Premenstrual dysphoric disorder (PMDD) doesn’t appear to have one specific cause, but it’s thought that a combination of hormone and psychological factors play a role.

Levels of estrogen and progesterone naturally fluctuate throughout our menstrual cycle, and they fluctuate particularly dramatically in the days leading up to menstruation. This can cause a wide range of physical and psychological symptoms known as premenstrual syndrome (PMS). It is thought that hormones could also affect serotonin, which is a chemical in the brain responsible for regulating mood. This explains the low moods and mood swings which tend to occur with PMS.

Some women, however, experience these symptoms much more severely than others, and this is known as PMDD. It isn’t clear why some women experience these severe symptoms when most others do not, but it is known that many women with PMDD also have anxiety, severe depression or seasonal affective disorder (SAD). It could be that these underlying mental health conditions could influence the severity of premenstrual symptoms, or it could simply be that the genetic makeup of women who are prone to these mental health conditions also makes them prone to PMDD.

Other health and lifestyle factors which also seem to play a role in PMDD include:
Alcohol or substance abuse
Family history of PMDD
Low levels of exercise
Obesity
Thyroid disorders