How the diagnosis is made

There is no blood, hormone or imaging test that confirms premenstrual dysphoric disorder (PMDD)1. To assess it, the doctor looks at your symptoms, when they occur in your cycle and their impact on your life2.

Daily tracking over at least two cycles

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 cycles3. The reason is simple: our memories are unreliable for saying, after the fact, when symptoms appeared and when they went away4. Without this tracking, the diagnosis is considered provisional5.

The British guideline asks for this diary to be kept before starting treatment, because treatment can mask the symptoms or make the record difficult to interpret6.

Ruling out other explanations

Healthcare professionals also check that the symptoms are not better explained by something else7:

  • another mental health condition, such as depression or an anxiety disorder, which can get worse before a period without going away afterwards8;
  • another condition, for example thyroid disease, or perimenopause9;
  • the effects of a hormonal treatment, including contraception10.

When the diary is inconclusive, the British guideline describes the temporary use of a medicine that puts the ovarian cycle to rest, to help clarify the diagnosis11.

The options described in the guidelines

The guidelines describe several groups of options, which can be combined12. None of them suits everyone, and it sometimes takes trying several13. The American guidelines also apply to adolescents, with some exceptions14.

What follows is general information, not advice. Care is decided case by case, taking into account your symptoms, your priorities (for example plans for a pregnancy), your health and the possible side effects13.

Lifestyle

The NHS lists regular physical activity, a balanced diet, enough sleep, mindfulness, stopping smoking and cutting down on alcohol15. The scientific evidence on these measures and on complementary approaches is, however, still limited or conflicting16. Before taking a supplement, it is advisable to talk to a healthcare professional, because there are known interactions with medicines17.

Psychological therapies

The British guideline asks for cognitive behavioural therapy (CBT) to be routinely considered in severe forms, and the NHS lists it among the talking therapies18.

SSRI antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants. The British guideline considers them one of the first-line medication options in severe forms19. A 2024 Cochrane review concludes that they probably reduce symptoms, and that they probably increase the risk of side effects such as nausea, fatigue or drowsiness20.

They can be taken continuously or only during part of the cycle, and the sources do not agree on the best regimen21. The British guideline asks for a treatment taken continuously to be stopped gradually, with explanations22, and for any plans for a pregnancy to be discussed23.

Hormonal options

Some combined contraceptive pills are among the hormonal options described24. For the most severe symptoms, the British guideline describes medicines that put the ovarian cycle to rest; it reserves them for these situations and provides for specific monitoring when they are used for a long time25.

Surgery, as a last resort

When other treatments have not helped, surgery to remove the ovaries, most often together with the uterus, may be considered; it ends the menstrual cycles and is not compatible with plans for a pregnancy26. The British guideline asks for its effect to be tested first with medication, and then provides for hormone replacement therapy26.

Preparing for your appointment

You can talk about this with your family doctor, your gynaecologist or a psychiatrist. For severe forms, the British guideline describes the value of a team bringing these professionals together, while noting that such teams are still uncommon27.

Keeping a symptom diary

The principle is simple28:

  1. each day, note the symptoms you feel and how intense they are;
  2. also note the days of your period;
  3. keep going for at least two full cycles;
  4. bring your records to every appointment.

The most widely used daily questionnaire is called the Daily Record of Severity of Problems (DRSP)29. In 2016, the British guideline considered that commercial tracking apps still needed to be validated30.

What you can bring

These help healthcare professionals look at the timing of your symptoms, their impact and other possible explanations710:

  • your symptom diaries, covering at least two cycles;
  • a list of your medicines and supplements, including your contraception;
  • your medical history, for example of depression, anxiety or thyroid problems;
  • concrete examples of what the symptoms change at work, in your studies or in your relationships;
  • your priorities: contraception, plans for a pregnancy, preferences or concerns about treatments.

Questions to ask

  • Do my symptoms match the timing of PMDD, or something else?
  • Do other causes need to be ruled out, and how?
  • Which options might apply to me, and what can I reasonably expect from them?
  • What side effects are possible, and what should I do if they occur?
  • How does an option fit with my contraception or plans for a pregnancy?
  • How long will it take to know whether an option is helping me?
  • Is psychological support available, and from whom?
  • Who should I contact if my symptoms get worse, or if dark thoughts come up?

If you have dark thoughts

Suicidal thoughts can be part of the symptoms31. You can say so at your appointment, even if nobody asks you: the authors of two research reviews consider that healthcare professionals should ask about this systematically32. If these thoughts become pressing, don't wait for the appointment: call one of the numbers below.

To understand the disorder itself better, see our key facts about PMDD.

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

    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
  2. 2

    To assess possible premenstrual dysphoric disorder, the doctor asks about the symptoms, when they occur in the cycle and their impact on the person's life.

    Established fact · checked on 18 October 2026

    Back to the text
  3. 3

    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
  4. 4

    Retrospective recall of symptoms is considered unreliable for establishing their link with the cycle, hence the value of a day-by-day record.

