PMDD

The symptoms of PMDD are similar to those of PMS, but they are generally more severe and debilitating. Symptoms occur during the last week of most menstrual cycles and usually improve within a few days after the period starts.

Five or more of the following symptoms must be present:

• Feeling of sadness or hopelessness, possible suicidal thoughts
• Feelings of tension or anxiety
• Panic attacks
• Mood swings marked by periods of teariness
• Persistent irritability or anger that affects other people
• Disinterest in daily activities and relationships
• Trouble concentrating
• Fatigue or low energy
• Food cravings or binge eating
• Sleep disturbances
• Feeling out of control
• Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain

There are no physical examination findings or lab tests specific to the diagnosis of PMDD. A complete history, physical examination (including a pelvic exam), and psychiatric evaluation should be conducted to rule out other potential conditions.

Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times they are likely to occur. This information may help the health care provider diagnose PMDD and determine the appropriate treatment.