Young Adult Mental Health & Substance Abuse Treatment Centers

PMDD in Young Adults: Premenstrual Dysphoric Disorder Symptoms and Treatment

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Do you experience depressive symptoms that are particularly intense one week of the month and seem nonexistent a couple weeks later? If so, you might be suffering from Premenstrual Dysphoric Disorder, or PMDD in young adults.

PMDD is an endocrine disorder experienced by some people who menstruate. It usually begins a week or more before menstruation and lasts for about two weeks out of every month. And it’s often debilitating, both mentally and physically, for those who experience it.

Many people mistake PMDD for premenstrual syndrome (PMS), but PMDD is much more severe and debilitating. However, understanding PMDD can help people normalize their experiences, develop self-compassion, and seek effective treatment.

Key Takeaways

  • PMDD is a depressive disorder that is considered an extreme extension of PMS.
  • PMDD usually begins a week or more before menstruation and lasts for about two weeks out of every month.
  • Symptoms are severe and include feelings of worthlessness, depressed mood, self-deprecating thoughts, fatigue, sleep problems, and interpersonal conflict.
  • Managing PMDD can involve therapy, lifestyle changes, and medications. 

What Is PMDD in Ages 18+?

Premenstrual Dysphoric Disorder is thought to be caused by abnormal sensitivity or reaction to hormonal changes. Considered an extreme extension of PMS, PMDD occurs during the luteal phase of the menstrual cycle during childbearing age.

Young adults with PMDD often experience severe mood changes or swings, severe irritability or anger, feelings of sadness, hopelessness, worthlessness, and anxiety or tension. Hence, PMDD is classified as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Young people with PMDD may also experience physical symptoms including fluid retention, bloating, and breast and joint soreness.

Overall, PMDD in young adults negatively impacts interpersonal relationships, self-esteem, and mental and physical health. It can cause a young adult to feel like they’re backsliding for over two weeks out of every month—half of their life. Many people then feel like they need to scramble to pick up the pieces and perform as much damage control as possible before the next PMDD episode begins. 

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PMDD Symptoms in Young Adults

Premenstrual Dysphoric Disorder is characterized by experiencing several physical and emotional symptoms during the week before menstruation. Within a few days of the onset of menstruation, symptoms begin to improve. About a week after menstruation, symptoms are markedly better or absent. 

According to the DSM-Vdiagnostic criteria for PMDD includes behavioral, emotional, and physical symptoms. In order to be diagnosed with PMDD, these symptoms must cause significant distress in a person’s life. They also must interfere with a person’s relationships, school, work, social activities, or other typical life activities. 

Emotional Signs of PMDD

  • Mood swings
  • Sadness or tearfulness
  • Increased sensitivity to rejection
  • Irritability and anger
  • Depressed mood, including feelings of hopelessness, worthlessness, and self-deprecating thoughts
  • Increased anxiety, tension, and feeling on edge

Behavioral PMDD Signs

  • Suicidal thoughts or ideation
  • Decreased interest in typically pleasurable hobbies and activities
  • Feeling overwhelmed or out of control
  • Conflict within interpersonal relationships
  • Difficulty concentrating
  • Panic attacks

Physical Symptoms of PMDD

  • Change in appetite or intense food cravings
  • Fatigue and lethargy
  • Inability to sleep, or sleeping much more than usual
  • Breast tenderness
  • Joint or muscle pain
  • Bloating or weight gain

What Causes PMDD in Your 20s?

PMDD in ages 18+ is still not fully understood. However, the symptoms are thought to be the result of an abnormal or severe reaction to hormonal changes due to menstruation.

People with a personal history of depression, mood disorders, or seasonal depression are at higher risk for developing PMDD in their teens or 20s. Smoking and alcohol or drug abuse may also increase the risk of Premenstrual Dysphoric Disorder.

Additionally, trauma and stress are thought to exacerbate PMDD. This may include past physical or emotional abuse, current life stressors, and ongoing traumatic events. 

Know the Facts

Between 5 and 8% of people who menstruate are thought to experience PMDD.

Why Is It Hard to Diagnose PMDD?

Groups that may experience PMDD include women, femmes, trans, non-binary, and LGBTQ people. However, many individuals in these groups encounter challenges in accessing treatment for PMDD, particularly gender-affirming care. 

Furthermore, there is a considerable lack of research and studies on PMDD. As a result, many doctors don’t fully understand PMDD and may misdiagnose it as major depressive disorder or bipolar disorder. Or they may write it off as normal PMS. This can be frustrating and dangerous for those experiencing the disorder.

In summary, Premenstrual Dysphoric Disorder should be taken just as seriously as any other depressive disorder. People experiencing symptoms and challenges surrounding PMDD deserve effective and affirming mental and physical healthcare. 

PMDD Depression vs. Major Depressive Disorder

The main difference between PMDD depression and major depressive disorder (MDD) is the timing of the symptoms and the additional physical PMDD symptoms. Moreover, the causes of the two disorders are different. In addition, PMDD symptoms include severe mood swings and irritability. These are potential signs of MDD as well, but are not as common. 

