How to Deal With Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a condition in which a sufferer experiences debilitating mood swings, depression, insomnia and various other symptoms in the week leading up to the onset of the period. It is more severe than the well-known premenstrual syndrome (PMS) and it can cause a sufferer to change the way they live so dramatically, that even work schedules and relationships are negatively impacted. It usually disappears when the period arrives, or shortly after. Read on to learn how to deal with premenstrual dysphoric disorder.

The Symptoms of PMDD

Check whether you are experiencing at least five or more of the following symptoms thought to be associated with PMDD:

  • Low energy levels, feeling deep fatigue, incredible tiredness.
  • Loss of interest in your usual activities and relationships.
  • Physical symptoms can include tender breasts, headaches, neck aches, muscle or joint pain, bloating, etc.
  • Irritability, feeling crowded and anger; some of this may be inflicted on other people you live or work with.
  • Feeling out of control; in some cases you may feel paranoid about people’s motives toward you.
  • Feeling tense, anxious.
  • Possibly experiencing panic attacks.
  • Mood swings, a dark mood descends and won’t leave, you may cry a lot or feel overwhelmed by emotional stimuli.
  • Feeling sad, hopeless; in some cases, thinking suicidal thoughts.
  • Resorting to binge eating, experiencing food cravings.
  • Difficulties falling asleep or staying asleep; insomnia (which can cause any feelings of anxiety, tension, anger, etc., to worsen).
  • Difficulties concentrating; your brain may feel “racy” or “foggy”.

Note when these symptoms arise for you. If they are occurring in the lead-up days to a period and seem to lessen or disappear after the period arrives, there is a possibility that you have PMDD. It’s a really good idea to keep a diary that covers at least three periods so that you can establish the pattern and present this to your doctor.

How to Deal With PMDD

Talk to someone who loves you unconditionally and understands you have PMDD. This could be a mom, a sibling, a spouse or a friend. Choose someone who knows it’s “that time of the month” and can be reassuring, not make judgments and can offer a comforting shoulder to lean on temporarily. If you don’t feel as if there is someone to talk to and you really need to talk, consider calling an organization that listens to people when they’re in trouble; a chat with someone who cares can do wonders.

  • A pet can be great comfort too. Unconditional love in oodles there, and you can get lots of affection back too.

See your doctor. Explain that you are experiencing at least five or more of the above listed symptoms in the days leading up to your period and that these feelings seem to evaporate or lessen greatly upon the arrival of your period. Your doctor will need to consider both the listed symptoms and other issues, such as whether there might be another condition or illness involved. You will likely undergo the following:

  • A thorough physical examination
  • A pelvic examination
  • A psychiatric examination.

Continue to keep a diary. Even after your doctor has diagnosed you and suggested various treatment approaches, it is important to note the changes (or lack of them) with treatment. This helps your doctor in continuing to pinpoint more coping methods for the future.

Discuss possible causes with your doctor. Research is still being done on the possible causes of PMDD. Hormonal changes might play a significant role, while already having a condition such as seasonal affective disorder, anxiety or severe depression can enhance the effects of PMDD. The usual suspects of poor diet and lack of exercise may also contribute to it, so it is thought that caffeine, salt and low exercise levels might exacerbate PMDD. Other possible causes include having a mother who has PMDD, smoking, being overweight and alcohol abuse. Low levels of serotonin could be another cause. If any of the possible causes are applicable in your case, be sure to raise them with your doctor to help him or her pinpoint what might be an issue for you.

Eat a healthy diet. Remove as much processed food and fast food from your diet as you can. Eat lots of leafy greens, wholegrain foods, vegetables and fruit. Reduce your reliance on salt, sugar, alcohol and caffeine.

  • Substitute caffeinated coffee and tea with decaffeinated or no-caffeine products. If you really love coffee, try to avoid it in the week your period is due; this will require good calendar watching on your behalf.

Take medication if your doctor considers this appropriate. This is something you’ll need to discuss with your doctor. If you already suffer from acute depression or anxiety, medication may be an important part of your general recovery. That said, not everyone wants to take medication, so do your research and be prepared to choose the option that works best for you. Remember that being proactively interested in your well-being is an important part of maintaining good health, as by making the choices yourself, you remain in greater control. The kinds of medication that might be useful, depending on the context, include:

  • Anti-depressants or anti-anxiety medication, especially where depression or anxiety are a constant issue for you
  • Birth control pill – some people find the pill helps correct hormonal imbalances and stabilizing ovulation; again, this is not for everyone but it might be helpful and is worth discussing
  • Diuretics – these can help with fluid retention
  • Ovulation suppressors
  • Supplements – calcium, B6, L-tryptophan and magnesium in the correct doses might assist but only on your doctor’s advice
  • Standard pain relievers, such as aspirin or ibuprofen, especially to relieve physical pain and tension.

Get lots of regular exercise. Try to go for a walk every day, or work out at your favorite exercise. Swimming, walking the dog a good distance, running, gym work, riding a cycle, etc. are all good forms of daily exercise.

