PMDD (+ How to Help Relieve Severe PMS Symptoms) - Dr. Axe

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Worse Than PMS: Understanding PMDD (+ 10 Natural Ways to Help Relieve PMDD Symptoms)


PMDD - Dr. Axe

PMDD, or premenstrual dysphoric disorder, is more than just PMS. While PMDD shares many PMS symptoms, it is a severe condition. In fact, PMDD symptoms can cause significant physical and emotional distress. The hormone-induced symptoms can be debilitating, and it’s estimated that PMDD affects somewhere between 2 percent and 10 percent of menstruating women. (1)

Premenstrual dysphoric disorder is characterized with both physical and psychiatric symptoms. Symptoms arise during the luteal phase of the menstrual cycle, occurring just after ovulation and before the period begins. This phase typically lasts from 12 to 14 days. (2, 3)

Women with PMDD symptoms experience a time between menses and ovulation where they are symptom-free. This condition is a significant mood disturbance that can seriously impact relationships, work, impair overall functioning and adversely affect the overall quality of life. (4)

According to Harvard Medical School’s Dr. Andrea Chisholm, many women with PMDD are often misdiagnosed. Sadly, many are told they are just hormonal and they need to adapt, and sometimes they are over-diagnosed. In fact, Dr. Chisholm warns that “it is all too common for women with PMDD to be incorrectly diagnosed with bipolar disorder.”

The severity of the emotional symptoms including anxiety, depression, social withdrawal and rapid mood swings is a cause for alarm. Again, PMDD is not just PMS, it is a serious condition that can dramatically affect your life. Women with PMDD are at an increased risk for both postpartum depression and suicide. (5)


Conventional PMDD treatment is often a combination of prescription anti-anxiety and depression medications, and, sometimes, birth control pills. Natural treatments may also be effective at relieving certain PMDD symptoms, including anxiety, depression and pain.

What Is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a hormone-based mood disorder. Symptoms appear during the luteal phase of the menstrual cycle and last until the menstrual flow begins. Women with PMDD are more sensitive to the effects of estrogen and progesterone, with research now pointing to genetics as a risk factor. (6, 7)

The luteal phase is a time just after ovulation and before the menstrual flow begins. It’s during this timeframe that PMDD symptoms occur. If you experience symptoms outside of this timeframe, you may have a mood disorder other than PMDD.

PMDD symptoms are severe, and can be debilitating. According to the Mayo Clinic, premenstrual syndrome and premenstrual dysphoric disorder have both physical and emotional symptoms, however, PMDD causes extreme shifts in mood that adversely affect work life and relationships. When looking at PMDD vs. PMS, it is important to recognize that PMS affects between 30 percent and 80 percent of menstruating women while PMDD affects somewhere between 2 percent and 10 percent of women of child-bearing ages. (8)


Symptoms of PMDD often emerge during your 20s and may worsen over time. In fact, according to Massachusetts General Hospital Center for Women’s Mental Health, they may worsen as you enter menopause. Common PMDD symptoms include: (9, 10)

  • Depression
  • Anxiety
  • Panic attacks
  • Tension
  • Irritability
  • Sudden mood changes
  • Loss of interest in daily activities
  • Social withdrawal
  • Brain fog
  • Forgetfulness
  • Poor concentration
  • Decreased energy
  • Food cravings
  • Changes in appetite
  • Insomnia
  • Breast tenderness
  • Headaches
  • Lethargy or fatigue
  • Muscle aches
  • Joint pain
  • Swelling of extremities
  • Bloating
  • Feeling overwhelmed
  • Sudden sadness

Causes & Risk Factors

PMDD causes are linked to the changes in hormone levels, not just the hormones themselves. That is why researchers believe that symptoms only occur during the luteal phase, for 12 to 14 days a month. Additionally, according to Massachusetts General Hospital’s Center for Women’s Mental Health, there is evidence that PMDD is a biological phenomenon and it is not just psychologically based. Certain risk factors are indicated:(10)

  • History of anxiety disorder
  • History of mood disorder
  • Family history of PMS or PMDD
  • Stress
  • Being in your 20s or 30s
What is PMDD? - Dr. Axe

Conventional Treatment

Diagnosing PMDD can be a challenge. There is no simple blood test or urine test that will tell you if you have it. The only way is to track your symptoms carefully for at least two menstrual cycles. Keep a detailed journal of all recognized PMDD symptoms you experience and discuss them with your doctor. As symptoms occur during the luteal phase of your menstrual cycle, indicate your cycle start and end dates in your journal. (10)

Once diagnosed, your doctor may prescribe medications and other interventions, including: (11)

  • Birth control pills
  • Progesterone therapy
  • Antidepressants
  • Mood stabilizers
  • Estrogen suppressors
  • Surgical interventions: hysterectomy or bilateral oophorectomy

10 Natural Ways to Relieve PMDD Symptoms

1. Calcium — 1,000 milligrams to 1,200 milligrams daily

For cramps and pain associated with PMDD, taking calcium has been shown to relieve the intensity of menstrual pain. In two separate clinical trials, doses of 1,000 milligrams or 1,200 milligrams of calcium daily significantly decreases pain levels. In one study, participants were given calcium or a placebo from the 15th day of the cycle until menstrual pain disappeared for three consecutive cycles. While there is no harm in taking calcium daily, the study does show it to be effective while you are experiencing PMDD symptoms. (8, 12)

2. Vitamin — B6 50 milligrams daily

To relieve PMS and PMDD cramps and depression associated with PMS and PMDD take 50 milligrams of vitamin B6 daily. Vitamin B6 research indicates that when taking a supplement, you shouldn’t take more than 50 milligrams daily, and the Cleveland Clinic recommends boosting your intake by consuming vitamin B6-rich foods. Some of the best foods to consume include turkey breast, grass-fed beef, pistachio nuts, tuna and avocado. (13, 14)

