Premenstrual dysphoric disorder is the most severe form of premenstrual syndrome and is characterized by significant physical and behavioral symptoms that occur in the late luteal phase of the menstrual cycle. These symptoms, which include anger, irritability, and depression, cause considerable distress and typically begin in adolescence and continue until menopause.

Premenstrual dysphoric disorder is characterized by a range of severe physical, behavioral, emotional, and cognitive symptoms, and irritability, mood swings, and depression are the most prominent. These symptoms typically occur during the late luteal and early follicular phases of the menstrual cycle and can significantly disrupt daily activities.

Premenstrual dysphoric disorder is diagnosed based on a history of severe, cyclic symptoms that meet specific criteria in the DSM-5, including at least 5 symptoms (with 1 being a major mood symptom), that cause significant distress during the late luteal phase of most menstrual cycles over the past year. Documentation of symptoms over at least 2 cycles using a validated questionnaire is required, and additional tests may be performed to rule out other conditions.

Medical treatments for premenstrual dysphoric disorder primarily involve selective serotonin reuptake inhibitors (SSRIs) to alleviate symptoms by increasing serotonin levels, with options for administration timing. Other treatments include serotonin-norepinephrine reuptake inhibitors (SNRIs), combined oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists, and, in severe cases, surgical removal of the ovaries.

Several supplements — including chaste tree, calcium, and vitamin D — have been studied for premenstrual dysphoric disorder, but most are only effective for mild to moderate symptoms and often require combination with other therapies. Chaste tree is the most researched, though the evidence supporting its effectiveness is low, particularly for psychological symptoms, compared to antidepressants.

There is limited evidence associating diet directly with premenstrual dysphoric disorder (PMDD), but a diet that is rich in whole foods and low in ultraprocessed items, salt, caffeine, and alcohol may reduce premenstrual symptoms. Although the specific effect on PMDD is uncertain, a healthy diet is unlikely to worsen the condition and may offer benefits.

Therapeutic interventions such as cognitive behavioral therapy, couple-based cognitive behavioral therapy, and mindfulness-based therapies can improve the quality of life for individuals with premenstrual dysphoric disorder. Additionally, acupuncture, acupressure, and exercise may help alleviate symptoms, though further research is needed.

The exact cause of premenstrual dysphoric disorder is unknown, but it is thought to stem from an abnormal sensitivity to hormonal fluctuations during the menstrual cycle, particularly in the luteal phase. This heightened sensitivity leads to an altered neurotransmitter response, and the serotonin system is particularly implicated in the disorder's pathology.