Premenstrual dysphoric disorder

Premenstrual dysphoric disorder, or PMDD, is similar to premenstrual syndrome (PMS) but with greater symptom severity. Like women with PMS, those with PMDD experience a multitude of physical and psychological symptoms that manifest before their menstrual period. Women with PMDD often suffer interference with work, socialization and relationships due to the disorder's symptoms.

Definition & Facts

Premenstrual dysphoric disorder is a severe form of premenstrual syndrome with often debilitating symptoms that are more manageable for women with PMS. But for women with PMDD, the symptoms are so intense that they can cause problems throughout patients' lives.

Symptoms of PMDD appear in the second half of the menstrual cycle. This is most commonly the week or two weeks prior to the menstrual period. The most common physical effects of PMDD are fatigue, moodiness, panic attacks, bloating, breast tenderness, headaches and other symptoms. PMDD makes daily life difficult, painful and troubling for those affected by the disorder. Up to 10 percent of menstruating women have PMDD, and personal or family history of depression increases the risk for PMDD.

Symptoms & Complaints

By definition, PMDD is severe enough to disrupt daily activities and normal functioning. As a result, untreated PMDD can seriously impact quality of life. A woman with PMDD can suffer from inability to function at work, home or school. Suicidal ideation and behavior can result from the disorder's mood swings and depression. Symptoms of PMDD may include any of the following:

• Depression or hopelessness
• Mood swings
• Anger with increased conflicts
• Tension
• Anxiety
• Irritability
• Difficulty concentrating
• Fatigue
• Disinterest in daily activities
• Appetite changes
• Sleep problems, either insomnia or excessive sleeping
• Feeling of being overwhelmed
• Bloating
• Breast tenderness
• Swelling
• Joint pain
• Muscle pain
• Headaches

Causes

PMDD's causes are not clear. Underlying anxiety and depression commonly experienced by women as part of PMS point to hormonal changes of the menstrual cycle as a contributing factor for PMDD. Low levels of serotonin in women with PMDD may also be the cause, according to recent studies. Serotonin is involved in control of mood, sleep, pain and attention.

Diagnosis & Tests

Symptoms believed to be PMDD should be evaluated by a doctor. Medical history, symptoms and a physical examination will help determine whether PMDD is the diagnosis. Psychiatric consultation is often included in the diagnostic process.

To arrive at a diagnosis, the doctor will consider whether other emotional issues are present, such as anxiety disorder or depression. Medical and gynecological conditions will also be considered. Endometriosis, menopause, uterine fibroids and hormonal imbalances cause similar symptoms to PMDD and could be the problem.

At least five contributing symptoms must be present before PMDD is diagnosed. These must occur for most of the seven days leading up to the menstrual period and diminish within two days of the period's onset.

Treatment & Therapy

Treatments used for premenstrual syndrome are also often helpful for alleviation of symptoms of PMDD. Those treatments include:

• Well-balanced nutrition: Limitation of intake of caffeine, refined sugar, alcohol and salt have been shown to help reduce symptoms of PMDD. Taking a daily supplement of calcium, vitamin B6 and vitamin E, and magnesium may prove beneficial.
• Physical exercise: Premenstrual symptoms are often helped by regular aerobic exercise.
• Antidepressants medications: The FDA has approved several antidepressants for treatment of PMDD, which can also help reduce symptoms. Some patients take these antidepressants continuously or only in the two weeks leading up to their menstrual period.
• Over-the-counter medications: Pain relievers available without a prescription can help with symptoms of PMDD like physical tenderness, back pain, headache and muscle cramping. Water pills, also known as diuretics, can help reduce bloating.
• Anti-anxiety medications: Some women benefit from prescribed anti-anxiety medications taken for just a few days of their menstrual cycle.
• Hormones: Synthetic hormones may be prescribed to stop ovulation. These include birth control pills. Hormones progesterone or estrogen may also be used to treat symptoms, although it is still unclear whether this course of treatment is effective.
• Surgery: In severe cases, ovulation may be stopped through surgery. This is usually a last resort.
• Counseling or psychotherapy and alternative therapies: Many women with PMDD benefit from counseling, education in coping strategies, relaxation therapy, reflexology, yoga, and meditation.

Prevention & Prophylaxis

• Antidepressant medication, specifically selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline to help with emotional symptoms, food cravings, sleep issues and fatigue
• Birth control pill administration without pill-free interval days or with reduced periods of pill-free intervals
• Nutritional supplements, including calcium, magnesium, vitamin B6 and L-tryptophan
• Herbal remedies, including chasteberry to reduce irritability, swelling, cramps, cravings and mood swings
• Regular exercise and avoidance of caffeine, alcohol, salt and refined sugars
• Stopping smoking
• Use of relaxation techniques, meditation, yoga and mindfulness to reduce stress
• Getting enough sleep each night without oversleeping
• Avoiding stressful situations and emotional triggers whenever possible, such as discussion of subjects causing relationship problems and arguments, like financial problems and relationship issues

Premenstrual dysphoric disorder is believed to be related to how neurotransmitters in the brain react to ovarian hormones. Because so little is known about the disorder, prevention employs methods very similar to treatment.