Premenstrual dysphoric disorder (PMDD) combines mood, physical or concentration symptoms that come back before your period and then fade after it starts1. It can affect anyone who has periods2. What sets it apart from the minor mood changes many people experience at this time is the intensity of the symptoms and their impact on daily life3.

This page brings together key facts to help you understand. It cannot tell you whether you are affected and does not replace medical advice.

The essentials

  • A disorder recognised by the international medical classifications45.
  • Symptoms that follow the cycle: they appear before your period and improve shortly after it starts6.
  • A minority of people affected, with estimates that vary widely7.
  • A cause that is still unknown8; the main hypothesis is a sensitivity to normal hormonal fluctuations9.
  • Several care options, to discuss with a healthcare professional10.

Premenstrual syndrome and PMDD: what is the difference?

Symptoms before a period are very common: tender breasts, bloating, fatigue, irritability1112. It is called premenstrual syndrome (PMS) when these symptoms come back in the second half of the cycle and interfere with daily life12.

PMDD is described as a severe form of premenstrual syndrome, in which emotional symptoms dominate13. Its symptoms can resemble those of PMS, but they are more intense14. According to the World Health Organization (WHO), in PMDD the distress, or the difficulties in personal, family, social, school or working life, are markedly greater3.

What are the symptoms?

The sources describe symptoms including15:

  • emotional: mood swings, irritability or anger, sadness or a sense of hopelessness, anxiety or tension, feeling overwhelmed or out of control;
  • thinking and energy: difficulty concentrating, fatigue, loss of interest in usual activities;
  • physical: sore breasts, bloating, joint or muscle pain, changes in appetite, disturbed sleep.

For PMDD to be considered, the criteria require at least one mood symptom, in addition to other symptoms16. Suicidal thoughts can also be part of the picture17: see below.

A characteristic timing

When the symptoms occur matters as much as what they are12. They appear during the luteal phase, the second half of the cycle, often one to two weeks before your period, and improve in the days after your period starts6. They then become minimal or absent in the week that follows, and this pattern repeats over most cycles in a year1.

Symptoms that are present all month and get worse before your period may point to something else, for example a premenstrual worsening of depression or of an anxiety disorder18. That is why day-by-day tracking is useful19: see how the diagnosis is made.

How many people are affected?

Figures vary widely from one study to another20. A 2024 meta-analysis estimates the frequency at about 3% when the diagnosis is confirmed by daily tracking over two cycles, and at nearly 8% when it remains provisional, a figure that is probably overestimated according to its authors7. In Switzerland, a health survey carried out in 2007 using a questionnaire found that about 3% of women met the criteria21.

So it affects a minority, but it is not rare, and the disorder is often underdiagnosed22.

Day to day: work, relationships, self-esteem

PMDD can make work, social life and relationships difficult14. The symptoms described include more conflict with the people close to you and withdrawing into yourself23. Because the symptoms come back with each cycle, these difficulties come back too, month after month1.

If this sounds familiar, know that this suffering is recognised24. In addition to medical support, talking with other people affected, in a local group or online, can help25.

What is known about the causes

It is not known exactly what causes PMDD8. The levels of oestrogen and progesterone measured in the blood are generally comparable in people with PMDD and in others26. The most commonly proposed explanation is therefore an increased sensitivity to the normal hormonal fluctuations of the cycle, particularly of oestrogen and progesterone9.

Research is also looking at chemical messengers in the brain, such as serotonin and GABA, and at genetic factors27. So this is not a “hormonal imbalance” that shows up in a blood test26.

A recognised disorder

PMDD is included in the WHO's International Classification of Diseases (ICD-11), under the code GA34.41, in the chapter on the genitourinary system; the WHO also lists it among the depressive disorders, because of the prominence of mood symptoms4. The American Psychiatric Association's diagnostic manual (DSM-5) classifies it among the depressive disorders5. According to a 2023 review, this recognition legitimises the distress people experience, even though the biological basis of the diagnosis remains to be clarified24.

Misconceptions

  • “It's just your period.” Mild mood changes before a period are common and are not PMDD; PMDD stands out through significant distress or difficulties3.
  • “It's all in your head.” The symptoms follow the hormonal cycle6, and the disorder is recognised by the WHO4.
  • “A blood test can tell.” No: the diagnosis is based on clinical criteria and daily symptom tracking28.
  • “There's nothing you can do.” Several groups of options are described in the guidelines10. See the options to discuss.

