Symptoms:

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

Five or more of the following symptoms must be present:

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

Signs and tests:

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 done 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.