We investigated dysmenorrhea, rumination, substance use and perceived stress as predictors of PMDD among women. We used a cross-sectional design and convenience sampling to recruit participants at a university in South Africa. A total of 1329 female students participated in the study. Data was collected using an online survey. Participants completed a demographic questionnaire, Premenstrual Screening Tool, Drug Use Disorders Identification Test, Adapted Ruminative Response Scale, Menstrual Symptom Questionnaire, and the Perceived Stress Scale. Descriptive analysis, correlations and logistic regression analysis were conducted using Statistical Package for the Social Sciences. A total of 135 participants screened positive for PMDD symptoms, indicating a prevalence rate of 10.2% for PMDD symptoms. The model predicted 90% of the cases correctly. Congestive dysmenorrhea, brooding, reflection and worry were identified as significant predictors of positive PMDD symptoms. Oral contraceptive use, spasmodic dysmenorrhea, perceived stress and drug use were not significant predictors. We recommend the development of a CBT based intervention targeting rumination in women with PMDD and education-based interventions regarding dysmenorrhea and PMDD among university students.