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Premenstrual Dysphoric Disorder - Symptoms, Causes, Diagnosis, Treatment and Complications

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Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome. This article explains the cause, symptoms, diagnosis, treatment, and complications of PMDD.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Sravanthi Nuthalapati

Published At June 1, 2022
Reviewed AtMarch 17, 2023

What Is Premenstrual Dysphoric Disorder?

Premenstrual dysphoric disorder (PMDD) is a health problem similar to premenstrual syndrome (PMS) but more severe. It causes physical and emotional symptoms like PMS, but women with PMDD find their symptoms exhausting. PMDD also causes extreme anxiety, mood changes, and depression; some women even attempt suicide. Symptoms usually decline two to three days after the period starts. It interferes with daily activities, including school, work, relationships, and social life. The treatment may include hormonal birth control pills and antidepressants.

What Are the Symptoms of Premenstrual Dysphoric Disorder?

The symptoms of premenstrual dysphoric disorder usually start a week before the periods and last until two to three days after the periods begin. Most of the symptoms are tiring and exhausting and interfere with daily activities.

The symptoms of the premenstrual dysphoric disorder include:

  • Depression or feeling hopeless.

  • Fatigue.

  • Mood swings.

  • Tension, irritability, and anxiety.

  • No interest in daily activities.

  • Unable to concentrate.

  • Insomnia.

  • Bloating and cramps.

  • Appetite changes.

  • Headache.

  • Tenderness of the breast.

  • Feeling anger and fighting with other people.

  • Hot flashes.

  • Muscle and joint pain.

  • Panic attacks.

What Are the Causes of Premenstrual Dysphoric Disorder?

The exact cause of premenstrual dysphoric disorder is not known. Few experts suggest that it may be due to decreased progesterone and estrogen hormones after ovulation and before menstruation, which may trigger PMDD. The hormone changes can lead to a deficiency of serotonin, a neurotransmitter. Serotonin is a substance naturally occurring in the brain and intestines that cause narrowing of blood vessels and affect mood and physical activities.

The other factors which play a role in causing premenstrual dysphoric disorders are,

How Is a Premenstrual Dysphoric Disorder Diagnosed?

A symptoms chart is used in the diagnosis of the premenstrual dysphoric disorder. It is used to determine any correlation between PMDD symptoms and the menstrual cycle. According to the American psychiatric association (APA) and diagnostic and statistical manual fifth edition guidelines, the symptoms of PMDD should be present for a minimum of two consecutive menstrual cycles prior to confirming the diagnosis of the premenstrual dysphoric disorder. According to the guidelines, the patients must have the following:

  • The symptoms must be present a week before menstruation.

  • It should interfere with regular daily activities.

  • The signs should stop a few days after the menstruation starts.

If the patient has the following symptoms, the doctor will take the medical history and perform a thorough physical examination. The doctors follow a few tests to check the emotional and mental feelings of the patient. Before finalizing the diagnosis of a premenstrual dysphoric disorder, the doctor will ensure that emotional problems like panic disorder and depression are not responsible for the symptoms. Doctors will check for other medical and gynecological conditions like fibroid, endometriosis, menopause, and hormone problems.

What Is the Treatment for Premenstrual Dysphoric Disorder?

Treatment of PMDD is directed at preventing or minimizing symptoms and may include:

  • Antidepressants - Selective serotonin reuptake inhibitors (SSRIs), such as Sertraline (Zoloft) and Fluoxetine (Prozac, Sarafem, others), may decrease emotional symptoms, food cravings, fatigue, and sleep problems. The symptoms of PMDD can be reduced by taking SSRIs every month or only during the interval between ovulation and the start of the period.

  • Oral Contraceptives - Taking birth control pills like Drospirenone and Ethinylestradiol with no pill-free interval or a shortened pill-free interval can reduce PMS and PMDD symptoms.

  • Diuretics - It can be helpful for women who have short-term weight gain from fluid retention.

  • Pain Relievers - Medicine that reduces pain like Ibuprofen or Aspirin can be prescribed for headaches, menstrual cramps, backache, and breast tenderness.

  • Nutritional Supplements - Several supplements have been recommended to treat the premenstrual dysphoric disorder, but studies do not support their long-term safety and efficacy. Consuming 1,200 milligrams of calcium and vitamin D every day may possibly reduce the severity of the symptoms of PMS and PMDD. Vitamin B-6, L-tryptophan, and magnesium also may help, but talk with the doctor for advice before consuming any supplements.

  • Alternative Medicine - Some research suggests that chaste berry (Vitex agnus-castus) may reduce mood swings, breast tenderness, irritability, swelling, cramps, and food cravings associated with premenstrual dysphoric disorder, but more research is required. Alternative remedies like yoga, qi therapy, guided imagery, saffron therapy, photic stimulation, and acupuncture can also be effective treatments. Consult with a doctor before trying one.

What Lifestyle Changes Can Help to Deal With the Premenstrual Dysphoric Disorder?

A few changes in daily activities can bring big changes in PMDD symptoms. These include:

  • Getting Frequent Exercise - Exercise does not need to be an intense workout in a gym. A quick 30-minute walk around the neighborhood every day can help to relax the mind and boost the mood.

  • Keeping the Stress in Check - It is impossible to avoid stress altogether, but try to avoid the factors causing stress and stay away from the main stressors. Also, relaxation techniques, such as meditation, yoga, mindfulness, and reflexology can be helpful,

  • Cut Down on Junk -Try to cut back on snacks and sweets high in sodium. Reducing the consumption of caffeine and alcohol can provide considerable relief.

