WHAT IS
PMDD?
🔄 PMDD (Premenstrual Dysphoric Disorder) is a cyclical, hormone-based mood disorder.
🧠 🟡 PMDD is a severe negative reaction in the brain that is directly connected to the natural hormonal fluctuations of the menstrual cycle and is triggered when ovulation occurs.
🟡 Ovulation
→ What it is: The release of an egg from the ovary.
→ When it happens: Around the middle of the menstrual cycle (typically day 14 in a 28-day cycle).
→ What it marks: The end of the follicular phase and the beginning of the luteal phase.
📌 Think of ovulation as the event, and the luteal phase as the aftermath that prepares your body for either pregnancy or menstruation.
🔴 PMDD (Premenstrual Dysphoric Disorder) has symptoms arising during the luteal, or premenstrual phase of the menstrual cycle and subsiding within a few days of menstruation due to the brain's sensitivity to the natural rise and fall of progesterone and estrogen.
🟡 ➡️🩸 Luteal Phase (Premenstrual Phase of the Menstrual Cycle)
→ What it is: The phase that follows ovulation.
→ When it happens: From ovulation and ends when menstruation starts (typically lasting 12 to 14 days on days 15–28 of your 28-day cycle).
→ What happens: The body produces progesterone to support a possible pregnancy. If there's no pregnancy, hormone levels drop, triggering the menstrual period.
📌 Think of ovulation as the event, and the luteal phase as the aftermath that prepares your body for either pregnancy or menstruation.
🧠 ⬆️ ⬇️ Although individuals with PMDD have normal hormone levels and typical hormonal fluctuations, their brains react abnormally to these fluctuations for reasons that are not yet fully understood.
🧠 ⬆️ ⬇️ Researchers have, however, established that this extreme brain response is triggered by estrogen and progesterone's normal rise and fall.
⚖️ While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance. It’s important to recognize the real issue to address the symptoms effectively.
PMDD Symptoms
😡💢😞😟 For those living with PMDD, severe symptoms like anger, irritability, depression, and anxiety can feel overwhelming and often interfere with daily life.
🟡 ➡️🩸 These symptoms present exclusively during the luteal phase, the 1–2 weeks before menstruation, and can resemble a severe mood disorder. However, the key distinction is that they consistently resolve shortly after the period begins, indicating a cyclical hormonal pattern rather than a persistent mental health condition.
🔴 PMDD does not cause heavy periods, cramps, or period pain, though symptoms such as premenstrual cramping, bloating, and breast tenderness are common.
🧠🌧️ PMDD can lead to severe emotional symptoms, including suicidal thoughts and behaviors.
🧠🌧️ Studies show that up to 34% of those with PMDD have reported past suicide attempts.
🔴 PMDD affects each person differently; symptoms can range from mild to moderate to severely life-disrupting.
PMDD Statistics
📈 Diagnosis & Awareness
5.5% of people who menstruate are estimated to be affected by PMDD — that’s over 115 million individuals globally.
Despite its prevalence, over 90% of people with PMDD report experiencing medical gaslighting or dismissal from providers.
50%+ of individuals with PMDD were misdiagnosed at some point — most commonly with bipolar disorder or major depressive disorder.
📌 Source: IAPMD Global Survey (2018), U.S. National Library of Medicine
💰Economic & Personal Impact
- 40% more likely to take sick leave
- 27% more likely to be unemployed
- Missed workdays
- Lost productivity
- Unnecessary or incorrect treatments
- Mental health crisis care
- 22% more likely to get divorced
- Strained relationships
- Career disruption
- Educational challenges
- Financial stress due to ongoing healthcare needs
📌 Sources: Hodgetts, S., & Kinghorn, A. (2025). Examining the impact of premenstrual dysphoric disorder (PMDD) on life and relationship quality: An online cross-sectional survey study. PLOS ONE, 20(4), e0322314.
Westermark, V., Yang, Y., Bertone-Johnson, E., Bränn, E., Opatowski, M., Pedersen, N., et al. (2024). Association between severe premenstrual disorders and change of romantic relationship: A prospective cohort of 15,606 women in Sweden. Journal of Affective Disorders, 364, 1.32-8.
Halvorsen, U., Yang, Y., Hysaj, E., Nevriana, A., Hägg, S., Valdimarsdóttir, U. A., et al. (2024). Premenstrual disorders and risk of sick leave and unemployment: A prospective cohort study of 15,857 women in Sweden. medRxiv.
IAPMD. Barriers to Care & Economic Impact.
Halbreich, U., et al. (2003). The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMDD). Psychoneuroendocrinology, 28 Suppl 3:1–23.
Lustyk, M.K.B., et al. (2004). Psychological and occupational impact of premenstrual symptoms in working women. Women's Health Issues, 14(5), 201–206.
