Introduction to PMDD diagnosis

“I’d never heard of PMDD before my diagnosis,” states a member of the Belle Health Community.

Premenstrual Dysphoric Disorder (PMDD) is a serious condition that involves intense premenstrual symptoms, like severe mood swings, irritability, anxiety, and depression. It can be difficult to manage, especially when it’s unclear if symptoms go beyond typical premenstrual syndrome (PMS).

On average, it takes about 12 years for someone to receive a PMDD diagnosis. Around 1 in 30 people with ovaries are likely to have PMDD.

Often misunderstood and misdiagnosed, the journey can be long and challenging. If you suspect your symptoms might align, follow our step-by-step guide to understand how to get a PMDD diagnosis.

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Symptoms That Could Indicate PMDD

Diagnosing PMDD requires thoroughly understanding its symptoms. Consider the following key indicators:

  • Emotional Symptoms: Intense mood swings, impatience, episodes of anger, or feeling overwhelmed. Additionally, profound sadness, hopelessness, or anxiety may be present.
  • Behavioral Changes: Withdrawal from usual activities, impaired concentration, and notable changes in social interactions.
  • Physical Symptoms: Bloating, headaches, breast tenderness, and joint or muscle pain are common.
  • Sleep Issues and Fatigue: Insomnia, excessive fatigue, or significant changes in sleep habits often accompany PMDD.

These symptoms happen in the week before your period (7-14 days before) and often get better when your period starts. The intensity and impact of these symptoms are crucial for distinguishing PMDD from typical PMS.

Uncertain if you’re experiencing PMDD? Take our quiz to learn more.

How Is PMDD Diagnosed?

Healthcare professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose PMDD.

What is the DSM-5?

The DSM-5 provides comprehensive guidelines for diagnosing mental health conditions. Based on the DSM-5, researchers have developed diagnostic tools like C-PASS to help the clinicians to diagnose PMDD.

DSM-5 Criteria for PMDD Diagnosis

Criterion A: At least five symptoms must be present in the week prior to menses, improve within a few days after the onset, and become minimal postmenses.

Criterion B: At least one of the following mood-related symptoms must be present:

  1. Marked affective lability (e.g., mood swings, sudden sadness or tearfulness, increased sensitivity to rejection)
  2. Marked irritability or anger, or increased interpersonal conflicts
  3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts
  4. Marked anxiety, tension, or feelings of being on edge

Criterion C: At least one of the following additional symptoms must be present, bringing the total to five when combined with Criterion B symptoms:

  1. Decreased interest in usual activities (e.g., work, school, hobbies)
  2. Difficulty concentrating
  3. Lethargy, fatigue, or marked lack of energy
  4. Significant changes in appetite; overeating or specific food cravings
  5. Sleep disturbances (insomnia or hypersomnia)
  6. A sense of being overwhelmed or out of control
  7. Physical symptoms such as breast tenderness, joint or muscle pain, bloating, or weight gain

Additional Criteria:

  • Criterion D: Symptoms must cause significant distress or impair work, school, social activities, or relationships.
  • Criterion E: The symptoms must not be an exacerbation of another disorder, such as major depressive disorder or generalized anxiety disorder.
  • Criterion F: Symptoms should be confirmed by prospective daily ratings during at least two symptomatic cycles.
  • Criterion G: Symptoms must not be by virtue of substance use or another medical condition (e.g., hyperthyroidism).

Doctors may label it ‘provisional premenstrual dysphoric disorder’ if the patient doesn’t track the symptoms for two cycles.

Keeping a Symptom Diary: The First Step to PMDD Diagnosis

To diagnose PMDD effectively, track your symptoms consistently. A detailed symptom diary helps you and your doctor identify symptom patterns and determine their severity over time. You can use a traditional journal or digital applications specifically designed for menstrual health tracking. Document the following:

  • Emotional changes, such as mood swings or episodes of anxiety
  • Physical symptoms, including pain, bloating, or fatigue
  • Variations in sleep quality and energy levels

Feeling cloudy? Shine light on symptoms with our PMDD tracker!

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Seeking Professional Help

Once you have consistent symptom records, consult a healthcare provider. The diagnostic process typically includes:

  1. Reviewing Your Symptom Diary: Sharing comprehensive symptom records helps the provider understand your unique experience more thoroughly.
  2. Ruling Out Other Conditions: Conditions like depression, generalized anxiety disorder, or thyroid dysfunction can present with overlapping symptoms. Your healthcare provider may conduct tests to exclude these alternative diagnoses.
  3. Discussing Treatment Options: Once diagnosed, your healthcare provider will discuss potential treatment strategies, including lifestyle adjustments, psychotherapy, medications like SSRIs, or hormonal therapies.