  • Eating for the Mood - Try to include foods that contain complex carbohydrates and lean protein, such as fish, chicken, nuts, and whole grains. This kind of food can elevate the level of tryptophan, a chemical that the body uses to produce serotonin. The hormonal changes can cause reduced serotonin levels.

These changes can not be a few weeks before they start impacting the symptoms. If there is no positive outcome, do not be discouraged, it may take time, so keep going.

What Are the Complications Caused Due to Premenstrual Dysphoric Disorder?

Premenstrual dysphoric disorder symptoms can be severe and interfere with a woman's daily activities. When the patient does not get treatment on time, these symptoms can significantly impact the quality of life and function at school, work, or at home. Women facing depression may have severe mood swings during the second half of their cycle and may require changes in medicine. Even suicidal thoughts can occur in a few women with PMDD. Suicide tendency in women with depression is most likely to happen during the second half of the menstrual cycle.

Conclusion:

The premenstrual dysphoric disorder will be solved after menopause; until then, tracking the symptoms will provide a better idea to deal with the symptoms and know the best treatment that works for the particular individual. Then, a doctor can provide the best treatment depending on the symptoms.

Frequently Asked Questions

1.

Is PMDD Considered a Mental Illness?

PMDD is a mood disorder caused due to fluctuations in estrogen and progesterone levels around menstruation time. It affects the emotional, physical, and mental health of the women. PMMD is a cyclic mood disorder that begins a few days before menstruation.

2.

How Do You Treat Premenstrual Dysphoric Disorder?

Premenstrual dysphoric disorder is treated through medications like antidepressants, diuretics, anti-inflammatory drugs, birth control pills, painkillers, and vitamin supplements. Stress is managed through regular exercise, yoga, and meditation. A healthy diet with nutritious food is also recommended.

3.

Can a Gynecologist Diagnose PMDD?

Yes, a gynecologist can diagnose PMMD with the following criteria:
- The signs and symptoms will begin the week before menstruation.
- The symptoms will interfere with daily activities.
- The symptoms will resolve after the menstruation starts.
- The diagnosis is made by eliminating other possible disorders like depression and panic disorder.

4.

Is PMDD Similar to Bipolar Disorder?

No, Bipolar disorder is a mental illness causing extreme and abnormal shifts in mood, behavior, and energy levels ranging from feeling low to high. PMDD is often misdiagnosed as bipolar disorder, but both are different mental illnesses.

5.

Is PMDD Related to PCOS?

No. PMMD is not related to PCOS. Both conditions can be diagnosed in a patient, but that does not mean one condition will lead to another. They are not associated with each other. Polycystic ovarian syndrome (PCOS) is the presence of small cysts on the ovaries due to hormonal imbalance.

6.

Which Female Hormonal Tests Can Diagnose PMDD?

No, there are no specific hormonal or other blood tests to diagnose PMMD. However, women with mood changes (sad, angry, and depressed) and physical symptoms like tender breasts, tiredness, body pain, weight gain, and bloating that start a week before menstruation and stop after the start of menstruation will confirm the diagnosis.

7.

Which Doctor Should be Consulted for PMDD?

A gynecologist and psychiatrist will help in diagnosing PMMD in women. PMDD is a mood disorder caused due to fluctuations in estrogen and progesterone levels around menstruation time. It affects the emotional, physical, and mental health of the women.

8.

Which Hormone Is Responsible for PMDD?

PMMD is a mood disorder that starts a few days before menstruation. It is believed that the reduced levels of estrogen and progesterone, along with serotonin, may play a role in causing PMMD symptoms. Estrogen and progesterone are female sex hormones, and serotonin is a neurotransmitter.

9.

How to Deal With a Spouse Suffering With PMDD?

A PMDD partner must be taken care of by supporting and reassuring them. They would need counseling therapy sessions and a healthy lifestyle to manage the stress and anxiety caused by PMMD. One should deal with these patients with patience, care, empathy, generosity, and reassurance.

10.

Is PMDD a Psychological or Physiological Condition?

PMDD is a psychological disorder with symptoms like anger, depression, tiredness, irritability, lack of focus and concentration, and insomnia, affecting women during the luteal phase of menstruation.

11.

Is PMDD Cause a Lack of Estrogen?

PMMD is a cyclic mood disorder that begins a few days before menstruation. It is believed the reduced levels of sex hormones estrogen and progesterone, along with the neurotransmitter serotonin, may play a role in causing PMMD symptoms. It affects the emotional, physical, and mental health of the women.

12.

Can PMDD be Cured Completely?

Yes, PMDD can be treated through medications like antidepressants, diuretics, anti-inflammatory drugs, birth control pills, painkillers, and vitamin supplements. Stress is managed through regular exercise, yoga, and meditation. A healthy diet with nutritious food is also recommended.

13.

Does Removing Ovaries Help to Cure PMDD?

Yes, a surgery that removes ovaries called oophorectomy is the last treatment for PMDD. The hormones are not produced and cause menopause. Other conservative treatment options include antidepressants, diuretics, anti-inflammatory drugs, birth control pills, painkillers, and vitamin supplements. Stress is managed through regular exercise, yoga, and meditation. A healthy diet with nutritious food is also recommended.

14.

When Do PMDD Symptoms End?

PMDD symptoms usually begin a week before menstruation and end a few days after menstruation. Women experience mood changes (sad, angry, and depressed) and physical symptoms like tender breasts, tiredness, body pain, weight gain, and bloating that start a week before menstruation and stop after the start of menstruation. 
Dr. Sravanthi Nuthalapati
Dr. Sravanthi Nuthalapati

Obstetrics and Gynecology

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