3. Vitex — Up to 400 milligrams daily before breakfast

Vitex, also known as either chasteberry or vita agnus-castus L, is known for relieving several PMS and PMDD symptoms including breast pain, swelling, cramps, food cravings, depression and anxiety.  Michigan Medicine of The University of Michigan indicates that vitex reduces elevated levels of prolactin, often associated with breast tenderness. Taking vitex before breakfast for at least three menstrual cycles can result in a significant reduction in symptoms. (15)

It is important to note that vitex may interfere with birth control pills, estrogen supplements and certain antipsychotic medications. Talk to your doctor before taking vitex or chasteberry supplements. (16)

4. St. John’s Wort — 900 milligrams daily

St. John’s Wort is used to relieve certain premenstrual syndrome symptoms including anxiety, depression and aggression. In a clinical trial published in the journal CNS Drugs, a dose of 900 milligrams of St. John’s Wort’s daily for two menstrual cycles dramatically improved both physical and behavioral symptoms of PMS. (17)

St. John’s Wort should be avoided if you are taking birth control drugs, Xanax, Lanoxin, Docefrez, Pondimin, Gleevec, Camptosar, Ketalar, Prilosec, Zegerid, Luminal, Dilantin, Tacrolimus, Warfarin/Coumadin, certain medications for HIV/AIDS and several other drugs. In addition, it is not recommended if you are pregnant, breastfeeding, have Alzheimer’s disease, ADHD, bipolar disorder, major depression, schizophrenia or if you are planning to have surgery. Stop St. John’s Wort at least two weeks prior to any scheduled surgery. (18)

5. Omega-3 Fatty Acids — 1–2 grams daily

Known for being essential for heart health, omega-3 fatty acids are also key in the fight against PMDD symptoms. In a clinical trial published in the journal Reproductive Health, study participants that took 1 to 2 grams of omega-3 fatty acids daily experienced significant reduction in premenstrual syndrome symptoms. Researchers note that the group that received the 2-gram dose experienced greater improvement. (19)


Essential oils for PMDD - Dr. Axe

6. Lavender Essential Oil

One of the best natural ways to treat depression, anxiety and to help improve the quality of sleep, lavender essential oil may also help to relieve PMDD symptoms. In a small clinical trial published in the journal Complementary Therapies in Clinical Practice, lavender essential oil was either inhaled or administered through an aromatherapy technique. Both were found to be effective for reducing anxiety and postpartum depression. (20)

In a review of multiple clinical trials, researchers found that a dose of 80 milligrams in a capsule form of lavender essential oil helps anxiety, depression and sleep quality and it didn’t cause any side effects. The benefits were noted fairly early in the treatment, with improvement in both anxiety and depression scores at two weeks, again at six weeks and at ten weeks. (21)

7. Peppermint Essential Oil

Headaches and pain are common PMDD symptoms and peppermint essential oil is one of the best natural remedies for headaches. In an older clinical study published in the journal Phytomedicine, rubbing peppermint essential oil on the temples was found to provide headache relief and researchers urged further trials. More recently, peppermint oil has been proven significantly more effective in clinical trials than a placebo for tension headaches. (22, 23)

Today, this great natural painkiller, is being studied extensively by researchers across the globe, to relieve abdominal pain in those with irritable bowel syndrome, relieve anxiety in those undergoing certain surgeries and for osteoarthritis of the knee. (24)

8.  Acupressure

Sharing many of the benefits of acupuncture, acupressure may help relieve certain PMDD symptoms, according to a recent clinical trial published in the journal Complementary Therapies in Medicine. Researchers conducted simple acupressure at the acupoints LIV3 and LI4 in women diagnosed with premenstrual syndrome. Acupressure was conducted 14 days before menstruation for three consecutive cycles. In addition to general PMS symptoms, anxiety and depression scores also improved. (25)

9. Feed Your Cravings

Cravings of highly sweet foods is natural for women going through PMDD, according to a report in the peer-reviewed journal Appetite. In the clinical study, women with PMDD experienced a desire to eat highly sweet foods and it was shown they experienced an emotional response to highly sweet foods. (26)

This doesn’t mean to rush out to fill your pantry with highly processed sweet foods. It means you need to find ways to satisfy your cravings with healthy options like nutrient-dense fresh fruits like watermelon, cherries, kiwi and berries. And when your cravings for sweets is strong, turn to homemade white chocolate candy or healthier molten lava cake and enjoy each bite.

10. Take Care of Yourself. When you have PMDD, the symptoms can be overwhelming and adversely affect your quality of life. According to the Mayo Clinic, mindfulness, meditation, exercise, yoga, sleep and avoiding stressful events and emotional triggers can help. (8) It is also imperative that you find a way to connect to those who are close to you and express the severity of your symptoms.


Women diagnosed with PMDD are at an increased risk for depression and suicidal behavior according to the Gia Allemand Foundation. (5)

Final Thoughts

  • PMDD, or premenstrual dysphoric disorder, is more than just PMS. It is a severe condition that includes both physical and emotional symptoms.
  • The severity of the emotional PMDD symptoms, including anxiety, depression, social withdrawal and rapid mood swings, is a cause for alarm.
  • Symptoms of PMDD often emerge during your 20s and may worsen over time.
  • PMDD causes are linked to the changes in hormone levels, not just the hormones themselves.
  • Conventional treatment typically includes birth control pills, prescription mood stabilizers, anti-depressants, estrogen suppressors and sometimes surgery.

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