What Causes PMDD: Exposing The Underlying Elements

Rishabh Mehta
Medically reviewed by
Dr. Kaushal

Review medical content on WOW Rx Pharmacy, so that accurate drug use information is easily accessible to everybody.
Dr. Akansha is a licensed Clinical Pharmacologist. She possesses remarkable knowledge in Pharmacovigilance, prescription analysis, drug information, and drug safety services. Additionally, she is a keen learner and an educator.

Last Updated:

premenstrual dysphoric disorder

Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome (PMS) that affects 2-8 percent of women. 

It can cause severe physical and emotional symptoms like pain, irritability, and depression. 

These start interfering with daily life and need to be treated. 

However, for determining the course of the right treatment, knowing the underlying cause of PMDD is important. 

Read ahead to find out what causes PMDD to analyze and mitigate the risk and seek a timely diagnosis. 

Causes of PMDD

The exact cause of PMDD is still unknown. 

However, some factors have been found to be responsible for causing PMDD. 


Mainly, sensitivity or abnormal reaction to reproductive hormones, two weeks before the period starts is the main reason behind PMDD. 

It alters the brain chemicals and neurological pathways, which can cause mood-related symptoms. 

The ones responsible are ovarian hormones Progesterone and its metabolite Allopregnanolone (ALLO). 

They rise in the second half of the menstrual cycle and drop before periods, which is a key factor resulting in PMDD. 

Another brain chemical that also acts as a hormone is Serotonin, which can also play a role in PMDD.

Despite being caused by hormonal changes, PMDD is also listed as a mental disorder under DSM-5 as it causes a variety of symptoms such as anxiety and depression.

Its role is to regulate mood, sleep, and hunger. 

Even its levels keep changing during the menstrual cycle, which explains its association with PMDD. 

Cigarette smoking

Moderate to severe smoking has a strong association with increased risk of PMS and PMDD. 

According to a 2021 study, smokers have a higher PMDD risk compared to non-smokers. 

Current and ex-smokers who smoked about 3 pack years have an Odds Ratio (OR) of 3.06 for PMDD. 

This risk is even higher for those who smoke for 3 to 8 pack years, which is an OR of 3.56).

Odd ratio is a measurement of the association between exposure and outcome. It finds out how strongly an event is related to an exposure to something. 

Moreover, the risk of developing PMS i.e., the early stage of PMDD, is greater for women who have started smoking in adolescence or early adulthood. 

Past traumatic events

Traumatic events have a strong correlation with PMDD risk. 

However, the exact mechanism remains unknown. 

The findings from the 2022 research suggest that early-life trauma is related to PMDD. 

Out of all such experiences, women who encountered chronic childhood trauma or emotional abuse have the highest probability. 

PMDD must not be left untreated as women with PMDD have a 7 times higher risk of suicide attempts. It is advised for both patients and doctors not to neglect the mental symptoms of PMDD and to seek adequate treatment for management. 


Weight GainSource: nomadsoulphotos
Woman with overweight

Just like any other health condition, obesity is related to PMDD as well. 

Body Mass Index (BMI) and PMDD are related as every 1 kg/m2 increase raises the risk of PMS by 3 percent. 

Moreover, the women with a BMI higher than 27.5 were at relatively higher risk than those with a BMI less than 20.0.

Those with a BMI greater than 35.0 have a relative risk of 1.66 of developing PMS/PMDD.

It was also found that a 1 kg/ m2 increase in BMI was also associated with physical and emotional symptoms such as

  • Increased swelling of hands and feet by 11 percent
  • Increased risk of backache, abdominal cramping, diarrhea or constipation, and food cravings by 5 to 6 percent
  • Increased risk of crying, mood swings, and irritability by 3 to 4 percent
Recommended Article
PMDD struggles are real but many natural treatment options can help you manage and lessen the severity of symptoms. To learn about them, read PMDD natural treatment


Genetics can also play an important role in PMS and PMDD risk. 

Peter Schmidt, M.D. of the Behavioral Endocrinology Branch of NIH, also confirmed the same. 

He said, “We found dysregulated expression in a suspect gene complex, which adds to evidence that PMDD is a disorder of cellular response to Estrogen and Progesterone.”

So, further studies are required to understand the genetic component better for evolving treatment for PMDD. 


PMDD is a severe form of PMS that causes symptoms like irritability, pain, and anger. 

So, for initiating PMDD diagnosis and treatment, it is crucial to understand the underlying causes first. 

Several factors, like genetics, smoking, obesity, and hormones, are responsible for PMDD. 

Women with past trauma have a high risk of developing PMDD. 

For effective management, it is essential to not only give importance to treatment but also awareness about who is at higher risk of PMDD. 

Such steps ensure that women take their health seriously and seek proper diagnosis instead of taking emotional and physical distress lightly. 

With timely treatment, the symptoms can be controlled, and risk can be mitigated to preserve health and quality of life. 

Frequently Asked Questions

Can emotional abuse lead to PMDD?

Yes, emotional abuse can lead to PMDD. Past trauma events are a known risk factor for PMDD. Women with early life trauma, especially emotional abuse and chronic childhood trauma, have the strongest association with PMDD. 

Which hormone is responsible for PMDD?

Sensitivity to changes in reproductive hormones is responsible for PMDD. Ovarian hormones Progesterone and Allopregnanolone rise in the second half of the menstrual cycle and drop before menstruation. This withdrawal is the key factor in PMDD risk. Moreover, Serotonin can also increase PMDD risk. 

What causes severe PMDD?

The exact cause of PMDD remains unknown. However, many factors are known to increase the risk of PMDD. Mainly, sensitivity to changing reproductive hormones is responsible for PMDD. Other factors include genetics, past traumatic events, obesity, and smoking. 

Is there any relation between PMDD and brain chemicals? 

There is a strong relationship between brain chemicals and PMDD. Serotonin, a brain chemical, also keeps fluctuating during the menstrual cycle. Since it is responsible for regulating sleep, mood, and hunger, it can cause the majority of PMDD symptoms like appetite changes, irritability, anger, and depression. 

If I smoke, do I have more chances of having PMDD?

 Smokers, whether current or those who smoked in the past, have a higher risk of having PMDD. Moreover, women who begin smoking in adolescence or early adulthood have more chances of PMDD in comparison to those who do not smoke or start in later stages of life. 

WowRxPharmacy uses only high-quality sources while writing our articles. Please read our content information policy to know more about how we keep our content reliable and trustworthy.

More Articles Like This

Leave a Comment

Receive the latest articles in your inbox!