoms. Cereals, nuts and legumes are a good source of tryptophan, a precursor to Serotonin, for example.

Physical exercises

The practice of physical exercises can be a great ally in combating the symptoms of PMDD.

This is because, when doing physical activity, the body releases endorphins, one of the hormones related to the sensation of pleasure and well-being.

When releasing this substance, in addition to provoking the feeling of happiness, in general, there is also the relief of symptoms such as stress and anxiety.

Vitamin Supplements

Some vitamins and minerals can help stimulate the body’s production of Serotonin and improve mood. Therefore, a vitamin supplementation can be good to combat the symptoms of the disorder.

Among the options that can be administered are:

  •  Calcium – 1200mg / day;
  • Magnesium – 500mg / day;
  • Vitamin B6 – 80mg / day;
  • Vitamin E – 300mg / day;
  • Omega 3.

These nutrients that can assist in encouraging and controlling good mood.


The realization of therapy sessions is one of the resources that can be used as an aid in combating the symptoms of the disorder.

As with other psychological conditions, psychology professionals have techniques that can help to minimize the mental effects caused by the problem.


Antidepressants are the most commonly used drugs in cases of PMDD. As the problem is classified as a depressive disorder, the administration of this type of drug helps to alleviate feelings of sadness and lack of courage and can be beneficial even in the fight against anxiety.

Contraceptive pill

The use of the contraceptive pill in the treatment of PMDD aims to regulate the hormones produced during the menstrual cycle.

The hormonal change that occurs during the period is, in general, responsible for the manifestation of symptoms. With the decrease and balance of changes, there is also a reduction in the effects caused during the cycle.

Medications: is there a medicine to relieve symptoms?

-Yeah . Medication administration is one of the therapeutic resources used to relieve the symptoms of PMDD. In general, the drugs used in the treatment are antidepressants, which aim to improve symptoms of depressed mood and lack of mood.

Some anxiolytics can also be administered, in order to relieve the symptoms of anxiety. However, it is worth mentioning that there is not necessarily a better medicine than the other and, therefore, it is up to the doctor to indicate the best option for each clinical picture.

Among some medications that can be indicated are:


The fluoxetine hydrochloride is an active ingredient which acts by increasing the serotonin levels available in the body.

Therefore, it is indicated for conditions such as depression and some disorders, including mood and personality.

The drug works by inhibiting the reuptake of Serotonin, that is, its reabsorption. With this inhibition, the hormone remains in the body for a longer time and, consequently, its effects are prolonged.


The sertraline hydrochloride is a drug which, as fluoxetine, acts by increasing the amount of serotonin available at brain.

Thus, it is indicated for the treatment of problems related to depression, compulsive, personality and mood disorders, including PMDD.


The Alprazolam is an anxiolytic , or medicament employed for treating anxiety. Some of its effects are the relief of symptoms such as tension, fear, difficulties with concentration, irritability, among others.

There is still no exact knowledge of the drug’s mechanism of operation, however, it is believed that the substance acts through links with the central nervous system.

Living together: how to deal with Premenstrual Dysphoric Disorder?

Living with PMDD may not be easy, however, with proper treatment it is possible to control the disorder and its symptoms and live normally.

In general, many women experience conflicts in their interpersonal relationships during the days leading up to menstruation. Therefore, one of the guidelines is that, during this period, people who live with those who suffer from the problem have patience and understanding.

It is important that family and friends try to minimize the possibilities of discussions and give space to the woman, if requested. It is worth understanding that, in a moment of crisis, the patient is not in her normal condition and can speak and take actions that she would not normally have.

PMDD is a little known problem and therefore many women are unaware that they have the condition. In general, they believe they are just symptoms of PMS or suspect they are depressed.

If there is any type of suspicion, either from the person himself or from his life cycle, it is very important to consult a professional who will be able to make the correct diagnosis of the problem and start treatment.

It should not be considered normal to live with the symptoms of PMDD, being possible to control and treat the manifestations, restoring well-being and quality of life for the woman.