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Diseases & Conditions

Premenstrual Dysphoric Disorder (PMDD)

(Also Called 'PMDD (Premenstrual Dysphoric Disorder)')

What is PMS?

Premenstrual syndrome (PMS) is a medical condition that affects some women of childbearing age. More than one in three women suffer from PMS, and one in 20 suffer so severely that their lives are seriously affected. PMS is related to a variety of physical and psychological symptoms that occur just before your menstrual period.

What causes PMS?

The exact cause of PMS is unknown, but it seems to be related to the fluctuating levels of hormones, including estrogen and progesterone, that occur in preparation for menstruation.

What are the symptoms of PMS?

There are many symptoms of PMS, and the number and severity of symptoms vary from woman to woman. In addition, the severity of the symptoms can vary from month to month. Common symptoms of PMS include:

  • Bloating
  • Breast tenderness
  • Weight gain
  • Aggression
  • Trouble concentrating
  • Headaches/backaches
  • Skin problems / acne
  • Fatigue
  • Tearfulness
  • Irritability
  • Anxiety
  • Mood swings and/or depression

How is PMS diagnosed?

There is no single test to diagnose PMS. It is a clinical diagnosis. However, there are some strategies your doctor may use to help diagnose PMS:

Thyroid test — Because thyroid disorders are common in women of childbearing age, and some of the symptoms of PMS—such as weight gain—are similar to symptoms of thyroid disorders, your doctor may order a test to evaluate thyroid functioning. This can help to rule out a thyroid disorder as a cause of your symptoms.

PMS symptoms diary — Your doctor may ask you to keep a diary to assess the frequency and severity of symptoms. By doing this, you can see if your symptoms correspond to certain times in your monthly cycle. While your symptoms may vary from month to month, a trend likely will appear after tracking your symptoms for a few months.

How is PMS treated?

Treatment for PMS is based on relieving symptoms. Treatment begins with a thorough assessment of your symptoms, as well as their impact of them on your daily life.

Education — You will be better able to deal with your symptoms if you can relate how you’re feeling to your menstrual cycles, knowing that you will feel better once your period starts. Keeping a monthly symptom diary will help you track your symptoms, as well as their severity and how long they last. While symptoms may vary from month to month, this diary can give you a good idea of how your periods affect your physical health and moods. Learning how to cope with the problems in your life may help relieve the stress and irritability you feel before your period. If you experience severe anxiety, irritability or depression, counseling and/or medication may be helpful.

Nutrition — A healthy diet is important to overall physical and mental wellness. Making changes in your diet—including reducing the amount of caffeine, salt and sugar and stay well hydrated with water and light juices—may help relieve symptoms of PMS. In some cases, nutritional supplements may be recommended. These include Vitamin B6, calcium and magnesium.

Exercise — Like a healthy diet, regular exercise can improve your overall health. It also can help relieve and help you cope with the monthly symptoms associated with PMS, especially dysmenorrhea (painful cramping and bloating).

Medications — Over-the-counter pain relievers—such as aspirin and ibuprofen—may help relieve symptoms such as headache, backache, cramps and breast tenderness. Make sure you have no contraindications such as peptic ulcer disease or kidney disease before using many pain relievers. Medications may be prescribed in cases of severe depression or anxiety.

Can PMS be prevented?

PMS itself cannot be prevented, but through education and appropriate treatment of symptoms, most women can find relief. A healthy lifestyle—including exercise and a proper diet—also can help a woman better manage the symptoms of PMS.

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. The symptoms of PMDD are similar to those of PMS, but are severe enough to interfere with work, social activities, and relationships.

How is PMDD diagnosed?

PMDD is diagnosed when at least five of the following symptoms occur seven to 10 days before menstruation and go away within a few days of the start of the menstrual period.

  • Mood swings
  • Marked anger
  • Irritability
  • Tension
  • Decreased interest in usual activities
  • Fatigue
  • Change in appetite
  • Sleep problems
  • Physical problems, such as bloating

Before a doctor makes a diagnosis of PMDD, he or she will rule out other emotional disorders—such as major depression or panic disorder—as the cause of the symptoms. In addition, underlying medical or gynecological conditions—such as endometriosis, fibroids, menopause and hormonal problems (such as a thyroid disorder)—that could account for symptoms also must be ruled out.

How common is PMDD?

PMDD occurs in 3 percent to 5 percent of menstruating women. Women with a personal or family history of mood disorders—including major depression or postpartum depression—are at greater risk for developing PMDD.

What causes PMDD?

As with PMS, the exact cause of PMDD is not known. Most researchers, however, believe PMDD is brought about by the hormonal changes related to the menstrual cycle. Recent studies have shown a connection between PMDD and low levels of serotonin, a chemical in the brain that helps transmit nerve signals.

Certain brain cells that use serotonin as a messenger are involved in controlling mood, attention, sleep and pain. Therefore, chronic changes in serotonin levels can lead to PMDD symptoms.

How is PMDD diagnosed?

Clinical evaluation should include a comprehensive review of the patient's symptoms and medical history, a physical exam, a gynecologic exam, and basic laboratory tests (such as a complete blood count, electrolytes, liver and kidney profile, and thyroid function tests).

Psychiatric evaluation should focus on symptoms of depression, seasonal variation of depression, alcohol and drug use, early victimization and trauma, family history of affective disorder (a group of disorders characterized by a disturbance of mood, accompanied by a manic and depressive syndrome), alcoholism, and current situational stresses.

How is PMDD treated?

Many women gain relief from the symptoms of PMDD with education and lifestyle changes, including exercise, vitamins, and a caffeine-free diet. Medications, including anti-depressants like selective serotonin reuptake inhibitors (SSRIs), may be used to treat the emotional symptoms of PMDD. In addition, individual and group counseling, and stress management can be beneficial in helping a woman cope with PMDD. The FDA has now approved the use of Yaz®, an oral contraceptive pill for the treatment of PMDD.

Sources

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 2/2/2011...#9132