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The jokes about PMS (premenstrual syndrome) are numerous, but it’s no joke to the women who suffer from it. There is a much more severe disorder called premenstrual dysphoric disorder (PMDD), which is an extreme, chronic condition that can affect women of childbearing age. Lifestyle changes and, at times, medications can help manage symptoms.
The cause of PMDD is not known. It may include abnormal reactions to the normal hormonal changes that occur with a woman’s menstrual cycles. The hormone changes can cause a serotonin deficiency. Serotonin, found naturally in the brain and gastrointestinal tract, can affect mood and physical symptoms.
Any woman of childbearing age can develop PMDD, but some are at increased risk. These include women who have a family history of PMS or PMDD or a personal or family history of depression, postpartum depression, or other mood disorders. Additional risk factors include being less educated and smoking cigarettes.
Symptoms of PMDD start about a week before menstruation is expected and end within a few days of the start of a menstrual period. The symptoms are usually so severe that the individual has trouble functioning in various aspects of life – home, work, and relationships. Their behavior is markedly different from that of other times during the month.
The following are common symptoms of PMDD:
- Depressed mood with feelings of hopelessness or worthlessness
- Increased anxiety and tension
- Irritability, tearfulness, sensitivity to rejection
- Changes in appetite, especially binging or overeating
- Changes in sleep patterns – insomnia or oversleeping
- Feelings of being overwhelmed or out of control
- Physical symptoms: breast swelling or tenderness, headaches, joint or muscle aches, bloating, and weight gain
How do doctors diagnose PMDD?
Evaluation begins with a careful history and physical examination. Your primary healthcare provider may also suggest a mental health evaluation with a specialist in mental health. There are few diagnostic tests. It may be useful to keep a journal of your symptoms.
To make the diagnosis of PMDD, certain criteria must be met. You must have at least five symptoms during most menstrual cycles over a year. The symptoms must occur during the week before your period and must stop within the first few days of your period. There must be significant distress associated with disruption in functioning at work, in social settings, or in other situations. The symptoms must not be related to other health conditions.
Is PMDD treatable?
PMDD is a serious, debilitating, chronic condition. At times, medications may be used, but none are specific to PMDD.
- Dietary modifications, including increasing protein and carbohydrates and decreasing consumption of sugar, salt, alcohol, and caffeine
- Regular exercise throughout the month, not just when symptoms are present
- Vitamin supplements, including vitamin B-6, calcium, and magnesium
- Anti-inflammatory medications such as ibuprofen or Naprosyn
- Selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) or escitalopram (Lexapro)
- Birth control pills
If you are experiencing the symptoms of PMDD, make an appointment with your primary provider. Before your appointment, write down whatever questions you have. It can be helpful to take someone with you to your visit to help you remember what your provider tells you. Ask any questions you may have. During the visit, write down any new diagnosis, new medication(s), or other treatments, tests your provider may order, and new instructions.
PMDD symptoms tend to get more severe as a woman ages. Treatment is usually chronic until menopause. Medications and interventions may need adjustment as your body ages and responds differently to treatment. Be persistent – you are your own best advocate.
