The diagnostic process for PMDD can be controversial. Although it's estimated that less than 10% of those who menstruate meet the diagnostic requirements for PMDD, about 18% have severe enough symptoms and should be treated/diagnosed.

PMDD is currently registered as a mood disorder and requires that 5 or more symptoms (decreased interest in, activities, difficulty concentrating, lack of energy, change in appetite, muscle/joint aches, bloating...) during the late luteal phase for at least 3 consecutive cycles within the last year, and must be free of these symptoms for at least 1 week during the follicular phase. Many may have severe degrees of common PMDD symptoms, but not 5 of those - or, the 1-week clearance may be difficult to measure due to pre-existing mental health conditions, which may simply be worsening during this time.