What are PMDD Symptoms and when are they at their worst?

Sep 29, 2021

Premenstrual Dysphoric Disorder (or PMDD to us!) is listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition – you might have heard of it as the DSM-5(1)

The DSM-5 is a really useful tool for us to pin down what symptoms categorise PMDD and it’s what professionals (should!) use to diagnose you!

PMDD does not discriminate: it will interfere with all aspects of your life – your work, school, social activities or close relationships…maybe even all of them. If five of the below symptoms sound familiar, with at least one symptom coming from the first AND second group, then you might find it supportive to reach out to a medical professional as you could be dealing with PMDD.

Group One

Mood swings

Feeling suddenly sad or tearful

Irritability or anger


Hopelessness or self-deprecating thoughts

Anxiety, tension or feeling on edge


Group Two

Lack of, or decreased, interest in usual activities

Difficulty concentrating

Change in appetite


Changes in sleeping habits – insomnia, or hypersomnia

Breast tenderness

Joint or muscle pain


Using the DMS-5 as a guide is in line with our commitment to providing science based information here at Luna Hub. And yet it’s also important to note that the full extent of PMDD is still emerging. We’d hazard a guess that over time more symptoms will be added as we get a better understanding of how PMDD works and impacts us. 


Symptoms not listed in the DSM-5 (but that we see a lot in the community!)

We really feel like the diagnostic criteria for PMDD is over-simplistic and there’s way more to the condition than the short (and somewhat nondescript) checklist above. We know from speaking to our community members that there are MANY other symptoms which seem to be common with PMDD – yet, they don’t appear anywhere in the DSM-5. Does that mean they’re not considered part of PMDD? Who knows?! But, we see them a lot, so it makes sense for us to include them here: 

  • Intrusive thoughts, suicidal ideation and self-harm 
  • Social withdrawal and “cocooning” 
  • Dissociation –  feeling disconnected from your surroundings, zoning out, a sense that the world around you doesn’t feel real, or even feel like you’re observing yourself from the outside looking in. 
  • Impulsive, risky or addictive behaviour 
  • Noise sensitivity (misophonia or hyperacusis)
  • Tinnitus (buzzing or ringing in ears) 
  • Difficulty talking and finding the “right” words (expressive aphasia)
  • Difficulty understanding things you hear or read (receptive aphasia) 
  • Frenetic or manic thoughts and energy – around ovulation then right before your period
  • Sore, puffy eyes and bloating which can change the appearance of your face 
  • Headaches and migraines 


So, when is PMDD at its worst? 


You could meet ten people with PMDD and they would all experience PMDD in their own unique ways, with different patterns or symptoms. With that in mind, the short answer is that it’s different for everyone but, for the majority, PMDD will be at its worst at some point after you ovulate and at some point before you start to menstruate.

The long answer?

A study by Reid, 2017 (2), indicated that there are typically four patterns that people experience with PMDD symptoms:


Luna Hub - Support for anyone living with PMDD
A – Symptoms start around a week before your period and gradually get worse the closer it gets.

B – Symptoms start a few days after ovulation and gradually get worse as your period approaches.

C – You get symptoms around ovulation, then a few days of relief, then symptoms return before your period.

D – Symptoms start pretty much at ovulation and remain all the way through to your period.  

The study noted that the rate at which symptoms resolve can vary dramatically too: some people find immediate relief with the onset of menstruation, while others have a slower recovery over a couple of days or find that symptoms only resolve at the end of menstruation.

We recently ran a poll over on Instagram to see which PMDD symptom pattern people most related to. 92 people responded and this is what came out:

Luna Hub - Support for anyone living with PMDD

So, according to our very non-scientific instagram survey, C seems to be the most common symptom pattern on this occasion, followed by D, then B, and finally A. Interesting!


There’s still a lot to learn about PMDD. We desperately need more scientific research to deepen our understanding of the range of symptoms and experiences.

In the meantime, getting to know your cycle and symptom pattern is a really positive step you can take to better manage PMDD. And, while it can be helpful to talk to others about their symptoms, the value really comes from tuning into your own rhythm and learning when those peaks and dips are likely to happen. After all, we’re all on a unique journey and experience PMDD differently, so getting to know what it means for us as individuals is really important. 

Get your free beginners guide to PMDD