    Expert consensus · checked on 18 October 2026

    Back to the text
  5. 5

    A confirmed diagnosis of premenstrual dysphoric disorder requires prospective symptom monitoring over two cycles; without this monitoring, the diagnosis is called provisional.

    Established fact · checked on 18 October 2026

    Back to the text
  6. 6

    The British guideline asks for the symptom diary to be kept over at least two consecutive cycles before starting treatment, because treatment can mask the symptoms or make the record difficult to interpret, and for these records to be brought to the following appointments.

    Recommendation · 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 4 “How is PMS diagnosed?”. Accessed on 18 October 2026.
    Back to the text
  7. 7

    The diagnosis is made only if the symptoms are not better explained by another mental disorder (for example a mood disorder or an anxiety disorder), by another medical condition (for example endometriosis, polycystic ovary syndrome, an adrenal gland disorder or excess prolactin) or by the effects of a substance or medication.

    Established fact · checked on 18 October 2026

    Back to the text
  8. 8

    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
  9. 9

    Other conditions can resemble premenstrual disorders or overlap with them, including depression, anxiety, perimenopause and thyroid disease; they are among the things healthcare professionals seek to rule out.

    Expert consensus · checked on 18 October 2026

    • Premenstrual Syndrome (PMS) — FAQ057 (new tab) — American College of Obstetricians and Gynecologists (ACOG), Updated in May 2021, reviewed in November 2025. Passage: Question “Can other conditions mimic PMS?”. Accessed on 18 October 2026.
    • Vivre avec le syndrome prémenstruel (new tab) — Geneva University Hospitals (HUG) — Pulsations magazine, Article from October 2023 (published online on 19 October 2023) (in French). Passage: Section “Une large palette de manifestations”. Accessed on 18 October 2026.
    Back to the text
  10. 10

    Hormonal treatments, including contraceptives, can cause mood, physical or cognitive symptoms; if these symptoms disappear after the treatment is stopped, once its effects have worn off, a diagnosis of premenstrual dysphoric disorder should not be made.

    Established fact · checked on 18 October 2026

    Back to the text
  11. 11

    When the symptom diary is inconclusive, the British guideline describes the use of GnRH analogues, medicines that put the ovarian cycle to rest, for 3 months to clarify the diagnosis.

    Recommendation · checked on 18 October 2026

    Recommendation based on clinical practice (good practice point), 2016 edition.

    • 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 4 “How is PMS diagnosed?”. Accessed on 18 October 2026.
    Back to the text
  12. 12

    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
  13. 13

    Care is individualised: no treatment is effective for everyone, and it may be necessary to try several approaches before finding the one that suits.

    Expert consensus · checked on 18 October 2026

    Back to the text
  14. 14

    The 2023 American guideline states that its recommendations also apply to adolescents, with some exceptions.

    Recommendation · checked on 18 October 2026

    Exceptions not checked (full text not accessible).

    Back to the text
  15. 15

    The measures the NHS lists as possibly helpful include regular physical activity, a balanced diet, enough sleep, mindfulness, stopping smoking and cutting down on alcohol; the ACOG also mentions regular physical activity and relaxation techniques.

    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 “Things you can do to help with PMDD symptoms”. Accessed on 18 October 2026.
    • Premenstrual Syndrome (PMS) — FAQ057 (new tab) — American College of Obstetricians and Gynecologists (ACOG), Updated in May 2021, reviewed in November 2025. Passage: Questions on exercise and relaxation. Accessed on 18 October 2026.
    Back to the text
  16. 16

    The scientific evidence on complementary approaches is limited or conflicting; for physical activity, the British guideline notes some benefit but calls for better-quality studies, and it highlights a large placebo effect in trials.

    Recommendation · 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 6.1 and Table 1. Accessed on 18 October 2026.
    Back to the text
  17. 17

    The guidelines ask for interactions between supplements and medicines to be taken into account; the ACOG advises talking to a healthcare professional before taking a product or supplement for premenstrual syndrome.

    Recommendation · 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 6.1. Accessed on 18 October 2026.
    • Premenstrual Syndrome (PMS) — FAQ057 (new tab) — American College of Obstetricians and Gynecologists (ACOG), Updated in May 2021, reviewed in November 2025. Passage: Question “Can dietary supplements help with PMS symptom relief?”. Accessed on 18 October 2026.
    Back to the text
  18. 18

    The British guideline asks for cognitive behavioural therapy (CBT) to be routinely considered in severe premenstrual syndrome, and the NHS lists it among the talking therapies offered for premenstrual dysphoric disorder.

    Recommendation · checked on 18 October 2026

    Grade A recommendation, but the British guideline notes that the available meta-analysis had a high risk of bias.

    • 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 6.2. 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
  19. 19

    The British guideline considers selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, to be one of the first-line medication options in severe premenstrual syndrome; the NHS lists them as the medicines usually offered for the anxiety and depression linked to premenstrual dysphoric disorder.