🔺 Self-Harm & Suicidialty
PMDD is associated with severe mental health risks, particularly during the luteal phase (the week before menstruation), when symptoms peak. Research and community-reported data reveal a troubling prevalence of self-harm, suicidal ideation, and suicide attempts:
🔺 34% of people with PMDD have attempted suicide at least once.¹
🔺 70%+ report experiencing suicidal thoughts or ideation during symptomatic times.¹
🔺 50%+ report engaging in self-harming behaviors (e.g., cutting, hitting, burning) to cope.¹
🔺 People with PMDD are 2x more likely to attempt suicide than those without it.²
🔺 15% to 30% of individuals with PMDD have attempted suicide at some point.³
🔺 A significant percentage report non-suicidal self-injury (NSSI) during the luteal phase—estimates range from 40% to 50% in some studies.⁴
📌 Sources: 1. IAPMD. Mental Health & PMDD Community Survey Data.
2. Opatowski, M., Valdimarsdóttir, U. A., Oberg, A. S., Bertone-Johnson, E. R., & Lu, D. (2024). Mortality risk among women with premenstrual disorders in Sweden. JAMA Network Open, 7(5), e2413394.e.
3. Osborn TL, Eisenlohr-Moul TA, et al. (2020–2021). Studies on suicidality in PMDD.
4. Eisenlohr-Moul TA, et al. (2017). Hormone sensitivity and self-injury in PMDD. Biological Psychiatry.
1980s → The term Late Luteal Phase Dysphoric Disorder (LLPDD) is used in clinical settings to describe severe premenstrual symptoms.
1994 → PMDD was listed in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)* as a condition requiring further research.
2013 → PMDD was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)* as a depressive disorder.
2016 → The National Institute of Health found that people with PMDD have a heightened sensitivity to estrogen and progesterone due to a genetic molecular mechanism. They confirmed this by comparing white blood cells from individuals with and without PMDD, revealing an altered hormonal response at the cellular level.
2019 → PMDD was officially included in the World Health Organization’s International Classification of Diseases, 11th Revision ICD-11**, as a disease of the genitourinary system, cross-listed as a depressive disorder. This recognition helped confirm PMDD as a real and legitimate medical diagnosis worldwide, opening the door to better awareness, research, and care.
2020 → Research findings indicate that there may be PMDD subtypes.
📌 *The Diagnostic and Statistical Manual of Mental Disorders (DSM) is published and maintained by the American Psychiatric Association (APA), a professional organization of psychiatrists based in the United States. The APA oversees the creation, revision, and dissemination of the DSM.
**The ICD-11 is the global standard for classifying and coding diseases and health conditions, used by healthcare providers and researchers worldwide. Developed by the WHO, it includes updated diagnostic criteria, reflecting the latest scientific research.
💭 I think I have PMDD.
Many people live with undiagnosed PMDD for years. Naming it can bring relief, but also uncertainty. It’s a learning curve, but you’re not alone—we’re here to help.
Emotional & Mood Symptoms
→ Mood/Emotional Changes (mood swings, sadness or tearfulness, and increased sensitivity to rejection) ✅
→ Lasting irritability or anger leading to increased interpersonal conflict ✅
→ Depressed mood, feelings of hopelessness, and a sense of worthlessness or guilt ✅
Anxiety & Tension
→ Feelings of tension or anxiety ✅
→ Feeling out of control ✅
Cognitive & Energy Changes
→ Trouble thinking or focusing
→ Tiredness or low energy
→ Lack of interest in daily activities and relationships
Behavioral & Appetite Shifts
→ Food cravings or binge eating
→ Trouble sleeping
Physical Symptoms
→ Bloating
→ Cramping
→ Breast Tenderness
These symptoms usually arise during the week or two before menstruation and ease within a few days after bleeding begins. A PMDD diagnosis requires at least five of these symptoms in total, including at least one core emotional symptom (marked with ✅).
✅ PMDD Self-Assessment Tool & Symptom Tracker
Self-Assessment Tool
Use IAPMD’s PMDD Self-Assessment Tool to help determine if you may have PMDD or PME. It's also possible to have both conditions, and if you're unsure, we recommend consulting an experienced provider for a proper diagnosis.
The PME Self-Assessment Tool is the first globally accessible tool. It was developed with a strong commitment to privacy and data protection, including HIPAA (US) and GDPR (EU) compliance.
Symptom Tracker
If you suspect you may have PMDD you can also use our printable tracker for your symptoms.
📌 Disclaimer: This Self-Assessment Tool is not a diagnostic instrument for PMDD or PME and should not replace professional medical care. It is intended solely as a preliminary assessment to help identify potential concerns for further evaluation by a healthcare provider.