Premenstrual dysphoric disorder
Premenstrual dysphoric disorder, or PMDD, is a relatively rare but severe form of premenstrual syndrome (PMS).
The symptoms of PMDD are more severe than with PMS.
Depression and suicidal thoughts are also a risk with PMDD.
How common is PMDD?
PMDD occurs in between 2% and 10% of menstruating women. Women with a personal or family history of depression or postnatal depression are at greater risk of developing PMDD.
What causes PMDD?
As with PMS, the exact cause of PMDD is not known. However most researchers believe PMDD is brought about by the hormonal changes related to the menstrual cycle. Studies have shown a connection between PMDD and low levels of serotonin, a chemical in the brain that helps transmit nerve signals. Certain brain cells that use serotonin as a messenger are involved in controlling mood, attention, sleep and pain. Chronic changes in serotonin levels can lead to PMDD symptoms.
What are the symptoms of PMDD?
The symptoms of PMDD can include any of the following:
- Mood swings
- Depressed mood or feelings of hopelessness
- Marked anger, increased interpersonal conflicts
- Tension and anxiety
- Decreased interest in usual activities
- Difficulty concentrating
- Change in appetite
- Feeling out of control or overwhelmed
- Sleep problems
- Physical problems such as bloating
How is PMDD diagnosed?
If you have any of the above listed symptoms, you should seek medical advice. Your doctor will review your symptoms and medical history and give you a thorough medical examination. Psychiatric evaluation may also be included.
Before a doctor makes a diagnosis of PMDD, he or she will rule out other emotional problems such as depression or panic disorder as the cause of the symptoms. Underlying medical or gynaecological conditions such as endometriosis, fibroids, menopause and hormonal problems that can account for symptoms must also be ruled out.
PMDD is diagnosed when at least five of the symptoms above, including at least one of the first four, occur for most of the time during the seven days before menstruation and go away within a few days of the start of the menstrual period. The symptoms must seriously affect a woman’s relationships and prevent her from functioning normally in daily life for a diagnosis of PMDD to be made. If the symptoms are present every day and do not improve with menstruation, they are unlikely to be due to PMDD.
How is PMDD treated?
Many of the same strategies used to treat PMS may also be helpful in relieving symptoms of PMDD. The four main forms of treatment are:
- Good nutrition. Many health experts recommend that women with PMDD should limit their intake of salt, caffeine, refined sugar and alcohol. Supplements such as calcium, vitamin B6, vitamin E and magnesium may be recommended. The effectiveness of any of these approaches has not been well-established.
- Exercise. Regular aerobic exercise such as walking or swimming appears to improve premenstrual symptoms. It's unclear whether it can treat PMDD.
- Medication. Selective serotonin reuptake inhibitor (SSRIs) antidepressants may be the most effective treatment for PMDD.
- Some over-the-counter painkillers such as aspirin or ibuprofen may help some symptoms such as headache, breast tenderness, backache and cramping. Diuretics, or water pills, can help with fluid retention and bloating.
- If anxiety is a component of the symptoms, an anti-anxiety medication may be recommended. Currently none are approved to treat PMDD.
- Hormones can be used to treat PMDD. Ovulation can be stopped either using medication or surgically (as a last resort). Medicines used to stop ovulation include oral contraceptives. The second hormonal approach to treat PMDD is the use of progesterone or oestrogen to relieve symptoms. It's unclear whether this approach is effective.
- Counselling. Therapy to help women with PMDD develop effective coping strategies may help some with PMDD. Relaxation therapy, meditation, reflexology and yoga may also help, but these approaches have not been widely studied.