PMDD: Clear Signs, How to Track Them, and What Helps

PMDD (premenstrual dysphoric disorder) is more than bad cramps and mood swings. It causes severe emotional and physical symptoms in the week before your period and can disrupt work, relationships, and sleep.

Common signs include intense irritability or anger, sudden sadness or crying, marked anxiety, trouble concentrating, low energy, breast tenderness, bloating, and changes in appetite. The key is timing: symptoms start in the luteal phase (after ovulation) and improve within a few days after bleeding begins. For a diagnosis, clinicians look for at least five symptoms, including one mood symptom, that repeat each cycle and cause real impairment.

How to track symptoms

Track symptoms daily for two cycles using a simple checklist: mood, anxiety, sleep, appetite, physical pain, and concentration. Note start and end dates of symptoms, their severity, and how they affect daily life. Use a phone app or a paper calendar. Accurate tracking helps your clinician tell PMDD from PMS, depression, or anxiety disorders that don’t follow your cycle.

What actually helps

First try basic self-care that reduces symptoms: regular aerobic exercise, 30 minutes most days; consistent sleep schedule; cut back on caffeine and alcohol in the luteal phase; and eat small, balanced meals with some protein. These changes can lower symptoms for many people and are safe to start while you track.

If symptoms still interfere with life, medical options include antidepressants (SSRIs like sertraline or fluoxetine), taken either daily or just during the luteal phase, and certain hormonal treatments like combined oral contraceptives or a GnRH agonist in severe cases. Calcium supplements and cognitive behavioral therapy also have evidence for benefit. Talk to your primary care provider or gynecologist about risks, side effects, and whether a mental health referral makes sense.

Be specific when you talk to your clinician: share your symptom diary, note how many days you miss work or avoid plans, and report any history of mood disorder or suicidal thoughts. If you feel unsafe or have active thoughts of self-harm, seek emergency help right away.

PMDD can overlap with anxiety and OCD. If you have obsessive thoughts or panic attacks tied to your cycle, mention that. Treatments may need adjustment when two conditions coexist.

Medication safety matters. If you already take medication for anxiety, depression, or another condition, check interactions before adding SSRIs or hormonal therapy. Your clinician can review your current meds and suggest safe options.

Tracking, basic lifestyle changes, and a clear conversation with your clinician are the fastest ways to find relief. Pharmstore.com has guides on common treatments and safe purchasing tips, but always follow a clinician’s prescription and keep emergency contacts ready if symptoms worsen.

About 368% of menstruating people have PMDD. It often starts in the 20s but can appear at any age. Pregnancy or menopause may change symptoms. Before trying supplements or stopping hormonal birth control, get medical advice 6hormone shifts can make symptoms better or worse and need a plan with your provider. You're not alone.