Need help now? If you are thinking about suicide or harming yourself, call or text 988 in the US (Suicide & Crisis Lifeline), or call your local emergency number.

Short answer

Rate each symptom once a day on the same simple scale, mark the days you bleed, and keep going for at least two menstrual cycles. Doctors confirm PMDD from this kind of daily record: symptoms build in the week or two before your period and ease within a few days after it starts.

Key facts

  • PMDD affects up to 5% of women of childbearing age.[1]
  • Symptoms appear in the week or two before a period and usually go away two to three days after it starts.[1]
  • A diagnosis needs five or more symptoms, including at least one mood-related symptom.[1]
  • Daily symptom ratings over at least two menstrual cycles are used to confirm the diagnosis.[2][3]

What should you rate each day?

Rate the same list every day, including days you feel fine. The calmer days after your period are what make the pattern visible. The Office on Women's Health calls PMDD a health problem that is similar to premenstrual syndrome (PMS) but is more serious.[1]

AreaExamples to rate
MoodIrritability or anger, sadness or despair, tension or anxiety, mood swings, crying often
Thinking and energyTrouble focusing, tiredness or low energy, feeling out of control, less interest in daily activities and relationships
BodyCramps, bloating, breast tenderness, headaches, joint or muscle pain, trouble sleeping, food cravings
ImpactHow much symptoms got in the way of work, school or relationships that day
CycleThe first day of each period and your bleeding days

The symptom examples above follow the Office on Women's Health list.[1]

How do you keep a PMDD symptom diary?

  1. Pick one time each day, such as before bed, and rate every symptom on the same scale. The Daily Record of Severity of Problems (DRSP), a form developed for PMDD, rates each item from 1 (not at all) to 6 (extreme).[4]
  2. Log the first day of each period.
  3. Keep going for at least two full cycles, without skipping the good days.[2]
  4. Add a short note when something unusual happens, such as an illness, a big stressor or a change in medication.
  5. Bring the record to your appointment, and ask whether your clinician prefers a specific form such as the DRSP.

How do you read the pattern?

Compare the week before your period with the week after it ends. In PMDD, symptoms are clearly worse in the week or two before the period and ease within two to three days after bleeding starts.[1] If symptoms stay high all month, something else may be going on, and that is worth raising with a clinician too.

When should you get help right away?

PMDD can bring feelings of despair and even thoughts of suicide.[1] If you are thinking about harming yourself, call or text 988 in the US to reach the Suicide & Crisis Lifeline,[5] or call your local emergency number. You don't need to finish two cycles of tracking before asking for help.