During the reproductive years, many women, before they have their menstrual cycles, experience emotional changes and transient physical changes. About 75% women report that even with regular menstrual cycles, they experience unpleasant psychological and physical symptoms, before menstruation begins. These symptoms are, in most cases, mild to tolerable. However, in certain cases, these symptoms can be severely disabling that can disrupt their daily activities and lives. About 2 to 10% women experience this condition, known as Premenstrual Dysphoric Disorder.

Premenstrual Dysphoric Disorder

What is Premenstrual Dysphoric Disorder?

Premenstrual Dysphoric Disorder or PMDD is a diagnosis that indicates severe premenstrual distress that is associated with dysfunction or deterioration in daily activities and lives.

Premenstrual Dysphoric Disorder or PMDD is a wide range of emotional or physical conditions or symptoms that usually occurs 5 to 11 days prior to the start of a menstrual cycle. The symptoms decrease in intensity as the onset of the menstrual cycle comes closer and terminates a few days after it begins.

Signs and Symptoms of Premenstrual Syndrome

The signs and symptoms of this condition vary to a great extent from person to person and every woman seems to have slightly different symptoms. Many women often mistake the PMS or Premenstrual Syndrome, with the Premenstrual Dysphoric Disorder or PMDD. Whereas PMS occurs in about 30 to 80% women in the reproductive age, Premenstrual Dysphoric Disorder or PMDD symptoms are more severe in intensity and occur in only 2 to 10% women. The most common symptoms of Premenstrual Syndrome or PMS that can occur in any woman are –

Physical Symptoms Premenstrual Syndrome or PMS:

  • Headaches
  • Feeling bloated
  • Nausea
  • Fatigue or lethargy
  • Backache
  • Pain and discomfort in your abdomen (tummy)
  • Breast pain
  • Breast tenderness
  • Muscle and joint pain
  • Swelling of extremities
  • Insomnia or trouble sleeping
  • Hypersomnia or excessive sleepiness
  • Weight gain (up to 1kg)

If the patient suffers from any long-term or chronic illness, like migraines or asthma, it gets worse.

Psychological Symptoms:

  • Tiredness
  • Anger
  • Depression
  • Anxiety or restlessness
  • Mood swings
  • Feeling upset or emotional
  • Irritability
  • Sense of feeling overwhelmed
  • Tearfulness
  • Appetite changes or food cravings
  • Loss of libido or losing interest in sex

Behavioural Symptoms:

  • Confusion and forgetfulness
  • Social withdrawal
  • Decreased self-esteem
  • Sensitivity to rejection
  • Difficulty concentrating
  • Clumsiness

What are the Signs and Symptoms of Premenstrual Dysphoric Disorder or PMDD?

The signs and symptoms of Premenstrual Dysphoric Disorder or PMDD are often similar to the symptoms of PMS. However, the symptoms of premenstrual dysphoric disorder are often more severe in intensity. At times, they are so severe that it disrupts the daily activities and survival of many women. Along with the previously mentioned symptoms, the symptoms of Premenstrual Dysphoric Disorder or PMDD can include –

  • Feelings of absolute hopelessness
  • Persistent depression or sadness
  • Decreased interest in usual activities
  • Complete withdrawal and recluse from social gatherings
  • Very low self-esteem
  • Severe anxiety
  • Extreme tension and irritability
  • Extreme and sudden anger
  • Sleeping too less or much more than usual
  • Panic attacks
  • Feeling out of control

What is the Epidemiology of Premenstrual Dysphoric Disorder or PMDD?

In about 80% of all women alone in the United States of America, some or the other kind of symptoms, associated with PMS or Premenstrual Syndrome can be seen to occur. However, 3 to 8% women experience the diagnostic condition called Premenstrual Dysphoric Disorder or PMDD. In India, the occurrence is around 6% of women in the reproductive age group. In Switzerland, it occurs in only 3% women in the reproductive age. Studies have shown a very high occurrence in Nigerian women, where 36% women in the reproductive age group experience these Premenstrual Dysphoric Disorder or PMDD symptoms.

What are the Causes of Premenstrual Dysphoric Disorder or PMDD?

No consensus regarding the etiology or the causes of Premenstrual Dysphoric Disorder or PMDD has been found currently. However, it is considered that the hormonal changes in a woman that take place while she has her menstrual cycle, plays a major role in causing these symptoms. However, genetic problem is often considered to be a possible cause of Premenstrual Dysphoric Disorder or PMDD. About 70% of women, who have Premenstrual Dysphoric Disorder, are found that their mothers too have had this condition; whereas, only 37% of women have this condition, despite the fact that their mothers do not have Premenstrual Dysphoric Disorder or PMDD. Along with these biological and genetic causes, there are yet other possible causes for this condition to occur and they are environmental, psychological as well as social. These are –

  • Thyroid disorders
  • Alcohol or substance abuse
  • Having a mother with a history of the disorder
  • Being overweight
  • Lack of exercise

Change in the levels of certain chemicals in the brain is also a suggested cause of Premenstrual Dysphoric Disorder or PMDD. One such chemical is serotonin that works as a mood regulator. Since its levels drop to a great extent, the mood swings associated with PMDD is caused.

