About premenstrual dysphoric disorder (pmdd)

What is premenstrual dysphoric disorder (pmdd)?

Premenstrual dysphoric disorder (PMDD) can be considered to be a severe form of premenstrual syndrome (PMS), with symptoms that interfere with daily activities and functioning.

  • PMDD occurs in 3% to 8% of menstruating women.
  • Fatigue, mood changes, and abdominal bloating are common symptoms, but numerous other symptoms may occur.
  • PMDD is diagnosed by a symptom diary or chart in which a woman records her daily symptoms for at least two consecutive menstrual cycles.
  • PMDD is effectively treated by medications including SSRIs and drugs that suppress ovulation and the production of ovarian hormones.

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) can be considered a severe form of premenstrual syndrome (PMS). Both PMS and PMDD are characterized by unpleasant physical and psychological symptoms that occur in the second half of a woman's menstrual cycle, most commonly in the days preceding the menstrual period. Physical symptoms such as bloating, breast tenderness, headaches, joint pain, food cravings, mood swings or frequent crying, panic attacks, fatigue, mood changes, irritability, and trouble focusing are among the most common symptoms. Other symptoms like anxiety and trouble sleeping have been reported. PMS symptoms may be troubling and unpleasant. PMDD may cause severe, debilitating symptoms that interfere with a woman's ability to function.

The American College of Obstetricians and Gynecologists estimates that at least 85 percent of menstruating women have at least one PMS symptom as part of their monthly cycle. PMS is much more common than PMDD. You must have 5 or more of the symptoms listed above to be diagnosed with PMDD.

Biologic, psychological, environmental, and social factors all seem to play a part in PMDD. It is important to note that PMDD is not the fault of the woman suffering from it or the result of a "weak" or unstable personality. It is also not something that is "all in the woman's head." Rather, PMDD is a medical illness that impacts only 3% to 8% of women. Fortunately, it can be treated by a health care professional with behavioral and pharmaceutical options.

PMDD has been previously medically referred to as late luteal phase dysphoric disorder.A number of medical therapies have been shown to be effective in managing PMDD symptoms.

What are the symptoms for premenstrual dysphoric disorder (pmdd)?

Breast tenderness symptom was found in the premenstrual dysphoric disorder (pmdd) condition

In both PMDD and PMS, symptoms usually begin seven to 10 days before your period starts and continue for the first few days of your period.

Both PMDD and PMS may cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however, at least one of these emotional and behavioral symptoms stands out:

What are the causes for premenstrual dysphoric disorder (pmdd)?

The cause of PMDD isn't clear. Underlying depression and anxiety are common in both PMS and PMDD, so it's possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders.

What are the treatments for premenstrual dysphoric disorder (pmdd)?

Antidepressants (SSRIs)

Several members of the selective serotonin reuptake inhibitor (SSRI) class of medications are effective in the treatment of PMDD. These medications work by regulating the levels of the neurotransmitter serotonin in the brain. SSRIs that have shown to be effective in the treatment of PMDD include:

  • fluoxetine (Prozac, Sarafem),
  • sertraline (Zoloft),
  • paroxetine (Paxil), and
  • citalopram (Celexa).

Up to 75% of women report relief of symptoms when treated with SSRI medications. Side effects can occur in up to 15% of women and include nausea, anxiety, and headache. SSRI medications to treat PMDD may be prescribed to be taken continuously or only during the 14-day luteal phase (second half) of the menstrual cycle. Other types of antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) and lithium (Lithobid) have not been shown to be effective in the treatment of PMDD.

Oral contraceptives and GnRH agonists

Medications that interfere with ovulation and the production of ovarian hormones have also been used to treat PMDD. Oral contraceptive pills (OCPs, birth control pills) can be prescribed to suppress ovulation and regulate the menstrual cycle.

Gonadotropin-releasing hormone analogs (GnRH analogs or GnRH agonists) have also been used to treat PMDD. These drugs suppress estrogen production by the ovaries by inhibiting the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause. Nasal and injection forms of GnRH agonists are available.

Examples of GnRH agonists include:

  • leuprolide (Lupron),
  • nafarelin (Synarel), and
  • goserelin (Zoladex).

The side effects of GnRH agonist drugs are a result of the lack of estrogen, and include hot flashes, vaginal dryness, irregular vaginal bleeding, mood changes, fatigue, and loss of bone density (osteoporosis). Adding back small amounts of estrogen and progesterone can help avoid or minimize many of the annoying side effects due to estrogen deficiency and help preserve bone density.

Danazol (Danocrine) is a synthetic drug that creates a high androgen (male type hormone) and low estrogen hormonal environment by interfering with ovulation and ovarian production of estrogen. It has been successfully used to treat PMDD, but up to 75% of women develop side effects from the drug including:

  • weight gain,
  • edema,
  • decreased breast size,
  • acne,
  • oily skin,
  • hirsutism (male pattern hair growth),
  • deepening of the voice,
  • headache,
  • hot flashes,
  • changes in libido, and
  • mood changes.

All of these changes are reversible, except for voice changes, but the return to normal may take many months. Because of these side effects, this medication is typically used only when other therapies have failed. Danazol (Danocrine) should not be taken by women with certain types of liver, kidney, and heart conditions.

Other treatments

Other treatments have also been shown in some studies to be beneficial in managing PMDD symptoms. Chasteberry extract (agnus castus fruit) was effective in decreasing the symptoms of PMS in a controlled trial. Several dietary supplements, including calcium, vitamin B6, and vitamin E, have also been shown in limited studies to reduce PMS/PMDD symptoms.

What are the risk factors for premenstrual dysphoric disorder (pmdd)?

Premenstrual Dysphoric Disorder (PMDD), is a mood disorder that affects some women during the second half of their menstrual cycle. It's marked by extreme emotional and physical symptoms that can have serious effects on your day-to-day life.

The symptoms can vary from woman to woman, but they usually include irritability, anger, frustration, sadness, anxiety, mood swings and fatigue. Some women also experience severe physical pain like headaches and joint pain.

The symptoms of PMDD usually start 5-11 days before the start of menstruation and continue until the first day of menstruation begins. The symptoms will then subside until after menses are finished, when they will return again with a vengeance! In some cases, though this doesn’t happen at all as some women just feel very tired all month long without any real change in moods or energy levels between cycles.

As you can see, PMDD can be quite debilitating, especially if you have other medical conditions such as fibromyalgia or chronic fatigue syndrome, which make it difficult for you to even get out of bed, let alone go through another day feeling exhausted and cranky all day long!

The four risk factors associated with PMDD are:

1. Having a history of depression

2. Being on hormonal contraceptives

3. Having a history of abnormal menstrual cycles (such as longer or shorter cycles)

4. Being in an abusive relationship

Symptoms
Intense irritability,Mood swings,Anxiety,Sadness or feeling hopeless,Loss of interest in usual activities,Feeling overwhelmed by daily tasks
Condition
Lack of sleep,Stress,Dieting or eating disorders,Medications such as antidepressants, birth control, and steroids,Alcohol and drug use,Major life events like divorce or death in the family
Drugs
Antidepressants,Anti-anxiety medications,Mood stabilizers,Surgical options

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