What is a Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a serious form of premenstrual syndrome (PMS) marked by significant emotional and physical symptoms that arise a week or two before the onset of menstruation. These symptoms can be so severe that they hinder a woman’s daily routines and relationships.

The symptoms of PMDD include:

Emotional symptoms:

• • • Feelings of sadness, hopelessness, and helplessness
    • Anxiety, tension, and irritability
    • Mood swings
    • Anger and increased conflicts with others
    • Difficulty concentrating
    • Lack of interest in daily activities

Physical symptoms:

• • • Fatigue and lack of energy
    • Changes in appetite and food cravings
    • Bloating, breast tenderness, and headaches
    • Sleeping problems
    • Joint or muscle pain

It’s worth noting that these symptoms are similar to those of premenstrual syndrome (PMS), however, PMDD symptoms are much more severe and disrupt daily life. The symptoms of PMDD should be evaluated by a professional healthcare provider to confirm the diagnosis and rule out other underlying conditions.

PMDD may develop due to a combination of factors that interact with one another. Hormonal changes play a significant role, as PMDD is related to the menstrual cycle and the fluctuation of hormones such as estrogen and progesterone, which can influence brain chemicals like serotonin and affect mood and emotional well-being. Genetics also contributes, with studies showing that some women may have a genetic predisposition to PMDD. In addition, some studies suggest an association between PMDD and chronic inflammation, a state of immune system activation that can be triggered by stress, infection, or other factors. Environmental factors, including exposure to particular toxins or pollutants, may also play a part. Psychological influences are relevant as well, as research suggests that women with PMDD may have a higher tendency to experience negative emotions such as anxiety or depression. PMDD can also occur along with other mental health disorders, for instance, depression or anxiety, which may contribute to its development. Although many things may influence PMDD, it’s important to remember that the exact reason is still not entirely known.

• • • Keep a symptom diary and track your symptoms, including the timing and severity of each one, to help you and your healthcare provider identify patterns of your PMDD.
    • Regular exercise can help reduce stress levels, improve mood, and relieve physical symptoms such as bloating and breast tenderness.
    • Eating a healthy diet, for instance, fruits, vegetables, and whole grains, can help to reduce symptoms of PMDD. Avoiding processed foods, caffeine, and alcohol can also be beneficial.
    • Get enough sleep. Aim for 7-9 hours of sleep each night and maintain a regular sleep schedule.
    • Practice stress-management techniques such as yoga, meditation, or deep breathing to improve mood.
    • Talk to your healthcare provider to determine the best course of treatment for you, which may include medication, therapy, or other interventions.

Diagnosing Premenstrual Dysphoric Disorder (PMDD) involves a careful evaluation by a healthcare provider. The process typically begins with a thorough medical history, during which your provider asks about your menstrual cycle, symptoms, and any other relevant medical information. A physical examination is then performed to eliminate other possible causes of your symptoms. You may also be asked to keep a detailed symptom diary for at least two menstrual cycles, tracking the timing and severity of each symptom. This helps confirm that symptoms consistently appear in the week or two before your period and improve shortly after it starts. Finally, your healthcare provider will rule out other conditions that may cause similar symptoms, such as depression or anxiety, before making a diagnosis.

Treatment for PMDD usually involves a combination of lifestyle changes, therapy, and medication, depending on the severity of symptoms and any underlying medical conditions. Several medications are commonly used, including selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft), which are effective in reducing PMDD symptoms. Hormonal birth control pills containing drospirenone and ethinyl estradiol can help regulate hormones and lessen symptoms, while GnRH agonists such as leuprolide (Lupron) may be prescribed to suppress ovulation in more severe cases. Therapy can also be beneficial, counseling provides a space to better understand and cope with symptoms, and support groups can offer a sense of belonging and shared understanding.