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Pre-Menstrual Dysphoric Disorder

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  3. Pre-Menstrual Dysphoric Disorder

Overview of Pre-Menstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome (PMS). It is a condition in which women experience significant mood changes and other symptoms during the luteal phase of the menstrual cycle, typically in the week or two before menstruation.

Prevalence of Pre-Menstrual Dysphoric Disorder

Globally, PMDD affects almost 2% of women. 

Signs and Symptoms of Pre-Menstrual Dysphoric Disorder

Pre-menstrual dysphoric disorder symptoms can vary from woman to woman but typically include severe emotional and physical symptoms occurring during the luteal phase of the menstrual cycle, the week or two before menstruation. The symptoms of PMDD can include:

  • Mood swings, including feelings of sadness, anxiety, irritability, and anger
  • Decreased interest in usual activities
  • Fatigue or low energy
  • Changes in appetite or food cravings
  • Insomnia or sleep disturbances
  • Feeling overwhelmed or out of control
  • Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
  • Difficulty concentrating or focusing
  • Decreased sex drive
  • Suicidal thoughts or behaviors (rare)

The symptoms of PMDD are usually severe enough to interfere with a woman's daily life, relationships, and work.

Types of Pre-Menstrual Dysphoric Disorder

Causes of Pre-Menstrual Dysphoric Disorder

The exact causes of premenstrual dysphoric disorder (PMDD) are related to hormonal changes occurring during the menstrual cycle. PMDD may be caused by hormonal interactions, such as estrogen and progesterone, and neurotransmitters in the brain, such as serotonin.

During the luteal phase of the menstrual cycle, estrogen and progesterone levels in the body increase and then decrease rapidly. This fluctuation in hormone levels can affect the balance of neurotransmitters in the brain, leading to the emotional and physical symptoms associated with PMDD.

Other factors that may contribute to PMDD include:

  • Genetics: PMDD appears to run in families, suggesting that there may be a genetic component to the disorder.
  • Environmental factors: Stress, lack of sleep, and poor nutrition can exacerbate PMDD symptoms.
  • Mental health history: Women with a history of depression, anxiety, or other mood disorders may be more likely to develop PMDD.
  • Other medical conditions: Women with certain medical conditions, such as thyroid disorders, may be at increased risk for PMDD.

It's important to note that while hormonal changes are a significant factor in PMDD, not all women with hormonal fluctuations experience PMDD.

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Risk Factors of Pre-Menstrual Dysphoric Disorder

While the exact cause of the pre-menstrual dysphoric disorder (PMDD) is not fully understood, certain factors may increase a woman's risk of developing the disorder. These risk factors include:

  • Age: PMDD typically occurs in women of reproductive age, with symptoms usually starting in the late 20s or early 30s.
  • Family history: Women with a family history of PMDD or mood disorders may be at increased risk for developing the disorder.
  • Hormonal imbalances: Fluctuations in estrogen and progesterone levels during the menstrual cycle can affect neurotransmitters in the brain and contribute to PMDD.
  • Mental health history: Women with a history of depression, anxiety, or other mood disorders may be more likely to develop PMDD.
  • Lifestyle factors: Stress, lack of sleep, and poor nutrition can exacerbate PMDD symptoms.
  • Other medical conditions: Women with certain medical conditions, such as thyroid disorders or endometriosis, may be at increased risk for PMDD.

Complications

The symptoms of pre-menstrual dysphoric disorder (PMDD) can be severe and impact a woman's daily life, including her relationships, work, and overall quality of life. In addition, PMDD can lead to several complications, including:

  • Depression: Women with PMDD may be at increased risk for developing depression, particularly if the disorder is left untreated.
  • Anxiety: PMDD can cause intense feelings of anxiety, which can be debilitating for some women.
  • Suicidal thoughts or behaviors: While rare, some women with PMDD may experience suicidal thoughts or behaviors, particularly during the most severe days of their cycle.
  • Impaired functioning: The symptoms of PMDD can make it difficult for women to perform daily tasks, including work or school responsibilities.
  • Relationship problems: The mood swings and irritability associated with PMDD can cause tension in personal relationships.
  • Substance abuse: Women with PMDD may be more likely to engage in substance abuse as a way to cope with the disorder.

