Premenstrual Dysmorphic Disorder Awareness Month

April is Premenstrual Dysphoric Disorder (PMDD) awareness month. PMDD is defined to be the severe form of premenstrual syndrome (PMS), which describes a group of symptoms experienced by many women prior to menstruation. Most notably, this includes mood swings, fatigue, breast tenderness, acne, and changes in appetite [1]. The differentiating factor that separates PMDD from PMS is that those with PMDD experience symptoms so severe that it impacts daily function [2].

Premenstrual Exacerbation (PME) is another relevant condition that may be experienced by menstruators in the luteal phase. PME results in worsening symptoms of preexisting conditions, including depressive, anxiety, personality, and eating disorders [3]. The key difference between PME and PMDD is that in PME, the symptoms persist all throughout the menstrual cycle — they just become more severe prior to menstruation. 

Those with PMDD or PME may experience increased suicidal thoughts, difficulty concentrating, decreased interest in normal activities, and increased interpersonal conflicts [2]. As a result, work and home life are notably disrupted, and relationships may become strained.

It is estimated that 1.6% of women and girls meet the criteria for PMDD diagnosis [4], while up to 64% of women with major depressive disorder experience PME [5]. 

Current treatment options for PMDD and PME include stress management, SSRIs, vitamin supplementation, birth control, and changes in diet [2].

PMDD comes as a result of increased sensitivity to the change in reproductive hormone levels during the luteal phase. Though the cause and mechanism of this sensitivity are not well understood, recent studies observed an altered gene complex that affects the body’s response to hormones in those with PMDD [6]. 

Continued research and awareness are essential to better understand the underlying biological mechanisms of PMDD and PME and to develop more effective, targeted treatments. However, recognizing and validating the impact of PMDD and PME on patients’ lives is a crucial first step toward improving care. 

References:

1. Mayo Clinic Staff. Premenstrual Syndrome (PMS) [Internet]. Mayo Clinic. 2022. Available from: https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780

2. Johns Hopkins Medicine. Premenstrual Dysphoric Disorder (PMDD) [Internet]. Johns Hopkins Medicine. 2019. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd

3. International Association for Premenstrual Disorders [Internet]. International Association for Premenstrual Disorders. 2025. Available from: https://www.iapmd.org/pme

4. University Of Oxford. New data shows prevalence of Premenstrual Dysphoric Disorder | University of Oxford [Internet]. www.ox.ac.uk. 2024. Available from: https://www.ox.ac.uk/news/2024-01-30-new-data-shows-prevalence-premenstrual-dysphoric-disorder

5. Lin J, Nunez C, Susser L, Liliya Gershengoren. Understanding premenstrual exacerbation: navigating the intersection of the menstrual cycle and psychiatric illnesses. Frontiers in Psychiatry [Internet]. 2024 Aug 8;15. Available from: https://pubmed.ncbi.nlm.nih.gov/39176230/

6. MD AC. Premenstrual dysphoria disorder: It’s biology, not a behavior choice [Internet]. Harvard Health Blog. 2017. Available from: https://www.health.harvard.edu/blog/premenstrual-dysphoria-disorder-its-biology-not-a-behavior-choice-2017053011768