What is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual dysphoric disorder, or PMDD, is a cyclic, hormone-based mood disorder, commonly considered a severe and disabling form of premenstrual syndrome (PMS). While up to 85% of women experience PMS1, only around 5% of women are diagnosed with PMDD, according to a study in the American Journal of Psychiatry.2 PMDD can arise at any time during a woman’s reproductive years although the average age of onset is 26 years.

Like PMS, the symptoms of PMDD begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins.3 While most women have PMS from time to time in the days leading up to their period, the symptoms do not cause any clinically significant distress or impact their ability to continue with their daily activities. However, for women with PMDD, the more severe PMS-related problems—particularly those that are psychological—prevent them from going about their everyday lives. Such psychological symptoms include depression and suicidal thoughts, anxiety, irritability and tension. These symptoms do not necessarily occur every cycle, but they are present in the majority of the cycles. Some months may be worse than others.

The onset of PMDD may begin at any time after a woman’s first period, although many individuals report a worsening of symptoms as they approach menopause.4 After menopause and during pregnancy, symptoms do not occur, though it is important to note that women with PMDD have a high risk of experiencing postpartum depression following the birth of a child.5

Causes of PMDD

Researchers are still working to determine the exact cause of PMDD, though it has been suggested that women with the disorder are more sensitive to normal levels of estrogen and progesterone fluctuation that cause premenstrual symptoms.6

Risk Factors

• Environmental: Stress, history of interpersonal trauma, and seasonal changes are all environmental factors associated with the presence of premenstrual dysphoric disorder.
• Genetic: While the heritability of premenstrual dysphoric disorder is unknown, it is estimated that premenstrual symptoms generally are 50% heritable.
• Menstrual Cycle Modifiers: According to the DSM-5, women who use oral contraceptives may have fewer premenstrual complaints than do women who do not use oral contraceptives.

PMDD Symptoms

To receive a diagnosis of PMDD, a woman must have experienced symptoms during most of the menstrual cycles of the past year and these symptoms must have had an adverse effect on work or social functioning.

While the core symptoms relate to mood and anxiety, behavioral and physical symptoms commonly occur also. It is crucial to note that the presence of behavioral or physical symptoms in the absence of mood and/or anxious symptoms is not sufficient for a diagnosis.

In the majority of cases, at least five of the following symptoms must be present in the week before the period, start to improve within a few days after the onset, and become minimal in the week following:7

• Mood swings
• Irritability or anger or increased interpersonal conflicts
• Depressed mood, feelings of hopelessness, or self-deprecating thoughts
• Anxiety, tension, and/or feelings of being on edge
• Decreased interest in usual activities
• Difficulty concentrating
• Marked lack of energy
• Changes in appetite
• Hypersomnia or insomnia
• A sense of being overwhelmed or out of control
• Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of bloating, or weight gain

Diagnosis

A clinician must determine that the patient’s symptoms are not merely an exacerbation of another disorder, such as depression or panic disorder, and cannot be attributed to the effects of substance abuse.

The symptoms should also be confirmed by prospective daily ratings of at least two symptomatic cycles.

What is The Difference Between PMS and PMDD?

PMS is a less serious condition than PPMD as it does not generally interfere with daily functioning and the symptoms exhibited are less severe in their intensity. s. For a diagnosis of PMDD to be made, a minimum of five symptoms are required to be present.

What’s more, although women may experience some fluctuation in mood in the days before their period, the psychological symptoms of PMDD such as severe depression, anxiety, and suicidal thoughts are not associated with PMS.

Comorbidity

Although a woman would not receive a diagnosis of PMDD if she only experiences a worsening in symptoms of another mental disorder around the time of menses, PMDD can be considered in addition to the diagnosis of another mental disorder if the individual experiences PMDD symptoms that are markedly different to those experienced as part of the ongoing disorder.

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PMDD Treatment

Medication
A group of antidepressants named selective serotonin reuptake inhibitors (SSRIs) can be prescribed to women suffering from PMDD. The FDA approved sertraline, fluoxetine, or paroxetine hydrochloride may be prescribed to help alleviate symptoms.

Moreover, over-the-counter pain relievers may help with breast tenderness, muscle aches and pains, cramps, and headaches. Your doctor may suggest you try ibuprofen, naproxen, or aspirin to help relieve these physical symptoms.

Birth Control
In 2010, the FDA approved the birth control pill containing drospirenone and ethinyl estradiol to treat PMDD.8 It may be worth talking to your doctor or gynecologist to determine whether or not this birth control pill (brand name Beyaz) is right for your body and could help with your PMDD symptoms.

Psychotherapy
Living with severe depression and anxiety shouldn’t be something you have to face alone. Cognitive behavioral therapy (CBT) is a structured, action-oriented type of psychological treatment that focuses on the interaction between thoughts, feelings, and behaviors. CBT has been shown to be an effective treatment for mood and anxiety disorders and has also been shown to help people cope better with physical symptoms, such as pain.

Surgery
When drug-based treatments are ineffective, surgical removal of the ovaries, known as an oophorectomy, may be considered. While ovary removal has been shown to relieve the symptoms of PMDD, it also causes women to stop ovulating and become menopausal, which also comes with a variety of symptoms. Opting for surgery in the form of ovary removal is a complex and serious decision that would likely be the last resort for PMDD treatment.

Alternative Treatments
If medication or surgery isn’t a viable treatment path, you may want to try natural remedies for PMDD symptoms. Research shows that mindfulness meditation can reduce anxiety, depression, and pain–all common symptoms of PMDD. To relieve menstrual cramps, take a warm bath and try different menstrual products during menstruation–for some women, tampons can increase cramping, so pads may be a better option.

Support and Resources

If you think you may be suffering from PMDD, we encourage you to seek diagnosis and treatment from your doctor and a mental health professional. Although PMDD can feel like a debilitating and lonely condition, it is important to remember that you aren’t alone. There are a variety of resources available to you for advice and support, both online and in the form of support groups. For more information, ask your healthcare provider about what is available in your area and check out the links below:

Peer Support with The Gia Allemand Foundation

PMDD Moms

PMDD, Hysterectomy and Life After

Last Updated: Aug 10, 2018