Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Many women experience symptoms of premenstrual syndrome (PMS), a combination of physical and emotional symptoms that arise a week or two before the menstrual period. Most women, an estimated three in four, experience symptoms of PMS, such as headaches, moodiness, and bloating, at some point in their lives.

Premenstrual dysphoric disorder (PMDD) is similar to PMS but involves more severe symptoms, including depression, irritability, and tension, that impact a person’s work or social functioning. Hormonal changes that occur during the week or so before the start of menstruation are thought to trigger psychiatric symptoms. A formal diagnosis of PMDD generally requires that five or more of the symptoms listed below must be present during the premenstrual period.

  • Experiencing strong and variable emotions, such as mood swings or feeling suddenly sad or tearful.
  • Marked irritability or anger.
  • Depressed mood or feelings of hopelessness.
  • Anxiety, tension, and feelings of being keyed up or on edge.
  • Decreased interest in usual activities (e.g., work, school, friends, hobbies).
  • Difficulty concentrating.
  • Lack of energy, easily fatigued.
  • Changes in appetite, overeating, or specific food cravings.
  • Hypersomnia (too much sleep) or insomnia.
  • A sense of being overwhelmed or out of control.
  • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.

PMDD is estimated to affect about 5% of menstruating women every year. (Pearson 2008) It can be treated with antidepressants, birth control pills, or nutritional supplements. Diet and lifestyle changes, such as reducing caffeine and alcohol, getting enough sleep and exercise, and practising relaxation techniques, can also help. PMDD was added to the Diagnostic and Statistical Manual of Mental Disorders in 2013.

By, Eman El Gamal M.D.

Source From psychiatry.org 

FAQs

Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). It causes physical and emotional symptoms every menstrual cycle in a week or two before your period. PMS causes bloating, headaches, and breast tenderness.

With PMDD, you might have PMS symptoms along with extreme irritability, anxiety, or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life.

PMDD affects up to 10% of women or people assigned female at birth (AFAB) of reproductive age.

Symptoms of PMDD vary by individual. They tend to appear a week or two before menstruation and go away within a few days of your period starting. In addition to PMS symptoms like cramping and bloating, you may have:

For some people, symptoms of PMDD last until menopause.

Experts don’t know why some people get PMDD. Decreasing levels of estrogen and progesterone hormones after ovulation and before menstruation may trigger symptoms. Serotonin, a brain chemical that regulates mood, hunger and sleep, may also play a role. Serotonin levels, like hormone levels, change throughout your menstrual cycle.

You may be more prone to PMDD if you have:

Untreated PMDD can lead to depression and, in severe cases, suicide. The disorder can cause severe emotional distress and negatively affect relationships and careers.

If you’re experiencing suicidal thoughts and live in the U.S., call or text the Suicide and Crisis Lifeline at 988. This national network of local crisis centres provides 24/7 free and confidential support. You can also dial 988 if you’re worried about a loved one who may need help.

Your healthcare provider will take a medical history and evaluate your symptoms. You may need to track your symptoms through one or two menstrual cycles. To diagnose PMDD, your provider will look for five or more PMDD symptoms, including one mood-related symptom. Your provider will rule out or diagnose other conditions such as anxiety, depression, or reproductive disorders.

Your healthcare provider may recommend one or more of these treatments to help manage PMDD:

  • Antidepressants called SSRIs (selective serotonin reuptake inhibitors) help manage your brain’s serotonin levels. Examples of SSRIs include sertraline, fluoxetine, and paroxetine HCI.
  • Hormonal birth control pills that have drospirenone and ethinyl estradiol.
  • Dietary changes such as cutting back on certain foods and caffeine. Vitamins such as B-6 and magnesium may also reduce your symptoms.
  • Over-the-counter pain medicines to ease cramps (dysmenorrhea), headaches, breast tenderness, and other physical symptoms.
  • Regular exercise to improve mood.
  • Stress management tools, such as deep breathing exercises and meditation.

There are some ways to manage symptoms of PMDD that don’t involve medication. For example, you can practice yoga, try meditation or find other ways to improve your mood. Changing certain aspects of your diet may also bring relief. Additionally, support groups or resources may help you. Be sure to talk to your provider about all the treatment options available.

Treating existing depression or anxiety may make it less likely that PMS could become PMDD. But PMDD could be related to the way your hormones work, and you might not be able to prevent it. In that case, treatment can bring relief.

With treatment, most people with PMDD get relief from their symptoms and are able to enjoy life more fully. Talking to a mental health specialist or joining a support group may also help. Most people don’t have symptoms after menopause.

Start your journey to Mental Wellness with Dr. Vatsal Suchak.

Book a Consultation