If dark thoughts come up

For some people, the days before their period bring dark thoughts, sometimes thoughts of suicide17. Reviews of the research show that suicidal thoughts and suicide attempts are more common in people who have PMDD29. If this happens to you, you are not alone, and it is not your fault.

These thoughts deserve to be taken seriously, even if they go away after your period. You can talk about them with a healthcare professional: the authors of these reviews in fact consider that healthcare professionals should ask about them30. You can also confide in someone you trust. If these thoughts become pressing, don't wait: call one of the numbers below.

Asking for help matters: treatment and support can help manage the symptoms31.

Sources for this page

Each number leads to a neutral statement and to the documents that support it. We summarise these sources in our own words; the links open the original documents.

  1. 1

    According to ICD-11, premenstrual dysphoric disorder is characterised, during most menstrual cycles in the past year, by mood symptoms (for example depressed mood, irritability), physical symptoms (for example lethargy, joint pain, overeating) or cognitive symptoms (for example difficulty concentrating, forgetfulness) that appear several days before menstruation, start to improve within a few days after it begins and become minimal or absent in the week that follows.

    Established fact · checked on 18 October 2026

    Back to the text
  2. 2

    Premenstrual dysphoric disorder can affect anyone who has periods.

    Established fact · checked on 18 October 2026

    Back to the text
  3. 3

    ICD-11 specifies that the mild mood changes that are common late in the cycle or during menstruation (emotional lability, irritability, tension) should not be classed as premenstrual dysphoric disorder; it is distinguished from premenstrual tension syndrome by markedly more severe symptoms, which cause significant distress or significant impairment in personal, family, social, educational or occupational functioning.

    Established fact · checked on 18 October 2026

    Back to the text
  4. 4

    In ICD-11, premenstrual dysphoric disorder has the code GA34.41 and the French label “Trouble dysphorique prémenstruel” (abbreviated TDPM). It is classified under GA34.4, whose French label is “Syndrome prémenstruel”, in Chapter 16, which covers diseases of the genitourinary system, and it is also listed among the depressive disorders because of the prominence of mood symptoms.

    Established fact · checked on 18 October 2026

    The English label of the GA34.4 grouping is “Premenstrual disturbances”, rendered in the French version as “Syndrome prémenstruel”.

    Back to the text
  5. 5

    The American Psychiatric Association's DSM-5 recognises premenstrual dysphoric disorder as a diagnosis in its own right and classifies it among the depressive disorders.

    Established fact · checked on 18 October 2026

    The DSM-5 text is not openly accessible and was not consulted: information reported by two reviews.

    Back to the text
  6. 6

    The symptoms occur during the luteal phase, that is, the second half of the cycle, often one to two weeks before menstruation, and improve in the days after menstruation begins.

    Established fact · checked on 18 October 2026

    ICD-11 refers to symptoms that begin “several days” before menstruation; the NHS and the IAPMD refer to one to two weeks.

    Back to the text
  7. 7

    A 2024 meta-analysis (44 studies, 50,659 participants) estimates the prevalence of premenstrual dysphoric disorder at 3.2% when the diagnosis is confirmed by prospective monitoring over two cycles and at 7.7% when the diagnosis is provisional; the authors consider that studies based on a provisional diagnosis probably produce artificially high figures.

    Uncertain · checked on 18 October 2026

    Very high heterogeneity between studies (I² = 99%). Restricted to general-population samples with a confirmed diagnosis, the estimate is 1.6%. Other sources give very different figures (see en-tdpm-prevalence-variable).

    Back to the text
  8. 8

    The exact cause of premenstrual dysphoric disorder is not known.

    Established fact · checked on 18 October 2026

    Back to the text
  9. 9

    The most commonly proposed explanation is an increased sensitivity to the normal hormonal fluctuations of the menstrual cycle, in particular of oestrogen and progesterone.

    Emerging evidence · checked on 18 October 2026

    The NHS, the RCOG and the 2022 review present it as a hypothesis (“may”, “presumed”); the IAPMD presents it as established. The CHUV page describes, for premenstrual syndrome, an abnormal response to the natural hormonal changes of the cycle.

