What are the diagnostic criteria for Premenstrual Dysphoric Disorder (PMDD)?

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Last updated: May 12, 2025 • View editorial policy

From the Research

Premenstrual Dysphoric Disorder (PMDD) diagnosis requires a comprehensive evaluation of symptoms that occur consistently during the luteal phase of the menstrual cycle and resolve within a few days of menstrual onset, with at least five specific symptoms present, including marked mood swings, irritability, depressed mood, anxiety, and decreased interest in activities, as supported by the most recent and highest quality study 1.

Key Symptoms and Diagnosis

To diagnose PMDD, symptoms must be present for most menstrual cycles over the past year and significantly impair daily functioning. The symptoms include:

  • Marked mood swings
  • Irritability or anger
  • Depressed mood
  • Anxiety
  • Decreased interest in activities
  • Difficulty concentrating
  • Fatigue
  • Appetite changes
  • Sleep problems
  • Feeling overwhelmed
  • Physical symptoms like breast tenderness or bloating Diagnosis typically requires tracking symptoms for at least two menstrual cycles using a daily rating form or calendar, as noted in various studies 2, 3, 4, 5.

Treatment Options

Treatment options for PMDD include:

  • Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (20mg daily) or sertraline (50-150mg daily), which can be taken either continuously or just during the luteal phase, as supported by the most recent study 1
  • Hormonal contraceptives, particularly those containing drospirenone like Yaz, may also help regulate symptoms
  • Lifestyle modifications including regular exercise, stress management techniques, dietary changes (reducing caffeine, salt, and alcohol), and calcium (1200mg daily) and vitamin B6 (50-100mg daily) supplements can provide additional symptom relief

Pathophysiology

PMDD is believed to result from abnormal sensitivity to normal hormonal fluctuations affecting neurotransmitter systems, particularly serotonin, as discussed in several studies 2, 4, 5.

Recommendation

Based on the most recent and highest quality evidence 1, the recommended treatment for PMDD is selective serotonin reuptake inhibitors (SSRIs), which have been shown to reduce overall self-rated premenstrual symptoms in women with PMDD, with moderate-certainty evidence.

References

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.