PMDD Symptoms Occur During the Luteal Phase
The symptoms of premenstrual dysphoric disorder are most prominent during the luteal phase of the menstrual cycle. This is the defining temporal characteristic that distinguishes PMDD from other psychiatric conditions 1, 2.
Temporal Pattern of PMDD
The diagnostic criteria for PMDD specify a precise timing pattern that directly answers this question:
- Symptoms begin several days before menses onset (during the luteal phase) 1, 2
- Symptoms start to improve within a few days after menses begins 1, 2
- Symptoms become minimal or absent within one week following menses onset 1, 2
This luteal phase timing is so critical that it serves as the primary distinguishing feature from other mood disorders. For example, bipolar disorder would show mood episodes lasting days to weeks independent of menstrual cycle timing, not strictly confined to the luteal phase 2.
Why the Luteal Phase?
The luteal phase is characterized by progressive increases in estrogen and progesterone levels until mid-luteal phase, followed by a slow decline before menstruation 2. Women with PMDD demonstrate differential sensitivity to these normal gonadal steroid fluctuations, rather than having abnormal hormone levels 2. The withdrawal of estrogen and progesterone during the luteal phase is hypothesized to trigger system dysregulation in vulnerable women 2.
Clinical Confirmation
Prospective symptom tracking for at least two menstrual cycles is essential to document this luteal phase pattern 3, 4. The symptoms must consistently appear between ovulation and menstruation and disappear within a few days after bleeding onset 5. This cyclic pattern occurring specifically during the luteal phase—not during the follicular phase, ovulation, or menstrual phase—is what defines PMDD 6, 7.