    Back to the text
  10. 10

    The guidelines describe several groups of options for premenstrual disorders: hormonal and non-hormonal medicines, psychological support, lifestyle and self-management measures, complementary approaches and surgery; they recognise that many patients may benefit from a combination of several interventions.

    Recommendation · checked on 18 October 2026

    American guideline known through its abstract only.

    • Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7 (new tab) — American College of Obstetricians and Gynecologists (ACOG) — Obstetrics & Gynecology, Obstet Gynecol 2023;142(6):1516–1533 (December 2023). Abstract only consulted (PubMed and publisher's website): full text available to subscribers only.. Passage: Abstract, “Recommendations”. Accessed on 18 October 2026.
    • Management of Premenstrual Syndrome: Green-top Guideline No. 48 (new tab) — Royal College of Obstetricians and Gynaecologists (RCOG) — BJOG, 2nd edition, published online on 30 November 2016 (BJOG 2017;124(3):e73–e105). Reviewed by the RCOG in May 2023, update in preparation. Open-access full text read on the publisher's website.. Passage: Summary of recommendations (Executive summary). Accessed on 18 October 2026.
    • PMDD (premenstrual dysphoric disorder) (new tab) — NHS (National Health Service, England), Page reviewed on 20 August 2026 (next review due on 20 August 2029). Passage: Section “Treatment for PMDD”. Accessed on 18 October 2026.
    Back to the text
  11. 11

    Symptoms before menstruation are very common among people who have periods.

    Established fact · checked on 18 October 2026

    The proportions vary with the definitions used: most women at some point in their lives according to the NHS, 91% reporting at least one symptom in the 2007 Swiss Health Survey, four in ten women according to the RCOG.

    Back to the text
  12. 12

    Premenstrual syndrome covers psychological symptoms (for example irritability, anxiety, mood swings) and physical symptoms (for example bloating, breast pain) linked to the second half of the cycle; it is their timing and their impact on daily life, rather than their nature, that form the basis of the diagnosis.

    Established fact · checked on 18 October 2026

    • Management of Premenstrual Syndrome: Green-top Guideline No. 48 (new tab) — Royal College of Obstetricians and Gynaecologists (RCOG) — BJOG, 2nd edition, published online on 30 November 2016 (BJOG 2017;124(3):e73–e105). Reviewed by the RCOG in May 2023, update in preparation. Open-access full text read on the publisher's website.. Passage: Section 2.1 “Definition of PMS”. Accessed on 18 October 2026.
    Back to the text
  13. 13

    Premenstrual dysphoric disorder is described as a severe form of premenstrual syndrome in which emotional and affective symptoms predominate.

    Established fact · checked on 18 October 2026

    Back to the text
  14. 14

    The symptoms of premenstrual dysphoric disorder can resemble those of premenstrual syndrome but are more intense; they can make work, social life and relationships difficult, and disrupt daily activities.

    Established fact · checked on 18 October 2026

    Back to the text
  15. 15

    The symptoms described include mood swings, irritability or anger, depressed mood or a sense of hopelessness, anxiety or tension, feeling overwhelmed or out of control, difficulty concentrating, fatigue, loss of interest in usual activities, changes in appetite, sleep problems, and physical symptoms such as sore breasts, bloating or joint and muscle pain.

    Established fact · checked on 18 October 2026

    Back to the text
  16. 16

    The diagnostic criteria require at least one mood symptom (mood lability, irritability, depressed mood or anxiety), together with other symptoms; according to the sources that describe it, DSM-5 requires at least five symptoms, including at least one mood symptom, during most cycles in the past year.

    Established fact · checked on 18 October 2026

    DSM-5 criteria known through secondary sources (MSD Manual, RCOG, Naik et al.).

    Back to the text
  17. 17

    Suicidal thoughts can be part of the symptoms of premenstrual dysphoric disorder.

    Established fact · checked on 18 October 2026

    Back to the text
  18. 18

    The symptoms of other disorders, such as depression, bipolar disorders or generalised anxiety, can worsen before menstruation while remaining present for the rest of the cycle; premenstrual dysphoric disorder differs in that symptoms are absent about a week after menstruation begins.

