Premenstrual dysphoric disorder
Individuals with PMDD report mood changes and negative affect during the luteal phase of their menstrual cycle. It is currently hypothesized that PMDD is caused by exposure to progesterone during the luteal phase, which may contribute to abnormal serotonergic activity in the brain. Some evidence suggests that women with PMDD have increased sensitivity to allopregnanolone, a progesterone metabolite, which may alter GABA receptors in the brain. A study using functional MRI demonstrated hypoactivation in the right dorsolateral prefrontal cortex, which is thought to be important for emotional regulation, in women with PMDD.
PMDD may occur any time after menarche. Risk factors include stress, history of trauma, seasonal changes, and family history of PMDD. The 1-year prevalence of PMDD is estimated to be between 1.8% and 5.8% of menstruating people. PMDD may also be associated with increased suicidal ideation and suicide attempts.
Patients with this disorder may have an increased risk of various general medical conditions.
Related topic: premenstrual syndrome
F32.81 – Premenstrual dysphoric disorder
596004 – Premenstrual dysphoric disorder
Differential Diagnosis & Pitfalls
- Premenstrual syndrome – Distinguished by fewer and less severe symptoms.
- Primary dysmenorrhea – Painful menses with cramping.
- Secondary dysmenorrhea – Painful menses due to endometriosis, adenomyosis, or fibroids.
- Mood disorder – Including bipolar disorder, major depressive disorder, and dysthymia; will present differently in history; may coexist with PMDD.
- Migraine headache – Some individuals may experience migraines around the time of menses, which may have a variety of physical and cognitive-affective symptoms.
- Gender dysphoria – Transmasculine individuals may experience heightened dysphoria and mood symptoms around and during menses, but these feelings generally persist after menses and are usually associated with other manifestations of gender dysphoria.
- Substance use or intoxication – Can be associated with changes in mood and emotional regulation.
- Medication side effects – Some individuals using hormones or other medications may experience mood changes.