Could You Be Suffering from PMDD? Understanding the Severe Form of PMS

Have you ever heard of PMDD? If not, you’re not alone. Premenstrual Dysphoric Disorder, or PMDD, is a severe form of PMS that affects up to 10% of women of reproductive age.¹ 

It’s a debilitating condition that can wreak havoc on mental health, relationships, and daily life. However, despite its prevalence, PMDD remains largely misunderstood and underdiagnosed.

Here’s what you should know.

What is PMDD?

PMDD is a severe form of premenstrual syndrome (PMS) that causes significant mood disturbances and physical symptoms in the week or two before menstruation. While PMS is common, affecting up to 75% of menstruating women, PMDD is much more severe and can be debilitating.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), PMDD is characterized by the presence of at least five symptoms, including one mood-related symptom, that significantly interfere with daily functioning. These symptoms must occur during the luteal phase of the menstrual cycle (after ovulation and before menstruation) and improve within a few days of the onset of menstruation.

Symptoms of PMDD include:

• Depressed mood, sadness, hopelessness, or feelings of worthlessness
• Anxiety, tension, or feeling on edge
• Mood swings, irritability, or increased anger and conflicts
• Decreased interest in usual activities
• Difficulty concentrating
• Fatigue and low energy
• Changes in appetite or sleep
• Feeling overwhelmed or out of control
• Physical symptoms like breast tenderness, headaches, joint or muscle pain, bloating, and weight gain

These symptoms typically start 7-10 days before menstruation and improve within a few days of the period starting. To be diagnosed with PMDD, a person must have at least five symptoms, including one mood-related symptom, that significantly interfere with daily functioning.

Causes & Risk Factors

The exact cause of PMDD is unknown, but it’s thought to be related to an abnormal reaction to hormonal changes during the menstrual cycle. Serotonin, a brain chemical that regulates mood, may also play a role. Serotonin levels fluctuate throughout the menstrual cycle and may be lower in people with PMDD.

Research suggests that women with PMDD may have an altered sensitivity to normal hormone fluctuations, particularly estrogen and progesterone. This heightened sensitivity may lead to the mood and physical symptoms associated with PMDD.

Risk factors for developing PMDD include:

• Personal or family history of depression, anxiety, or other mood disorders
• History of trauma or abuse
• Cigarette smoking
• High-stress levels
• Obesity

Twin studies have also suggested a genetic component to PMDD, with possible heritability.^(ref) However, more research is needed to fully understand the genetic basis of PMDD.

Epidemiology

Epidemiological studies estimate that PMDD affects 3-8% of women of reproductive age worldwide. However, the true prevalence may be higher due to underdiagnosis and misdiagnosis.

Many women with PMDD are misdiagnosed with other mood disorders like depression or anxiety.

PMDD appears to be most common in women in their late 20s to early 40s. Some studies have suggested racial and ethnic differences in the prevalence of specific premenstrual symptoms, but the overall prevalence of PMDD does not appear to differ significantly between racial groups.

Treatment Options

Treatment for PMDD typically involves a combination of lifestyle changes, medications, and therapy.

Lifestyle changes that may help manage symptoms include:

• Regular exercise
• Stress reduction techniques like yoga or meditation
• Healthy sleep habits
• Limiting caffeine and alcohol intake

Medications used to treat PMDD include:

• Antidepressants, particularly SSRIs like fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil)
• Birth control pills containing drospirenone and ethinyl estradiol, which can help regulate hormones
• GnRH agonists that induce temporary menopause

For severe cases that don’t respond to other treatments, surgical removal of the ovaries (oophorectomy) may be considered as a last resort. Cognitive behavioral therapy and other forms of counseling can also be effective in managing the emotional symptoms of PMDD. Therapy can help women develop coping strategies, manage stress, and improve relationships.

The Importance of Awareness

Despite affecting millions of women, PMDD remains largely misunderstood and underdiagnosed. Many women suffer in silence, not realizing their symptoms are part of a treatable condition.

Increasing awareness about PMDD is crucial for getting more women the help they need.

If you think you may have PMDD, don’t hesitate to talk to your healthcare provider. Tracking your symptoms over several menstrual cycles can help your doctor make an accurate diagnosis. With proper diagnosis and treatment, it is possible to manage the symptoms of PMDD and improve quality of life.

Source:

1. UNC School of Medicine