PMDD symptoms begin sometime after the middle of a monthly cycle (after ovulation), usually get worse during the week before menses, and then usually disappear within a few days of the start of menses. The symptoms follow this pattern every month or almost every month.

Here are the symptoms that make up the diagnosis of PMDD. All of the symptoms do not need to be present, and they may vary from month to month. At least 5 are required to make the diagnosis, including at least one of the first four.*

1. Very depressed mood, feeling hopeless
2. Marked anxiety, tension, edginess
3. Sudden mood shifts (crying easily, extreme sensitivity)
4. Persistent, marked irritability, anger, increased conflicts
5. Loss of interest in usual activities (work, school, socializing, etc.)
6. Difficulty concentrating and staying focused
7. Fatigue, tiredness, loss of energy
8. Marked appetite change, overeating, food cravings
9. Insomnia (difficulty sleeping) or sleeping too much
10. Feeling out of control or overwhelmed
11. Physical symptoms such as weight gain, bloating, breast tenderness or swelling, headache, and muscle or joint aches and pains

*Adapted from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, 2000, with permission from the American Psychiatric Association

PMDD symptoms are not always present. Symptoms disappear during or by the end of menses, and return at about the same time during following cycles. If symptoms are present every day, then they are unlikely to be due to PMDD.

To be considered PMDD, symptoms must be severe enough to really disrupt a woman's life -- interfere with work, school, social activities or interpersonal relationships.

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