Diagnosis of Premenstrual Dysphoric Disorder or PMDD

No lab test or physical examination can diagnose Premenstrual Dysphoric Disorder or PMDD. In order to distinguish the symptoms of this condition from the other medical conditions that can lead to such symptoms, the doctor or medical care provider will ask the patient to keep a diary or calendar to note down the symptoms that occur and the time of their occurrence. For the confirmation of the clinical nature of these symptoms and to diagnose it as Premenstrual Dysphoric Disorder or PMDD, the doctor would ask to chart the symptoms prospectively for two consecutive ovulation cycles. If at least 5 of the symptoms that are associated with his condition match with the patient's condition, it is diagnosed as Premenstrual Dysphoric Disorder or PMDD.

During this diagnosis, the doctor ensures that all the underlying gynaecological and medical conditions as well as emotional problems such as fibroids, endometriosis, hormonal problems, menopause and panic disorder, depression etc. are ruled out.

What is the Treatment of Premenstrual Dysphoric Disorder or PMDD?

The most effective and widely used treatment methods associated with Premenstrual Dysphoric Disorder or PMDD are –

  • Medicine to Treat Premenstrual Dysphoric Disorder or PMDD:

Antidepressants such as Paxil CR, Sarafem and Zoloft are the most common medications that are prescribed by the doctor. Sometimes, some over-the-counter pain relievers, such as aspirin, ibuprofen and naproxen are also prescribed. The doctor may also recommend birth control pills or Zoladex, Danazol, Lupron and Synarel to stop ovulation.

  • Diet and Nutrition for Premenstrual Dysphoric Disorder or PMDD:

In order to reduce the feeling of bloating and to retain fluid in the body, smaller meals are recommended, along with limiting the consumption of salty foods. Calcium, vitamin E, vitamin B6, and magnesium supplements are also recommended.

  • Lifestyle changes for Premenstrual Dysphoric Disorder or PMDD:

Alcohol, caffeinated drinks etc. can significantly affect the mood swings. Hence, avoiding them, along with quitting smoking can help in retaining the energy levels.

  • Exercise for Premenstrual Dysphoric Disorder or PMDD:

Physical activities like walking, swimming, cycling etc. and moderate regular aerobic activities for about 2 hours, can effectively reduce tiredness, stress and depression and improve the overall health.

Alternative Treatments for Premenstrual Dysphoric Disorder or PMDD

  • Psychotherapy to Treat Premenstrual Dysphoric Disorder or PMDD:

Since lowered self-esteem, withdrawal from society, feeling of hopelessness and other negative psychological and psychosocial attitudes are often attributed to and associated with Premenstrual Dysphoric Disorder, cognitive-behavioural therapy can be of great help. It can significantly reduce the interpersonal conflicts through assertiveness training, stress reduction and management of anger.

  • Herbal Therapies to Treat Premenstrual Dysphoric Disorder or PMDD:

Prostaglandin – is an anti-inflammatory compound that can reduce prolactin levels. This reduces breast tenderness and engorgement. Recent studies have shown the safety and efficacy of chaste tree berry and evening primrose oil in the synthesis of prostaglandin. Irritability, headache, anger along with breast fullness are significantly reduced with these herbal therapies.

  • Hormonal Therapies to Treat Premenstrual Dysphoric Disorder or PMDD:

GnRH agonists, histrelin, leuprolide and goserelin can significantly reduce stress and depression levels, by inducing amenorrhea and anovulation. At times, Danazol (Danocrine), a weak androgen hormone is also prescribed by the doctors.

Coping with Premenstrual Dysphoric Disorder or PMDD

Coping with PMDD, once the diagnosis has been made, is an even more intense task. As the doctor recommends a treatment method, it needs to be made assured that the treatment method is properly working. It takes about three menstrual cycles to check the effectiveness of the treatment. Lifestyle changes are the best way to reduce some of the physical as well as psychological conditions.

As the ovulation process starts, it is indeed helpful to engage oneself in yoga and meditation as it helps in reducing the stress and tension. Participating in a gathering, interacting with friends and family and discussing with them about the way one feels, can help her overcome and combat with the stress and depression. In this condition, knowing that you are not the only one facing and suffering from this condition is of great support and relief to come out of this stress. Hence joining a support group led by a psychologist or counsellor can be of immense help. Trying online chat rooms, talk therapies as well as public support forums can be of additional help. The patient must understand that it is a condition that one has no control over. Hence, accommodating through the days and being supportive, when the symptoms occur, is of great help.

A stable treatment process is a must to ensure that the symptoms are gradually receding. It must be made assured that regular visit to the doctor and a mental health professional is being made, so that they can identify the progress level. The medicines that the doctor has prescribed, must be regularly taken, even if there is no symptoms felt anymore. The doctor will understand how long it needs to be taken. Continuing to interact in group sessions provides additional support and help get a relief for long term.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 5, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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