• Uniquely Female

What's Worse Than PMS? PMDD

If premenstrual symptoms are so severe in the days before your period that they interrupt your life, you might have a more debilitating form of PMS called PMDD (premenstrual dysphoric disorder.)

Women with PMDD experience serious and chronic physical and emotional symptoms, including feelings of being overwhelmed, anxious and depressed.

“PMDD is tied to your menstrual cycle,” explains Augustina Addison, MD. “One to two weeks before your period begins, you develop symptoms of PMDD. Most of them go away a few days after your period begins.”

While the exact cause of PMDD is not known, doctors believe it is related to changes in the brain chemical serotonin and hormone levels throughout the menstrual cycle.

Symptoms Can Be Severe

The symptoms of PMDD are much more severe than PMS, says Dr. Addison. “It can affect your relationships, work, and school. Your doctor may diagnose you with PMDD if you have at least five of the possible symptoms for the majority of your menstrual cycles for a year.” Possible symptoms include:

• Irritability or anger 
• Depressed mood
• Feelings of tension or anxiety 
• Panic attacks
• Mood swings or crying often
• Lack of interest in activities you enjoy
• Trouble concentrating
• Fatigue
• Increased appetite
• Trouble sleeping
• Feeling out of control
• Physical symptoms, such as:
  • Cramps
  • Bloating
  • Breast tenderness
  • Headaches
  • Joint or muscle pain

Depression and anxiety are the most common symptoms, yet the severity varies in each woman. “Some women are unable to get out of bed, or their anxiety is so severe, they’re unable to function at work or school,” says Dr. Addison. “It’s not as simple as ‘Oh, I’m anxious because I have to take an exam.’ This is more like ‘I can’t function, can’t get out of bed.’ That’s why it’s so important to seek treatment.”

PMDD’s Cause Based In Biology

While the exact cause of PMDD is not known, doctors believe it is related to changes in the brain chemical serotonin and hormone levels throughout the menstrual cycle.

Serotonin affects your mood. The hormone changes that come with the menstrual cycle can cause a drop in serotonin, affecting how you feel physically and emotionally. Some women may be more sensitive to the rise and fall of serotonin and hormone levels.

“We normally see PMDD in women who have other conditions, like a history of depression or anxiety or another mental disorder,” explains Dr. Addison. “Although we also have seen it in teenagers who have not been diagnosed with depression or anxiety.”

About 5 percent of women of childbearing age are diagnosed with PMDD. Your doctor will make a diagnosis by talking to you about your symptoms and by doing a physical exam. If mental health symptoms are a big concern, you may also see a psychologist or psychiatrist. 

Your doctor may ask you to keep a calendar or diary of your symptoms. Most women with PMDD have five or more symptoms with every menstrual cycle for at least a year. For some women, symptoms increase and get worse over time, lasting until menopause.

Treatment Can Make a Difference

If you think you suffer from PMDD, you should contact your doctor, Dr. Addison advises. “You’re not just being moody or unreasonable. Your partner should encourage you to seek treatment; it’s a mental disorder.”

How you manage PMDD depends on your specific symptoms. Your doctor will recommend the best treatments for you. Common treatments include lifestyle changes, medicines and counseling.

Treatments for PMDD may include:

• Regular exercise
• Healthy diet rich in protein 
• Avoiding sugar, salt, caffeine, and alcohol
• Stress management
• Antidepressants to regulate serotonin levels 
• Birth control pills to regulate menstrual hormones
• Over-the-counter pain relievers and anti-inflammatory medicines

Be sure to talk with your doctor if you feel worse or if you have thoughts of hurting yourself or others. 

PMDD Still Not Fully Understood

PMDD is designated as a disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), used by doctors to make a mental health diagnosis. “Like most disorders, PMDD can run in families,” says Dr. Addison. “If your mom or sister or aunt had severe symptoms around their periods, you might, too.”

There is debate over whether this accurately portrays the condition, says the American Psychological Association. Some do not believe PMDD is a real disorder. Others wonder why women must be diagnosed with a mental health condition for their symptoms to be believed.

Whatever the case may be, the symptoms of PMDD are very similar to major depressive disorders  – and medicines do help women who use them for treatment, says the American Psychological Association. The main difference is that PMDD is cyclical and related to menstrual hormone changes.

To learn more about PMDD, talk to your doctor or health care provider or search for a provider.

Source: Augustina Addison, MD; Women’s Health.gov; American Psychological Association; PubMed Health