Understanding and treating PMDD

PMDD represents the most severe form of premenstrual disorders and differs fundamentally from PMS in diagnostic criteria, symptom severity, and functional impact. While PMS affects 20-50% of women with mild to moderate symptoms, PMDD is diagnosed when at least five specific symptoms occur during the final week before menstruation, including at least one core mood symptom: marked mood swings, irritability or anger, depressed mood, or anxiety. These symptoms must cause clinically significant distress or interference with work, school, social activities, or relationships. The symptoms begin during the luteal phase and resolve within a few days after menstruation starts, followed by a relatively symptom-free follicular phase—a cyclical pattern that distinguishes PMDD from other mood disorders. Women with PMDD often describe feeling "like a different person" during the premenstrual week, with emotional volatility, cognitive difficulties, physical discomfort, and a profound sense of being overwhelmed that simply doesn't occur with typical PMS.