An Overview of Premenstrual Dysphoric Disorder (PMDD)

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Premenstrual dysphoric disorder (PMDD) is a mood disorder that affects 3% to 8% of women in the week to two weeks before their period. More severe than premenstrual syndrome (PMS), symptoms include mood swings, anxiety, depression, and fatigue that impact daily living. The exact cause of PMDD is unclear. However, it is believed to be due to an interaction between hormone fluctuations and neurotransmitters that regulate mood.

While PMDD symptoms can be debilitating, medications including hormonal birth control and antidepressants, along with therapy and lifestyle changes, can help to reduce their severity and help you have better days throughout the month.

Symptoms

Women with PMDD experience both physical and emotional symptoms that are more extreme than PMS and occur one to two weeks before starting menstruation and resolve two to three days after a period begins.

While there are specific diagnostic criteria that doctors use to diagnose PMDD, women may experience a wide range of symptoms as a result of the condition, including:

  • Feeling sad, hopeless, or suicidal
  • Severe feelings of stress, tension, or anxiety
  • Panic attacks
  • Mood swings that include bouts of crying
  • Constant irritability or anger that affects other people
  • Loss of interest in usual daily activities and relationships
  • Inability to concentrate or focus
  • Fatigue or loss of normal energy
  • Food cravings or binging
  • Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain

Causes

The cause of PMDD is not fully understood. It is believed to be an abnormal reaction to hormonal fluctuations throughout the menstrual cycle. Research suggests a correlation between PMDD and low levels of serotonin, and it is suspected that changes in estrogen and progesterone levels in the two weeks prior to menstruation may alter serotonin levels.

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.

Diagnosis

There are no blood or imaging tests that can help to determine PMDD. The diagnosis is based on your medical history and how your self-reported symptoms align with specific diagnostic criteria.

The timing and severity of symptoms differentiate PMDD from other conditions. Keeping track of your symptoms for at least two full months before your appointment can help your doctor provide an accurate diagnosis. You can use a notebook, calendar, or period tracker app such as Clue or Glow.

Symptoms must be present seven to 14 days before the start of menstruation and resolve shortly after one's period arrives for a diagnosis of PMDD to be considered.

Your doctor will also need to rule out other mood disorders, such as bipolar disorder, depression, or generalized anxiety disorder. In addition, underlying medical and gynecological conditions such as thyroid problems, endometriosis, fibroids, menopause, and hormonal imbalances also must be ruled out.

Treatment

Your doctor will decide on the right course of treatment for your PMDD symptoms. Many women with PMDD take a steady dose of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) throughout the month or an increased dose for two weeks before their periods.

Hormones are also used to treat PMDD. Many women find taking medication to stop ovulation can eliminate the hormone fluctuations that lead to symptoms. Your doctor may also recommend medications or creams containing progesterone or estrogen.

Coping

Living with PMDD can be challenging. In addition to medication, women with PMDD may find some relief using holistic techniques, relaxation exercises, stress relief practices, and other strategies in the week before their period. Here are some methods that are suggested for easing PMS symptoms:

  • Eat right: Follow the rules of good nutrition. Health experts recommend that women with PMDD limit their intake of salt, caffeine, refined sugar, and alcohol.
  • Take supplements: Calcium, vitamin B6, vitamin E, and magnesium are recommended for easing PMS and PMDD symptoms. 
  • Reduce stress: PMDD is cyclical, so you have a good idea of when it will resurface. When possible, lower your expectations for productivity and cut back on social commitments in the week before your period, and try to incorporate stress-relieving techniques, such as deep breathing or meditation. Book yourself a massage, pedicure, reflexology, or other types of pampering sessions during this time.
  • Get exercise: Even light exercises, like walking, yoga, or tai chi, can help to relieve symptoms.
  • Try OTC meds: Over-the-counter (OTC) pain relievers may help with some symptoms, such as headaches, breast tenderness, backaches, and cramping. Diuretics can help with fluid retention and bloating.
  • Seek professional mental health care: Some women suffering from the symptoms of PMDD also seek out counseling for help developing coping strategies that work best for them.
  • Find peer support: Talking with other women who understand PMDD can help. The International Association for Premenstrual Disorders offers online support groups you can consider.

Women with PMDD may be more likely to have suicidal thoughts. If you feel you are in danger of hurting yourself, call the Suicide Prevention Hotline at 1-800-273-8255 or instant message with Lifeline Chat.

A Word From Verywell

PMDD can cause emotional, physical, and professional difficulties for many women. If you think you are affected by PMDD, make an appointment to speak with your doctor to get proper treatment and support. They can help you to find the right medication and treatment plan for you.

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