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PMDD Symptoms: Physical, Emotional, Behavioral, and Cognitive

Premenstrual Dysphoric Disorder (PMDD) Symptom Clusters

PMDD is a severe form of PMS with symptoms causing marked functional impairment in the luteal phase, resolving after menses onset.

Physical

  • Breast tenderness, bloating, weight gain
  • Headaches, muscle/joint aches
  • Fatigue, sleep changes (insomnia/hypersomnia)
  • GI: nausea, constipation, diarrhea

Emotional

  • Marked irritability, anger, mood lability
  • Depressed mood, hopelessness, self-deprecating thoughts
  • Anxiety, tension, feeling "on edge"
  • Crying spells, social withdrawal

Behavioral/Cognitive

  • Difficulty concentrating, memory complaints
  • Appetite changes, food cravings
  • Decreased interest in usual activities
  • Feeling overwhelmed, out of control

Diagnostic Criteria (DSM-5)

≥5 symptoms (at least 1 emotional) in most menstrual cycles, with functional impairment. Symptoms must be confirmed by prospective daily rating for ≥2 cycles.

Management

  • SSRIs (first-line; continuous or luteal-phase dosing)
  • Combined oral contraceptives (drospirenone/ethinyl estradiol)
  • GnRH agonists (severe, refractory)
  • CBT, lifestyle (exercise, calcium, stress reduction)

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