Learn ways to help you sleep. Rather than resorting to sleeping pills, try the many available techniques that can help you to sleep better. 

Reduce and eliminate unhelpful drugs. If you smoke, PMDD is a good reason, among many others, to quit. And if you have a problem with drinking excess amounts of alcohol, seek help from your doctor. Even if you’re not a heavy drinker, small amounts of alcohol might be a problem for your particular metabolism, so try not drinking any alcohol in the week leading up to a period to see if minimizing your intake helps. Record this in your diary and speak to your doctor about the results.

See your doctor for a review. After trialing ways to cope with PMDD for a few periods, revisit your doctor to discuss the outcome. If you feel better, keep up the new things you’re doing. If you still have problems, show your doctor the diary you’ve kept and explain which symptoms don’t seem to be alleviated so far. It is important to keep working on fixing as much of PMDD as you can, at least to the extent that you can lead a normal life again.

Consider getting some form of counseling or therapy. If you have mood swings, depression, anxiety, etc., talk therapy can be highly beneficial. For example, if you descend into a dark place when PMDD hits and think nobody loves you, you’re a complete failure and you just want to die, these thoughts are the condition talking, not the real you. Indeed, the thoughts aren’t real––they’re manifestations of the mood swing that has overtaken you. Therapies such as cognitive behavioral therapy (CBT) or mindfulness based cognitive therapy (MCBT) can help you to listen to the thoughts in an abstract, objective way without associating them with your very self. In that way, you can learn to talk over them, reacting to them as the disembodied gatecrashers that they really are and send them packing.

How to Deal With Work and PMDD

Talk to your immediate supervisor and explain that you have PMDD. Explain the types of impact it has in your case but offer immediate and concrete solutions too. Basically, get some support and understanding, while showing it won’t affect your work performance as a whole.

  • See if it’s possible to make a deal to work from home in a flexible way. You still get the work done but without the pressure of people who might be just too much when you’re feeling so bad. More and more people are finding it is possible to work from home some days of the week, depending on the type of work they do; do some research first so that you can present a good case.
  • If you get irritable with co-workers at this time of the month, it might help to explain that you aren’t well rather than having them feel you suddenly dislike them. That said, some people are less than understanding, so be careful what you say, and to whom. It might just be better to ignore them or avoid them if you feel a sudden urge to vent on such people.

Find ways to work around the symptoms. Life goes on, regardless of whether or not you have PMDD and that can be a problem. In a perfect world, you’d be able to call work and say, “Sorry, got PMDD, need two days off” and everyone would be cool about it. The work world hasn’t evolved to cope with cyclical unwellness, so you will just have to do your best. Some coping suggestions are presented in this section.

Change the way you work. This isn’t for everyone, but it can work for some. Go freelance, work as a contractor, be a consultant, etc. Do work in which you determine the work hours, rather than the place of business. Find a job that only cares about what you deliver, not that you’re sitting or standing in the right place all day long. Fortunately, unlike previous generations of women, technology has made this a real possibility.

Get in later and go home earlier. Make up for it by working harder on non-affected days. You can also bring work home, although your rest is really important for coping.

  • Reschedule meetings or presentations that you know will suffer from you being unwell.
  • Bow out of after-work social events. Either make an excuse not to go at all, or turn up to be polite, then leave early.

Take over-the-counter drugs to get through the day. Aspirin, Tylenol, ibuprofen, etc., can help calm some of the pain and physical symptoms. Take anti-anxiety and anti-depressant medication if your doctor thinks this will help.


  • Your hormones don’t define you or mean that you are unfit for anything. Anyone who says this is being unkind, thoughtless and plain stupid about the realities of being a human being. The moodiness that descends at this time of the month does not make you any less a person and isn’t about letting down womanhood. Dismiss the thought that you’re weak or letting down the side; PMDD symptoms are internally driven by standard bodily processes. You need tender loving care (and whatever other inputs the doc suggests) in order to be able bounce back, not confusing and ignorant putdowns.
  • Call emergency services immediately if you are contemplating suicide. Suicidal thoughts as a result of PMDD are to be taken seriously; it is your condition doing the talking, not reality. It is really important to get help, fast.


  • PMDD can vary in its severity from month to month. Some periods you may wonder if it has gone for good (sadly, this is usually a false alarm). At other times, PMDD comes on with a vengeance, period after period in a row with no let up in severity. If you are the sort to experience swinging severity, it can be helpful to check that you are not slipping in eating healthily, that you’re not being subjected to more than usual stress and that you’re getting enough sleep, as sometimes this may be contributing to a spate of more-severe-than-usual PMDD experiences in a row. Use your diary to help discern patterns.
  • PMDD isn’t going to go away. That’s why mindfulness based cognitive therapy can be really helpful––reaching acceptance that PMDD is something you have to live with and learn to manage on a monthly basis is part of coping well. It helps to accept that there will always be a few days a month when you’re not your usual self; that way, you can make allowances, changes and workarounds that ensure you get through these few days as intact as possible. And let people who care about you know that you have PMDD; it will not only let them support you but it will explain a lot that they might otherwise not feel so understanding about.