Misdiagnosis: PMDD vs PMS

Knowing if you have PMS or PMDD is difficult, because they share many symptoms. However, there some key differences:

PMS generally involves physical symptoms like bloating, breast tenderness, and mild mood changes. These symptoms do not severely impact daily functioning.

PMDD, on the other hand, includes severe emotional symptoms. These can include intense mood swings, irritability, anxiety, or depression that interfere with work, social activities, and relationships.

According to the DSM-5, PMDD requires at least five symptoms, including one mood-related symptom. These symptoms must consistently appear during the luteal phase and reduce after menstruation begins. PMS symptoms, while similar, are usually less severe and do not meet these criteria.

Other PMDD Overlapping Conditions

One of the significant challenges in diagnosing PMDD is the overlapping of symptoms. PMDD shares symptoms with various mental health and medical conditions. Getting the wrong diagnosis is common, leading to inappropriate treatments that may not address the root of the problem.

  • Premenstrual Exacerbation (PME): PME can intensify symptoms of other underlying conditions. Individuals with depression, bipolar disorder, or ADHD may experience worsening symptoms during the luteal phase.
  • Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD): Anxiety, irritability, mood swings, and episodes of depression are shared symptoms with PMDD. One of the key differences lies in the cyclical nature of PMDD, while GAD and MDD are continuous. Symptoms of PMDD start predictably in the weeks before your period and improve after it. This pattern makes it crucial to distinguish PMDD from other mood disorders.

Because these symptoms overlap, healthcare providers must thoroughly evaluate to distinguish PMDD from other conditions. Accurate diagnosis can help ensure individuals receive appropriate treatment tailored to their unique needs.

Why Getting a PMDD Diagnosis Matters

A PMDD diagnosis is crucial for finding the right treatment plan and improving quality of life.

Many individuals struggle for years, unaware that their severe premenstrual symptoms are part of a condition that actually exists. A diagnosis helps you access the right treatments and regain control of your health.

Treatment Options for PMDD

Once diagnosed, treatment for PMDD can vary based on individual needs and symptom severity. Common approaches include:

  • Medications: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are the first line of treatment to PMDD. Hormonal treatments, like birth control pills, can also be an alternative.
  • Lifestyle Adjustments: Regular exercise, a balanced diet, and stress management techniques can help alleviate some symptoms. ACOG (American College of Obstetricians and Gynecologists) guidelines recommends regular exercise to help manage physical and emotional premenstrual symptoms. Also according to ACOG, a balanced diet seems to modulate premenstrual symptoms
  • Cognitive Behavioral Therapy (CBT): CBT has proven to be effective in managing emotional symptoms of PMDD. The ACOG strongly recommends CBT for the management of affective symptoms.

Summary

Here is a summary of this step-by-step guide to a PMDD diagnosis:

  1. Identify Symptoms: Understand key PMDD symptoms, such as emotional, behavioral, physical, and sleep issues.
  2. Track your Symptoms: Keep a detailed symptom diary, documenting emotional and physical changes for at least two cycles.
  3. Consult a Healthcare Provider: Use your symptom records to help healthcare professionals in assessing your condition.
  4. Rule Out Other Conditions: Undergo evaluations to exclude other disorders that may have overlapping symptoms, like depression or anxiety.
  5. Discuss Treatment Options: Once diagnosed, explore different treatment options, including lifestyle changes, therapy, or medication.

If you suspect you have PMDD, tracking your symptoms is a crucial first step. Consider using the Belle app to meticulously log your symptoms and patterns.

References

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA
  • Eisenlohr-Moul TA, Girdler SS, Schmalenberger KM, Dawson DN, Surana P, Johnson JL, Rubinow DR. Toward the Reliable Diagnosis of DSM-5 Premenstrual Dysphoric Disorder: The Carolina Premenstrual Assessment Scoring System (C-PASS). Am J Psychiatry. 2017 Jan 1;174(1):51-59. doi: 10.1176/appi.ajp.2016.15121510. Epub 2016 Aug 13. PMID: 27523500; PMCID: PMC5205545.
  • Management of Premenstrual Disorders: ACOG Clinical Practice Guideline No. 7. Obstet Gynecol. 2023 Dec 1;142(6):1516-1533. doi: 10.1097/AOG.0000000000005426. PMID: 37973069.