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Prevention

Some lifestyle changes and self-care strategies may help reduce the severity of symptoms and improve the overall quality of life. These include:

  • Regular exercise: Regular physical activity can help to reduce stress and improve mood, which may help to reduce the severity of PMDD symptoms.
  • Healthy diet: Eating a healthy, balanced diet that is rich in fruits, vegetables, whole grains, and lean protein sources can help to improve overall health and may reduce the severity of PMDD symptoms.
  • Adequate sleep: Getting enough sleep is important for overall health and well-being and may help to reduce the severity of PMDD symptoms.
  • Stress reduction techniques: Practicing relaxation techniques, such as yoga, meditation, or deep breathing, can help to reduce stress and improve overall mood.
  • Supplements and alternative therapies: Some women may find relief from PMDD symptoms by taking certain supplements, such as calcium, magnesium, or vitamin B6. Additionally, some alternative therapies, such as acupuncture or massage therapy, may help to reduce stress and improve mood.

It's important to note that while these strategies may help to reduce the severity of PMDD symptoms, they are not a substitute for medical treatment. If you are experiencing severe premenstrual symptoms, it's important to speak with your healthcare provider for an evaluation and appropriate treatment options.

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Diagnosis

Here are some steps to diagnose PMDD:

  • Keep a menstrual diary: A menstrual diary can help track the symptoms that occur during each menstrual cycle. It can help identify if the symptoms are consistent with PMDD.
  • Rule out other conditions: PMDD symptoms can be similar to other conditions such as depression, anxiety, and thyroid disorders. A medical professional will evaluate for other medical and psychological conditions contributing to the symptoms.
  • Meet with a medical professional: If you suspect you have PMDD, it is essential to seek medical advice from gynecologists and psychologists. They will take a detailed medical history, including menstrual history, and perform a physical examination to rule out any underlying medical conditions.
  • Complete a symptom questionnaire: Your healthcare provider may ask you to complete a symptom questionnaire, which can help assess the severity of your symptoms.
  • Evaluate the timing of symptoms: PMDD symptoms usually occur during the week before menstruation and disappear within a few days after the start of the menstrual flow. Symptoms will be absent during the rest of the menstrual cycle.
  • Assess symptom severity: To diagnose PMDD, the severity of symptoms must be significant enough to impact daily life activities.
  • Rule out medication effects: Some medications can cause premenstrual-like symptoms. It is important to discuss with your healthcare provider any medications you are taking to rule out medication-induced symptoms.

Treatment of Pre-Menstrual Dysphoric Disorder | When to Consult a Doctor

Fortunately, there are several treatments available to alleviate the symptoms of PMDD. Here are some treatment options:

  • Lifestyle changes: Lifestyle modifications can help reduce the symptoms of PMDD. Exercise, a healthy diet, and stress management techniques such as yoga, meditation, or deep breathing exercises can be helpful.
  • Medications: Several medications can be used to treat PMDD symptoms. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can be effective in reducing mood symptoms, irritability, and anxiety. Birth control pills, hormone replacement therapy, and diuretics can also be used.
  • Supplements: Nutritional supplements such as calcium, magnesium, vitamin B6, and omega-3 fatty acids are beneficial in reducing the symptoms of PMDD.
  • Cognitive-behavioral therapy (CBT): CBT is a form of talk therapy that focuses on changing negative thoughts and behaviors. CBT can help manage the psychological symptoms of PMDD.
  • Alternative therapies: Acupuncture and massage therapy have been shown to reduce the severity of PMDD symptoms in some women.

The treatment of PMDD is tailored to each individual's symptoms and severity. You can book an appointment with a gynecologist via Healthwire to get a treatment plan for you. 

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