Premenstrual Dysphoric Disorder (PMDD): Symptoms, Causes & Treatment

Bloating, cramps, headaches, and breast tenderness are all common symptoms that tend to indicate a menstrual cycle is in full swing. But when the symptoms are severe and greatly affect daily living, it may be an indication of Premenstrual Dysphoric Disorder.

What is Premenstrual Dysphoric Disorder (PMDD)?

You may have heard about Premenstrual Syndrome, otherwise known as PMS, but do you know about Premenstrual Dysphoric Disorder (PMDD)? 

Well, unlike PMS, PMDD is an extreme and more serious health-related complication. PMDD affects women who are around the child-bearing age. This syndrome can have a longer-lasting effect on mood and irritability. Usually beginning one to two weeks before a period begins, PMDD can be debilitating to women, both emotionally and physically. PMDD can cause depressive thoughts, suicidal ideation, and anxiety.

Symptoms of Premenstrual Dysphoric Disorder

There are many symptoms of PMDD, but they vary for each individual as well as varying in their intensity. The most common symptoms of PMDD include: 

• Long-term irritability and/or anger
• Depressive symptoms
• Overwhelmed/out of control
• Heightened anxiety
• Emotional instability
• Bodily aches and pains
• Lack of interest in daily activities
• Abdominal cramps
• Nausea
• Fainting
• Hypersomnia or insomnia 
• Fatigue

Although these symptoms may seem very similar to those of premenstrual syndrome, PMDD symptoms are more severe in their intensity and tend to require treatment and help from a licensed professional.

Causes of PMDD

Although scientists and researchers have not found an exact cause, there are some suggestions as to what might cause 10% of women to live with PMDD. A large number of these researchers believe this disorder is caused by a greater sensitivity to the hormone level changes.

Other research supports the possibility that genetic variations may play a role in predicting who will develop PMDD. It also suggests that smoking, trauma, and stress could all have adverse effects on hormone sensitivity levels, creating greater sensitivity or making the symptoms worse.

Diagnosis of Premenstrual Dysphoric Disorder (PMDD)

A licensed doctor, psychiatrist, or therapist) is needed to make the diagnosis of PMDD. In order for them to make a diagnosis, they are going to ask a few specific questions about when symptoms started, what type of symptoms are being experienced, the severity of the symptoms, and how consistent they have been. You may also be asked about your medical history and if there are any family histories of PMDD or other disorders.

It is important to have a tracked record of symptoms throughout the past two menstrual cycles. To complete the diagnosis, the care provider will screen for a minimum of 5 of the 11 listed symptoms of PMDD in the Diagnostic and Statistical Manual of Mental Disorders (DSM), with one required mood-related symptom. In the DSM, 5^th ed., PMDD now has its own, official diagnosis.

It is most important to know about your health history and to continue to advocate for your mental and physical health needs. If you feel as though you aren’t receiving the help you need, continue tracking your symptoms and reach out through other avenues. Mental health professionals and gynecologists could be alternative resources to go to due to their specialization in the fields of mental health and female reproductive systems.

Treatment

There are a few different treatment modalities for those suffering from PMDD.

One treatment method is utilizing antidepressants to slow or block serotonin reuptake in the brain. Specifically, selective serotonin reuptake inhibitors (SSRIs) are often the first choice due to their ability to relieve anxiety and depression symptoms, although researchers are still uncertain as to how exactly SSRIs help treat PMDD.

Since the use of SSRIs is effective at relieving symptoms of PMDD, researchers support the need to only take the antidepressants intermittently as they work rather quickly. However, this depends on the severity and type of symptoms being experienced.

Another treatment for PMDD is hormone therapy. Typically used when other modalities have been tried and failed, hormone therapy can trick your body into thinking it is going through menopause, therefore reducing symptoms. This alternative has negative side effects such as the risk of developing osteoporosis.

Lifestyle changes tend to be up for debate amongst researchers for their ability to treat PMDD. For those with milder cases, engaging in aerobic activities (walking, running, biking) may reduce mild symptoms, as well as making dietary changes. Nutritional supplements have proven effective in treating PMS symptoms, but there is little evidence supporting their use for PMDD.

Since PMDD can cause psychological stressors and symptoms, talk therapy and counseling is a healthy avenue to try. To help manage and cope with symptoms of PMDD, many therapists use cognitive behavioral therapy (CBT). This type of therapy helps with challenging and changing unhealthy thoughts and developing skills to combat them.

Living with PMDD

Although it may be more difficult to live with the symptoms of PMDD, there is always hope and ways to get help. One way to cope is by understanding that you are not alone in this battle. There are other women out there searching for their answers and trying to advocate for better access to information about PMDD. 

It may take some time, but you will find a treatment that works for you. Whether that be by using SSRIs and/or beginning therapy or changing up lifestyle habits to help alleviate minor symptoms, there is a way that works for you. It may take a cycle or two to see if a change works, so do not give up hope.

A last note to remember: PMDD is a brain disease and should be treated as such. It might feel the most logical to attempt to heal the physical symptoms, but it is really stemming from a disruption in the brain. It is important to seek professional guidance so that you can take back your life and find ways to manage living with PMDD.

Featured Image Credit: Photo by Andrea Piacquadio (PEXELS)

References

1. https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd
2. https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd
3. https://my.clevelandclinic.org/health/articles/9132-premenstrual-dysphoric-disorder-pmdd
4. https://iapmd.org/hormones-and-pmdd
5. https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
6. https://my.clevelandclinic.org/health/articles/9132-premenstrual-dysphoric-disorder-pmdd#:~:text=Diagnosis%20and%20Tests&text=You%20may%20need%20to%20track,anxiety%2C%20depression%20or%20reproductive%20disorders.
7. https://www.health.harvard.edu/womens-health/treating-premenstrual-dysphoric-disorder
8. https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/treatment/#:~:text=Gonadotropin%20releasing%20hormone%20(GnRH)%20analogues,treatments%20have%20been%20effective%20though.
9. https://www.aafp.org/pubs/afp/issues/2002/1001/p1239.html#afp20021001p1239-t2
10. https://www.ncbi.nlm.nih.gov/books/NBK279045/table/premenstrual-syndrom.table1diag/