If you feel irritable, depressed, or anxious in the week or two before your period, it may be a sign of something more than PMS.

Every woman experiences their periods differently. Some women have little to no symptoms. Others experience severe symptoms such as debilitating menstrual cramps or excessive bleeding.

If you’re having severe pain and bleeding, you may have premenstrual dysphoric disorder (PMDD).

Women who experience PMDD symptoms might feel defeated because the symptoms occur monthly. Also, the symptoms can affect your relationships and impact your work performance.

Trying to manage your symptoms can be challenging, and it can get worse with time. But learning more about the condition and its symptoms can help you understand how best to handle them when they arise.

Premenstrual dysphoric disorder affects about 5.5% of women and occurs in those of reproductive age. People diagnosed with PMDD make up a small fraction of the 75% of women who experience premenstrual syndrome (PMS) with their daily cycles.

Though the symptoms can look the same, PMS and PMDD are separate conditions.

When you experience PMS, you may feel mood or physical changes within days of your period. The symptoms can range from anxiety and depression to breast tenderness and headaches. One way to think about PMDD is that it’s PMS to the extreme.

The effects are so severe that PMDD is classified as a depressive disorder in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The condition is a new classification because the brain negatively responds to the natural rise and fall of estrogen and progesterone levels. People with the condition experience physical and mental symptoms.

The difference between other depressive disorders and PMDD is that this type of depression is directly linked to your menstrual cycle. Therefore, the symptoms may be definitive of the disorder but can easily be overlooked because it mirrors other forms of depression and anxiety.

Going through a particularly hard or traumatic life event can increase your chances of being diagnosed with PMDD. Also, if a family member was diagnosed with PMDD, your chances are higher as well.

Symptoms of PMDD can be both physical and psychological.

Some of the common physical symptoms are:

  • low energy levels or excessive tiredness
  • changes in appetite that could lead to food cravings or binge eating
  • having trouble falling or staying asleep
  • breast swelling or tenderness
  • weight gain and bloating
  • muscle or joint pain
  • headaches

The psychological symptoms of PMDD include:

  • a sense of loss of control or overwhelmed
  • panic attacks
  • mood swings, like feeling suddenly tearful or experiencing an increased level of emotional sensitivity
  • anxiety or depression, feeling hopeless or guilty
  • loss of interest in activities, such as spending time with friends, working, or hobbies
  • inability to concentrate or focus

When you see a healthcare professional to discuss these symptoms, they’ll evaluate you to see if five of these symptoms are present in the days before your period and if they improve with the start of menstruation.

Also, they’ll want to know if the symptoms stopped altogether the week after your period. This cycle indicates you may be experiencing PMDD symptoms.

If you think you may have PMDD, consider tracking your symptoms using a symptom tracker app, printout, or a journal. Tracking will help ensure you receive an accurate diagnosis and treatment plan to fit your needs.

Many women with PMDD often go undiagnosed or misdiagnosed. It’s easy for some healthcare professionals to chalk it up as a hormonal imbalance or even diagnose someone with bipolar disorder.

A precise diagnosis is crucial to your recovery. If you’re not satisfied with your initial evaluation, consider getting a second opinion.

There’s not much known about the causes of PMDD. Still, some possible contributing factors include:

  • Hormonal sensitivity: Hormone changes during the menstrual cycle may lead to PMDD. For example, your serotonin level fluctuates during your menstrual cycle and women with PMDD may be more sensitive to it. Another hormone found in progesterone — allopregnalone (ALLO) — designed to calm the mind can have a contradicting effect in PMDD and lead to anxiety, agitation, and other negative mood changes.
  • Genetics: PMDD may be an inherited disorder from parents and grandparents who also had PMDD. According to the DSM-5, there’s an estimated heritability range of 30% to 80%, meaning that about 30% to 80% of PMDD cases may be attributed to genetics.
  • Family history of mental health conditions: If you have a family history of depression or anxiety, this can also lead to PMDD.
  • Cigarette smoking: A review found that smoking can increase a person’s chances for PMS or PMDD.
  • Stress or trauma: High levels of stress or a history of traumatic life event can be a factor in developing PMDD.

When trying to determine whether you should seek help, consider these questions:

  • Are my period symptoms more than just cramping, bleeding, and bloating?
  • Does my period and days leading up to my period affect my quality of life and the lives of those around me?
  • Do I have PMDD or could it be something else?

If you answer “yes” to any of these questions, consider discussing your concerns with a healthcare professional.

Try to listen to your body and what it’s trying to tell you. If you’re living with this condition, talking with a trusted family doctor or gynecologist may be your first step to finding help and relief from your symptoms.

PMDD can lead to changes in behavior, severe discomfort, and suicidal ideation. However, you’re not alone, and there are treatment options available that range from medication and stress management to group or individual therapy.

PMDD is treatable, and with the right help and support, you can learn to manage your symptoms.