Premenstrual dysphoric disorder is an extreme form of premenstrual syndrome that affects girls. The PMDD can often be treated with medication and lifestyle changes.
Premenstrual syndrome (PMS) affects 20 to 40 percent of women. Approximately 3 percent to 8% of them suffer from symptoms that make it difficult to carry out everyday activities. The condition is called premenstrual dysphoric disorder (PMDD).
It is important to note that premenstrual dysphoric disorder PMDD is much more severe and debilitating than premenstrual syndrome (PMS). In PMDD, an individual experiences a number of physical and psychological symptoms which negatively impact their daily lives.
PMDD needs to be treated when it occurs because it is a chronic condition. You can treat PMDD with medication and lifestyle modifications.
In this blog, we examine the causes, symptoms, diagnoses, and treatments of this debilitating condition.
Here are some PMDD facts:
- PMDD disrupts daily functioning and requires medical treatment.
- Symptoms of PMDD are worse and less common than PMS.
- Most women experience symptoms during the second half of their menstrual cycle.
- PMDD can cause severe symptoms up until menopause.
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PMDD symptoms are similar to PMS symptoms but are more severe. In most cases, symptoms of PMDD arise during the week before menstruation and clear in the days following the onset of menstruation.
A person suffering from PMDD usually finds it difficult to function normally at the time of the onset of symptoms. A person with this condition may experience relationship problems and disruptions at work and at home.
The most common symptoms of PMDD are:
- Severe fatigue
- Mood changes, including nervousness, irritability, anxiety and depression
- Crying and emotional sensitivity
- Difficulty concentrating
- Heart palpitations
- Self-consciousness and paranoia
- Coordination difficulties
- Trouble remembering
- Bloating, nausea and vomiting
- Numbness and tingling
- Hot flashes
- Changes in vision and eye complaints
- Allergies and infections of the respiratory system
- Painful menses
- Decreased libido
- Easy bruising
- Heightened sensitivity
The problem of fluid retention may cause decreased urine production, breast tenderness, swelling of the fingers, toes, and ankles, as well as temporary weight gain.
Other symptoms may include itching, acne, and a worsening of cold sores. These symptoms are primarily affective or relate to anxiety.
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In PMDD and PMS, the exact cause is unknown.
A study suggests that PMDD arises in women when their brains respond abnormally to normal fluctuations of hormones during menstrual cycles. As a result, serotonin, a neurotransmitter, could be deficient.
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PMDD symptoms can be similar to other mental disorders, and therefore health care providers will probably perform a physical examination, gather medical history, and order tests to rule out other conditions.
A symptom chart may also be used to assist in the diagnostic process to determine whether symptoms are related to the menstrual cycle.
A diagnosis of PMDD must be made based on the symptoms of PMDD occurring for two consecutive menstrual cycles as per the guidelines in the Diagnostic and Statistical Manual (5th Edition) of the American Psychiatric Association (APA).
The guidelines state that symptoms must:
- Begin one week before menstruation
- Resolve within a few days after the first period
- Disrupt daily living
There must be at least five symptoms for PMDD to be diagnosed:
- Depressed or hopelessness feelings
- Anxiety or tension
- Mood Swings or increased sensitivity
- Angry or irritation
PMDD symptoms can include the following:
- Lack of interest and motivation for common activities, which may be accompanied by social withdrawal
- Difficulty concentrating
- Changes in appetite
- Sleeping problems including excessive sleep (hypersomnia) or insomnia
- An overwhelming sense of helplessness or a sense of being out of control
Aside from breast tenderness and swelling, PMDD can also cause headaches, joint pain, weight gain and bloating.
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Premenstrual dysphoric disorder treatment
Medication that affects ovulation and medication which affects the central nervous system (CNS) may help with PMDD.
The following antidepressants can be used for PMDD treatment:
- SSRI antidepressants such as sertraline (Zoloft), fluoxetine (Prozac, Sarafem), citalopram (Celexa) and paroxetine (Paxil).
- Oral contraceptives that contain ethinyl estradiol and drospirenone.
- Gonadotropin-releasing hormone analogs such as leuprolide (Lupron), goserelin (Zoladex) and nafarelin (Synarel)
- Danazol (Danocrine)
Premenstrual symptoms have been treated with supplements, but studies demonstrating their long-term safety and efficacy are lacking.
The following are examples:
- Use of chasteberry extract to relieve pain
- Evening primrose oil
- Magnesium oxide.
- Dietary supplementation with vitamin B6, magnesium, calcium and vitamin E
The Journal of Chemical and Pharmaceutical Science (JCPS) published a meta-analysis in 2016 suggesting that vitamin B6 may be able to alleviate PMS symptoms in a safe and inexpensive manner.
Several systematic reviews, published between 2009 and 2011, found that evening primrose oil is not effective.
St. John’s wort was found to be ineffective in both the 2009 and 2011 studies.
Additionally, scientists have concluded that calcium and vitamin D supplements can play a role in reducing PMS symptoms and protecting against osteoporosis. So, PMDD may be helped by this as well.
You can buy chasteberry supplements online, but before taking supplements, you should consult a health professional.
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PMDD can be treated successfully with alternative approaches like:
- Qi therapy
- Saffron therapy
- Guided imagery
- Photic stimulation
Further studies are needed to prove that these treatments work.
Diet and exercise
You should change your diet by
- Decreasing intake of alcohol, sugar, salt and caffeine
- Increasing protein and fiber intake
Exercise, strategies for reducing stress, and perspectives that view menstruation positively may help.
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You might find it helpful to:
- Relax the day before your period starts
- Discussing the situation with a partner or friend
- Find activities that relax you, such as reading a book, watching a movie, taking a walk or taking a bath
Consult your doctor right away if you believe you might be suffering from PMDD. In order to avoid the long-term effects of PMDD, it is advised to seek treatment right away.
What are the complications of PMDD?
It is possible for PMDD to lead to depression and, in severe cases, suicide if it isn’t treated. It can negatively impact relationships and careers as well as cause severe emotional distress.
You can reach the National Suicide Prevention Lifeline at 1.800.273.8255 if you are experiencing suicidal thoughts. Crisis centers across the country provide 24-hour free and confidential psychological support to people experiencing suicidal crisis or emotional distress.
What can I do to prevent PMDD?
It is possible to prevent PMDD from developing by treating existing depression or anxiety. It may not be possible to prevent PMDD because it is related to hormones. There are cases in which treatment can relieve the symptoms.