Premenstrual Dysphoric Disorder (PMDD)

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. 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 the 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
• Trouble concentrating
• Headaches/backaches
• Skin problems/acne
• Fatigue
• Tearfulness
• Irritability/aggression
• Anxiety
• Mood swings and/or depression

How is PMS diagnosed?

There is no single test to diagnose PMS. It is a clinical diagnosis which is made by discussing your concerns with your doctor. However, there are some strategies your doctor may use to help diagnose PMS. These include:

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. Sometimes women are surprised to find that the symptoms do not seem to vary with the fluctuation of their hormonal cycles. Women who have many of the emotional symptoms throughout the month may actually suffer from depression and/or anxiety. Making a correct diagnosis is the most important first step towards feeling better.

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

How is PMS treated?

Treatment for PMS is based on relieving symptoms. Treatment begins with a thorough assessment of your symptoms, as well as the 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. While symptoms may vary from month to month, the symptoms diary mentioned above 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 staying well-hydrated with water and light juices—may help relieve symptoms of PMS. A number of vitamin supplements are often taken to try to help PMS symptoms, including vitamin B6, vitamin E, calcium, and magnesium. However, none of these supplements have been shown in well-designed studies to be better than placebo (sugar pills or dummy pills, which can help 30 percent of the time without an active ingredient). Talk to your doctor about the safety of trying calcium or magnesium supplements for you. Excess vitamin E or vitamin B6 is usually discouraged due to studies showing concerns about side effects, especially with vitamin B6. This vitamin can cause permanent nerve damage in women with daily doses in excess of 50 mg per day. It is best to try to get your vitamins by eating a diet rich in unprocessed fruits and vegetables.

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 depression or anxiety that are disruptive to a woman’s lifestyle. Birth control pills and other hormonal contraceptives can help by controlling the hormonal fluctuations of the monthly cycle.

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) that could account for symptoms must be ruled out.

How common is PMDD?

PMDD occurs in 3 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 as needed.

Psychiatric evaluation should focus on symptoms of depression, seasonal variation of depression (looking for worsening in the winter), alcohol and drug use, early victimization and trauma, family history of affective disorder (a group of disorders characterized by a disturbance of mood), 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. Hormonal contraceptives may help, though it is important to be patient until a right fit for the woman’s body chemistry can be found. The optimal hormonal option/method can vary between each person. The FDA has approved the birth control pill Yaz® for the treatment of PMDD. However, other oral contraceptives may also help a woman with PMDD. In addition, individual and group counseling, and stress management can be beneficial in helping a woman cope with PMDD.