Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Approximately 5% of women meet the diagnostic criteria for PMDD, which is comprised of psychological and somatic symptoms as well as functional impairment.1 In the following video, IFM educator Monique Class, MS, APRN, BC, IFMCP, discusses strategies for assessing patients with PMDD and shows how a practitioner-patient collaboration during this assessment may better inform treatment considerations.


PMDD is a version of PMS, but there’s more depression with it, and sometimes anxiety. It happens right before the menstrual period, and it typically ends two to three days after the menses stops.

What I am looking for is:

  • What are the triggers?
  • What are the cues?
  • What goes on around them that makes this happen?

Then I look at a month-long salivary test, or check out a urine test so that I can really understand what is going on with the hormones during that time.

But it’s not just about the hormones; it’s what’s going on in their life.

Because there is a tipping point during that phase of—that luteal phase where, as the hormones shift, their ability to handle the allostatic load of their life changes.

You have to look at it from all dimensions—what’s going on in their life that they need to take a time out from, and what’s going on with the distribution of the hormones that I can go in and rebalance in various ways.

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  1. Lanza di Scalea T, Pearlstein T. Premenstrual dysphoric disorder. Psychiatr Clin North Am. 2017;40(2):201-216. doi:10.1016/j.psc.2017.01.002

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