Improving PMDD Care Through Accurate Diagnosis and Emerging Treatments

As a debilitating mood disorder that causes clinically significant distress and may increase suicide risk, it is imperative that clinicians are able to accurately differentiate premenstrual dysphoric disorder (PMDD) from typical premenstrual symptoms. 

In this insightful Q&A, Kristin Lasseter, MD, Founder and President, Reproductive Psychiatry and Counseling, shares insights from her 2025 Psych Congress session, “PMDD Uncovered: Neurobiological Insights and Treatment Innovations.” Dr Lasseter emphasizes the importance of accurately diagnosing PMDD using evidence-based practices, dives into the disorder’s pathophysiology, and discusses existing and emerging treatment options that may enhance patient outcomes.

For more news and insights from the 2025 Psych Congress in San Diego, CA, visit the meeting newsroom here on Psych Congress Network.

Psych Congress Network: Many patients and even some clinicians conflate PMDD with severe premenstrual syndrome (PMS). What are the most critical diagnostic distinctions between the two, and what validated diagnostic tools should clinicians use to ensure they are making an accurate diagnosis? 

Kristin Lasseter, MD: The most critical distinction in making a diagnosis between PMDD and PMS is the number of symptoms present. PMDD requires at least 5 symptoms with at least 1 being an affective symptom and at least 1 being a somatic or cognitive symptom. PMS only requires 1 symptom to be present. Additionally, PMDD requires prospective rating scales. The most common validated diagnostic tool for PMDD is the Daily Record of Severity of Problems, or DRSP.

PCN: What role do neurosteroids—particularly allopregnanolone—play in shaping our current understanding of PMDD’s pathophysiology? 

Lasseter: So far, research suggests that neuroactive steroids, particularly estrogen, progesterone, and progesterone's metabolites play a big role in the pathophysiology of PMDD. In particular, many studies provide evidence that one particular progesterone metabolite, allopregnanolone, and its interaction with the GABA-A receptor, is responsible for the majority of affective symptoms of PMDD.

PCN: Could you elaborate on why testing hormone levels for PMDD is not an evidence-based practice? 

Lasseter: Women with PMDD have been shown to have normal levels of progesterone and estrogen, and research has not shown a difference in serum hormone levels related to PMDD. Additionally, testing hormone levels currently plays no role in diagnosing or treating PMDD. 

PCN: Beyond SSRIs and oral contraceptives, what other therapeutic approaches are available for clinical practice? How can clinicians determine which treatment modality individual patients might respond best to? 

Lasseter: Outside of SSRIs and oral contraceptives, GnRH agonists and surgical menopause have the most evidence for successful treatment of PMDD. Cognitive behavioral therapy (CBT) is also another evidence-based treatment. So far, we do not have guidelines on determining which treatment modalities patients will respond best to. It seems only about 50% respond to SSRIs, and about 50% respond to GnRH agonists. Oral contraceptives have an even lower response rate.  

One hypothesis is that there are different subtypes of PMDD and only certain subtypes respond to certain treatments. We need more research on this, as well as development of other treatments. One obvious treatment that has yet to be published in research is allopregnanolone agonists, such as brexanolone and zuranolone.

PCN: Is there anything else from your session that you’d like to highlight to our audience?

Lasseter: Since PMDD is very often misdiagnosed, it is important that clinicians understand how to diagnose it. More often, patients who are believed to have PMDD, actually have premenstrual exacerbation of another underlying mental illness, and successful symptom resolution relies on improving the treatment for that mental illness in that particular patient. By over diagnosing PMDD and missing the diagnosis of premenstrual exacerbation, we are doing our patients a disservice since they will continue to experience significant impairment from these disorders.

Kristin Yeung Lasseter, MD, is a board-certified psychiatrist based in Austin, Texas who specializes in Reproductive Psychiatry and Women’s Mental Health. She is the founder and president of Reproductive Psychiatry and Counseling, which hosts multiple psychiatrists and psychotherapists in Central Texas specializing in mental health across the reproductive life span. Dr Lasseter is also the Director of Perinatal Psychiatry at The Women’s Center of Texas at St. David’s North Austin Medical Center, and Affiliate Faculty at The University of Texas Dell Medical School, Department of Psychiatry and Behavioral Sciences. She volunteers her time at Postpartum Support International’s Psychiatric Consult Line and raises awareness about reproductive mental health through speaking engagements and social media (Facebook & Instagram: @the.reproductive.psychiatrist).

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