PMDD is often misdiagnosed as MDD by healthcare professionals. That’s because the psychological symptoms of PMDD and MDD can be very similar and even identical. These include feelings of sadness, anxiety, loss of interest in formerly pleasurable activities, appetite changes, fatigue, and thoughts of death or suicidal ideation. 

While PMDD and MDD are not the same, they can co-occur. That is, an individual can suffer from both of these depressive disorders at the same time.

Here are some of the differences between PMDD depression and major depressive disorder.


  • Thought to be caused by abnormal reactions to hormonal changes in a menstruating body
  • Other possible causes include genetics, a history of trauma, smoking, and stress
  • Symptoms start the week before menstruation and improve markedly around a week after the onset of menstruation
  • Includes physical symptoms such as fluid retention, bloating, and breast and joint soreness
  • Symptoms interfere with one’s work, sleep, interpersonal relationships, and management of daily life tasks


  • Possible causes include genetics, brain chemistry, a history of trauma, stress, and major life events such as the death of a loved one, divorce or breakup, or loss of a job
  • Symptoms are not correlated with a menstrual cycle
  • Physical symptoms include headaches, digestive problems, and unexplained physical pain
  • Symptoms last for at least two weeks and interfere with one’s work, sleep, interpersonal relationships, and management of daily life tasks

How Is PMDD Diagnosed?

To diagnose PMDD, a healthcare provider will ask a patient to track symptoms through at least two menstrual cycles. They may also ask about medical history and lifestyle, as well as any history of trauma or current stress. Additionally, a physical examination or blood tests may be performed to rule out other potential disorders or diseases. 

Several physical as well as psychological symptoms must be present. These symptoms must occur during the week before menstruation and begin improving after menstruation. If symptoms of PMDD are present but don’t correlate with menstruation, another disorder, such as MDD, may be involved.

While there is no single definitive test for PMDD diagnosis, there are several PMDD assessment scales. These include the Premenstrual Symptoms Screening Tool (PSST), the Calendar of Premenstrual Experiences (COPE), the Visual Analog Scale (VAS), and the Patient-Reported Outcomes Measurement Information System (PROMIS).

Treatment for PMDD in Young Adults

Treatment for PMDD in young adults varies according to the individual. What works for one person may not work for another. This means that treatment may require patience, trial and error, and the right healthcare providers. 

Here are a few common approaches for treating PMDD in young adults.

Lifestyle Changes

Lifestyle changes may reduce the severity and impact of PMDD as part of a treatment plan. Potential lifestyle changes a general practitioner or specialist may recommend include:

  • Getting consistent exercise
  • Having a well-rounded diet
  • Making sure to get enough sleep
  • Reducing stress
  • Decreasing use of substances such as alcohol, tobacco, and caffeine


Selective serotonin reuptake inhibitors (SSRIs), or antidepressants, are commonly prescribed to help with debilitating symptoms of PMDD. Antidepressants may be taken only during the luteal phase while symptoms are present, or they may be taken long term. The dosage and type depend on the individual. 

Oral contraceptives may also be prescribed for people experiencing PMDD. However, some people report their symptoms become worse with contraceptives. Such medication may be inappropriate for use and will depend on several factors. These include potential negative side effects, the desire to get pregnant or not, and possible unwanted hormonal changes. 

Therapy for PMDD in Young Adults

Therapy can help a young person dealing with PMDD develop healthy coping mechanisms and implement positive lifestyle changes. Moreover, therapy for PMDD can support young people to address underlying trauma and stress that may be exacerbating the disorder. 

Therapy can be combined with medications or other positive changes. While therapy is not a quick fix, it should be an integral part of treatment for a severe mental health disorder like PMDD.  

How Newport Institute Addresses Young Adult Depression

Newport Institute’s programs for depression help young adults who struggle with disorders like PMDD feel whole, happy, and themselves again. 

Young adult treatment at Newport helps people ages 18–35 and their families discover effective coping and problem-solving skills. In addition, they connect with others who are experiencing similar struggles. And they strengthen skills like emotional resilience, rest, self-compassion, and optimism. 

Each client has a tailored treatment plan according to their needs and goals. We employ modalities including CBTDBT, and family therapy in order to provide the best possible care. Our programs are designed to help young adults gain the tools and self-knowledge they need to feel safe and healthy in their lives. 

Young adults in our integrated treatment programs receive:

  • Medical care from a doctor
  • Group, individual, and family therapy
  • Experiential therapies, including yoga, art, martial arts, and more (depending on location)
  • Life skills training and tools for coping with depression
  • Connection to other young adults in the program
  • Resources and tools to build self-worthself-compassion, and emotional resilience even in the face of difficulties

Start the healing journey today. Contact us for a free mental health assessment.

Frequently Asked Questions

  • What is PMDD?
  • What are the symptoms of PMDD?
  • What does a PMDD episode look like?
  • Is PMDD a form of bipolar disorder or MDD?
  • At what age does PMDD usually start?
  • How do I check if I have PMDD?
Mental Health / April 16, 2023

Newport Institute

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