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Premenstrual Dysphoric Disorder (PMDD)

What is premenstrual dysphoric disorder (PMDD)?

A much more severe form of the collective symptoms known as premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) affects approximately 3 percent to 8 percent of women of reproductive age and is considered a severe and chronic medical condition that requires attention and treatment.

What causes PMDD?

Although the exact cause of PMDD is not known, several theories have been proposed. One theory states that women who experience PMDD may have abnormal reactions to normal hormone changes that occur with each menstrual cycle. This may include fluctuation of estrogen and progesterone levels that normally occurs with menstruation, causing a serotonin deficiency, in some women (serotonin is a substance found naturally in the brain and intestines that acts as a vessel-narrowing substance, or vasoconstrictor). Additional research is necessary.

What are the risk factors for PMDD?

While any woman can develop PMDD, the following women may be at an increased risk for the condition:

  • Women with a personal or family history of mood disorders

  • Women with a personal or family history of postpartum depression

  • Women with a personal or family history of depression

Consult your health care provider for more information.

What are the symptoms of premenstrual dysphoric disorder?

The primary symptoms that distinguish PMDD from other mood disorders (i.e., major depression) or menstrual conditions is the onset and duration of PMDD symptoms—with symptoms appearing during the week before and disappearing within a few days after the onset of menses—and the level by which these symptoms disrupt daily living tasks. Symptoms of PMDD are so severe that women have an impaired level of functioning at home, at work, and in interpersonal relationships during this symptomatic time period. This diminished level of functioning is generally in great contrast with the same woman's interactions and abilities at other times during the month.

The following are the most common symptoms of premenstrual dysphoric disorder. However, each individual may experience symptoms differently. Symptoms may include:

Psychological symptoms

  • Irritability

  • Nervousness

  • Lack of control

  • Agitation

  • Anger

  • Insomnia

  • Difficulty in concentrating

  • Lethargy

  • Depression

  • Severe fatigue

  • Anxiety

  • Confusion

  • Forgetfulness

  • Decreased self-image

  • Paranoia

  • Emotional hypersensitivity

  • Crying spells

  • Moodiness

  • Sleep disturbances

Fluid retention

  • Edema (swelling of the ankles, hands, and feet)

  • Periodic weight gain

  • Oliguria (diminished urine formation)

  • Breast fullness and pain

Respiratory problems

  • Allergies

  • Infections

Eye complaints

  • Visual disturbances

  • Conjunctivitis

Gastrointestinal symptoms

  • Abdominal cramps

  • Bloating

  • Constipation

  • Nausea

  • Vomiting

  • Pelvic heaviness or pressure

  • Backache

Skin problems

  • Acne

  • Neurodermatitis (skin inflammation with itching)

  • Aggravation of other skin disorders, including cold sores

Neurologic and vascular symptoms

  • Headache

  • Vertigo

  • Syncope (fainting)

  • Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs

  • Easy bruising

  • Heart palpitations

  • Muscle spasms

Other

  • Decreased coordination

  • Painful menstruation

  • Diminished libido (sex drive)

  • Appetite changes

  • Food cravings

  • Hot flashes

The symptoms of PMDD may resemble other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Always consult a health care provider for a diagnosis.

How is PMDD diagnosed?

Aside from a complete medical history and physical and pelvic examination, diagnostic procedures for PMDD are currently very limited. Your health care provider may consider recommending a psychiatric evaluation to, more or less, provide a differential diagnosis (to rule out other possible conditions). In addition, he/she may ask that you keep a journal or diary of your symptoms for several months, to better assess the timing, severity, onset, and duration of symptoms. In general, in order for a PMDD diagnosis to be made, the following symptoms must be present:

  • Over the course of a year, during most menstrual cycles, five or more of the following symptoms must be present:

    • Depressed mood

    • Anger or irritability

    • Difficulty in concentrating

    • Lack of interest in activities once enjoyed

    • Moodiness

    • Increased appetite

    • Insomnia or hypersomnia

    • Feeling overwhelmed or out of control

    • Other physical symptoms

  • Symptoms that disturb social, occupational, or physical functioning

  • Symptoms that are not related to, or exaggerated by, another medical condition

Treatment for premenstrual dysphoric disorder

Specific treatment for PMS will be determined by your health care provider based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Symptoms present

  • Your tolerance for specific medications, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

PMDD is a serious, chronic condition that does require treatment. Several of the following treatment approaches may help alleviate or decrease the severity of PMDD symptoms:

  • Dietary modifications (to increase protein and carbohydrates and decrease sugar, salt, caffeine, and alcohol intake)

  • Regular exercise

  • Stress management

  • Vitamin supplements (i.e., vitamin B6, calcium, and magnesium)

  • Anti-inflammatory medications

  • Selective serotonin reuptake inhibitors (SSRI)

  • Oral contraceptives (ovulation inhibitors)

For some women, the severity of symptoms increase over time and last until menopause (when menses ceases). For this reason, a woman may require treatment for an extended period of time, and may require several reevaluations to adjust medication dosages throughout the course of treatment.