Premenstrual Dysphoric Disorder

Med Clin North Am. 2019 Jul;103(4):613-628. doi: 10.1016/j.mcna.2019.02.007.


Premenstrual dysphoric disorder (PMDD) comprises emotional and physical symptoms and functional impairment that lie on the severe end of the continuum of premenstrual symptoms. Women with PMDD have a differential response to normal hormonal fluctuations. This susceptibility may involve the serotonin system, altered sensitivity of the GABAA receptor to the neurosteroid allopregnanalone, and altered brain circuitry involving emotional and cognitive functions. Serotonin reuptake inhibitors are considered the first-line treatment. Second-line treatments include oral contraceptives containing drospirenone, other ovulation suppression methods, calcium, chasteberry, and cognitive-behavioral therapy.

Keywords: Antidepressant; Etiology; Oral contraceptive; Premenstrual dysphoric disorder; Premenstrual syndrome; Treatment.

Publication types

  • Review

MeSH terms

  • Contraceptives, Oral / therapeutic use
  • Contraceptives, Oral, Hormonal / therapeutic use*
  • Female
  • Humans
  • Premenstrual Dysphoric Disorder / diagnosis*
  • Premenstrual Dysphoric Disorder / drug therapy*
  • Premenstrual Syndrome / diagnosis
  • Premenstrual Syndrome / drug therapy
  • Selective Serotonin Reuptake Inhibitors / therapeutic use*
  • Women's Health


  • Contraceptives, Oral
  • Contraceptives, Oral, Hormonal
  • Serotonin Uptake Inhibitors