Premenstrual Dysphoric Disorder (PMDD) - Test Your IQ of Women's Health

Premenstrual dysphoric disorder (PMDD) is 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. Fatigue, mood changes, irritability, and abdominal bloating are among the most common symptoms of PMS and PMDD.

PMDD differs from PMS in that symptoms are severe enough to interfere with work or school, social activities, and relationships.

Although the precise cause of PMS and PMDD is unknown, it is believed that these conditions result from the interaction of hormones produced by the ovaries at different stages in the menstrual cycle (such as estrogen and progesterone) with the neurotransmitters (chemicals that serve as messengers) in the brain. While the ovarian hormone levels are normal in women with PMDD, it is likely that the brain's response to these normally-fluctuating hormone levels is abnormal. Additionally, while stress clearly is associated with PMS and PMDD, it is not considered to be a cause of PMDD.

For the diagnosis of PMDD to be made, a woman must have at least 5 symptoms on the list below (including at least 1 of the first 4) cyclically in the time prior to her menstrual period.
- Markedly depressed mood, feelings of hopelessness, or self-deprecating thought
- Significant anxiety or tension
- Marked swings in emotions (for example, becoming tearful easily and frequently)
- Persistent and pronounced anger or irritability, or increased conflicts with people
- Decreased interest in usual activity
- Difficulty concentrating
- Sluggishness, easy fatigue, lack of energy
- Substantial change in appetite, food cravings, overeating
- Excessive sleeping or insomnia
- Physical symptoms such as breast pain, bloating, or headaches

If a doctor suspects PMDD, the patient may be asked to complete a symptom chart or calendar prospectively. This means that they record their symptoms each day for a given period to establish the diagnosis. The symptom chart can be compared with the menstrual calendar to illustrate the relationship of symptoms to the menstrual cycle.

The symptom chart is used to track the frequency and severity of PMDD symptoms, and may require the patient to track moods, behaviors, and conditions such as anger, irritability, tension, sadness, changes in sleep habits, pains, changes in breasts, cravings, nausea, weight gain, headaches, acne, and constipation.

PMDD can be serious and debilitating for women who suffer with the disorder. Left untreated, the symptoms of PMDD can seriously impact a woman's quality of life. As such, it is fully appropriate to seek medical care for troubling physical or emotional symptoms related to the menstrual cycle.

It is important to note that the depressive symptoms of PMDD may be associated with thoughts of suicide and suicidal behavior. This is a medical emergency for which health care should be accessed immediately.

PMS is much more common than PMDD. PMS may affect up to 30% of women with regular menstrual cycles, while only 3% to 8% of these women have true PMDD.

Recalling from the explanation in question 2, it is believed that PMS and PMDD result from the interaction of hormones produced by the ovaries with the neurotransmitters in the brain.

Antidepressants are classified as selective serotonin reuptake inhibitor (SSRI) medications, which work by regulating the levels of the brain chemical known as serotonin. Many members of this classification are highly effective in treating PMDD. 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 antidepressant medications.

In addition to antidepressants, women who suffer from PMDD can benefit from many other treatment options.

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) are drugs that treat PMDD symptoms by suppressing estrogen production by the ovaries. These drugs inhibit the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause.

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, acne, hot flashes, and facial hair.

Some women notice that their PMDD symptoms are more bothersome than when they were younger. This is usually the result of untreated PMDD. Left untreated, PMDD can have serious mood complications, including suicidal thoughts and behaviors. Along with this, untreated PMDD can worsen with age.

Many treatments have also been shown in some studies to be beneficial in managing the symptoms of PMDD. 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.

Natural, drug-free treatments can include eating a well-balanced diet, regular physical activity, drinking plenty of water, and avoiding caffeine, alcohol, and salt, especially in the days before menstruation.

Since PMDD is thought to result from interactions between ovarian hormones and neurotransmitters in the brain, there is no known way to prevent its occurrence.