    Established fact · checked on 18 October 2026

    Back to the text
  19. 19

    The sources recommend confirming the link between the symptoms and the cycle with a daily record, kept day by day, for at least two menstrual cycles.

    Recommendation · checked on 18 October 2026

    ICD-11 says “ideally”, the NHS “may be helpful”; the ACOG fact sheet on premenstrual syndrome refers to two to three months.

    Back to the text
  20. 20

    Published estimates of how common premenstrual dysphoric disorder is vary widely depending on populations and methods: about 2 to 6% in the United States and up to 18% in some worldwide estimates according to the MSD Manual, 2% according to a gynaecologist at Geneva University Hospitals (HUG), 3 to 8% in the United States according to a 2022 review.

    Uncertain · checked on 18 October 2026

    The IAPMD puts forward “1 in 20 individuals who menstruate”. No single figure is agreed upon.

    Back to the text
  21. 21

    In the 2007 Swiss Health Survey, 3.1% of the women aged 15 to 54 who were surveyed met the criteria for premenstrual dysphoric disorder according to a screening questionnaire.

    Uncertain · checked on 18 October 2026

    Retrospective questionnaire, without daily symptom tracking: in the terms of the 2024 meta-analysis, this is a provisional diagnosis. 3,522 women answered the questions on impact.

    Back to the text
  22. 22

    Premenstrual dysphoric disorder is described as a source of severe, disabling distress that is often underdiagnosed; many people live for years without a diagnosis.

    Expert consensus · checked on 18 October 2026

    Statement from a reference work and a patient association, with no figures to support it.

    Back to the text
  23. 23

    The symptoms described include marked irritability or anger leading to more conflict with others, and a loss of interest in usual activities that can lead to withdrawal.

    Established fact · checked on 18 October 2026

    Back to the text
  24. 24

    According to a 2023 review, the recognition of premenstrual dysphoric disorder by the WHO and by the American Psychiatric Association legitimises the distress and the social and occupational impairment of the people affected, but its biological validity remains to be clarified.

    Uncertain · checked on 18 October 2026

    Open research question; other sources describe biological lines of research (see en-tdpm-pistes-recherche).

    Back to the text
  25. 25

    The NHS states that, in addition to medical support, support from other people affected, in a local group or online, can be helpful.

    Expert consensus · checked on 18 October 2026

    • PMDD (premenstrual dysphoric disorder) (new tab) — NHS (National Health Service, England), Page reviewed on 20 August 2026 (next review due on 20 August 2029). Passage: Section “Help and support for PMDD”. Accessed on 18 October 2026.
    Back to the text
  26. 26

    Blood levels of oestrogen and progesterone are comparable in people with and without a premenstrual disorder.

    Expert consensus · checked on 18 October 2026

    Back to the text
  27. 27

    Lines of research include the neurotransmitters serotonin and GABA, a progesterone derivative (allopregnanolone) and genetic factors.

    Emerging evidence · checked on 18 October 2026

    Back to the text
  28. 28

    No blood, hormone, saliva or imaging test can confirm premenstrual dysphoric disorder: the diagnosis is based on clinical criteria and on daily symptom tracking, and these tests can only help rule out other causes.

    Expert consensus · checked on 18 October 2026

    Back to the text
  29. 29

    Two meta-analyses published in 2021 associate premenstrual dysphoric disorder with suicidal ideation and suicide attempts that are more frequent than in people without a premenstrual disorder.

    Emerging evidence · checked on 18 October 2026

    The size of the association differs: odds ratios of about 4 (ideation) and 7 (attempts) in Prasad et al., and of about 2.3 and 2.1 in Yan et al. In Yan et al., all the diagnoses in the included studies were provisional.

    Back to the text
  30. 30

    The authors of these meta-analyses consider that healthcare professionals should systematically assess suicide risk and remain alert to signs of suicidal ideation in the people affected.

    Expert consensus · checked on 18 October 2026

    Back to the text
  31. 31

    The NHS considers it important to ask for help if in doubt, because treatment and support can help manage the symptoms.

    Expert consensus · checked on 18 October 2026

    • PMDD (premenstrual dysphoric disorder) (new tab) — NHS (National Health Service, England), Page reviewed on 20 August 2026 (next review due on 20 August 2029). Passage: Section “When and where to get medical help”. Accessed on 18 October 2026.
    Back to the text