    Recommendation · checked on 18 October 2026

    Back to the text
  20. 20

    A 2024 Cochrane review (34 randomised trials) concludes that SSRIs probably reduce premenstrual symptoms in premenstrual syndrome and premenstrual dysphoric disorder, and that they probably increase the risk of adverse effects, the most common being nausea, fatigue and drowsiness.

    Established fact · checked on 18 October 2026

    Moderate certainty (GRADE). The authors report suspected publication bias and that 68% of the studies were funded by the pharmaceutical industry.

    Back to the text
  21. 21

    SSRIs can be taken continuously or only during the second half of the cycle; the British guideline accepts both, whereas the 2024 Cochrane review concludes that continuous use is probably more effective.

    Uncertain · checked on 18 October 2026

    The sources disagree on the best regimen; the page does not recommend any regimen.

    Back to the text
  22. 22

    When SSRIs are taken continuously, the British guideline asks for them to be stopped gradually to avoid withdrawal symptoms, and for the people being treated to be told how to stop them safely.

    Recommendation · 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: Summary of recommendations, “Non-hormonal medical management of PMS”. Accessed on 18 October 2026.
    Back to the text
  23. 23

    The 2016 British guideline asks for preconception counselling to be offered to people taking SSRIs for premenstrual syndrome.

    Recommendation · 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: Summary of recommendations, “Non-hormonal medical management of PMS”. Accessed on 18 October 2026.
    Back to the text
  24. 24

    The hormonal options described include certain combined contraceptive pills: the British guideline considers those containing drospirenone to be a first-line medication option, and the NHS lists the combined pill among the possible hormonal treatments.

    Recommendation · checked on 18 October 2026

    Grade B in the British guideline. The ACOG notes that hormonal contraceptives do not always relieve mood symptoms.

    • 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 6.3.1.1. 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.
    • Premenstrual Syndrome (PMS) — FAQ057 (new tab) — American College of Obstetricians and Gynecologists (ACOG), Updated in May 2021, reviewed in November 2025. Passage: Question “What medications reduce PMS symptoms?”. Accessed on 18 October 2026.
    Back to the text
  25. 25

    The British guideline reserves GnRH analogues, which put the ovarian cycle to rest, for the most severe symptoms; beyond 6 months, it provides for combining them with add-back hormone therapy and, for long-term treatment, monitoring of bone density.

    Recommendation · 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: Summary of recommendations, “Hormonal medical management of PMS”. Accessed on 18 October 2026.
    Back to the text
  26. 26

    Surgery (removal of the ovaries, most often together with the uterus) is described as a last-resort option, when other treatments have not helped; it ends the menstrual cycles and is not compatible with plans for pregnancy. The British guideline asks for the effect of a GnRH analogue to be tested first, as well as tolerance of the hormone replacement therapy that is advised afterwards, particularly before the age of 45.

    Recommendation · checked on 18 October 2026

    The NHS mentions removal of the ovaries, fallopian tubes or uterus; the RCOG recommends hysterectomy with removal of both ovaries and advises against hysterectomy that conserves the ovaries.

    Back to the text
  27. 27

    According to the British guideline, people with severe premenstrual syndrome may benefit from a multidisciplinary team (general practitioner, gynaecologist, mental health professional, dietitian), an arrangement it considers desirable but not widespread.

    Recommendation · 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 5.2. Accessed on 18 October 2026.
    Back to the text
  28. 28

    Keeping a symptom diary means noting and rating the symptoms felt each day, as well as the days of menstruation, for at least two cycles, then bringing these records to the appointment.

    Expert consensus · checked on 18 October 2026

    • Premenstrual Syndrome (PMS) — FAQ057 (new tab) — American College of Obstetricians and Gynecologists (ACOG), Updated in May 2021, reviewed in November 2025. Passage: Question “How is PMS diagnosed?”. 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: Section 4 “How is PMS diagnosed?”. Accessed on 18 October 2026.
    • What is PMDD? (new tab) — International Association for Premenstrual Disorders (IAPMD), Undated page. An association of people affected and professionals: less authoritative than a guideline, always cited together with another source.. Passage: Section “Symptom Tracker”. Accessed on 18 October 2026.
    Back to the text
  29. 29

    The most widely used daily questionnaire is the Daily Record of Severity of Problems (DRSP), considered simple to complete and reliable for tracking symptoms.

    Expert consensus · checked on 18 October 2026

    Back to the text
  30. 30

    According to the 2016 British guideline, commercial symptom-tracking apps still need to be validated, and the retrospective PSST questionnaire is validated for screening but not for diagnosis.

    Recommendation · checked on 18 October 2026

    Observation from 2016; the situation regarding apps may have changed since.

    • 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 4 “How is PMS diagnosed?”. Accessed on 18 October 2026.
    Back to the text
  31. 31

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

    Established fact · checked on 18 October 2026

    Back to the text
  32. 32

    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