Premenstrual dysphoric disorder (PMDD)

Symptoms of premenstrual syndrome (PMS) are common. In fact, about 90% of menstruating women experience PMS symptoms at some point in their lives. But for a small number of people, symptoms become more severe. Up to 5% of menstruating women develop symptoms of premenstrual dysphoric disorder (PMDD).

PMS and PMDD share some similar symptoms. However, the symptoms of PMDD are severe and, at times, debilitating. Both physical and emotional symptoms may develop that can interfere with a person’s ability to function.

The article below covers the symptoms of PMDD, causes, and treatment options.

Fast facts on PMDD

Here are some key points about premenstrual dysphoric disorder:

• The symptoms of PMDD disrupt normal daily functioning and require medical treatment.
• PMDD is less common than PMS, and the symptoms are more severe.
• A person typically experiences symptoms during the second half of the menstrual cycle.
• The symptoms of PMDD can last until menopause.

Symptoms

The symptoms of PMDD are similar to but more severe than those experienced in PMS. Symptoms are typically present during the week before menses and resolve within a few days after menstrual onset. Those who experience PMDD may not function at their typical capacity while symptoms are present. The condition can affect relationships and disrupt routines at home and work.

Symptoms of PMDD may include:

• severe fatigue
• mood changes, including irritability, nervousness, depression, and anxiety
• breast tenderness
• difficulty concentrating
• cramps
• panic attacks
• problems sleeping
• abdominal bloating, increased appetite, and gastrointestinal upset
• headaches
• backache
• joint or muscle pain
• lack of interest in daily activities
• decreased libido

Fluid retention may also develop and lead to breast tenderness, decreased urine production, temporary weight gain, and swelling of the hands, feet, and ankles. Skin problems, such as acne, inflammation, itching, and a worsening of cold sores, may also occur.

Causes

The exact causes of PMDD and PMS remain unclear. Changing hormone levels that occur during the menstrual cycle appear to play a role in developing PMDD. The neurotransmitter serotonin also fluctuates throughout the monthly cycle due to changing hormones. That change may contribute to PMDD.

Some women also have an increased risk of developing PMDD. For example, having a personal or family history of postpartum depression, mood disorders, or depression increases a person’s risk of PMDD.

Diagnosis

The symptoms of PMDD can be similar to those of other conditions, so healthcare professionals usually perform a physical exam, obtain a medical history, and order certain tests to rule out other conditions when making a diagnosis.

The use of a symptom chart during the diagnostic process helps determine any correlation between the symptoms and the menstrual cycle.

Guidelines from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) require that the symptoms of PMDD be present for a minimum of two consecutive menstrual cycles before making a diagnosis of PMDD.

According to the guidelines, symptoms must:

• be present a week before the onset of menses
• resolve after the start and within the first few days of flow
• interfere with normal daily living

To receive a diagnosis, a person must experience at least five symptoms, including at least one of the following mood-related symptoms:

• feelings of sadness or hopelessness
• feelings of anxiety or tension
• mood changes or increased sensitivity
• feelings of anger or irritability

Treatment

A combination of medication and lifestyle modifications may help treat PMDD. Medications that affect ovulation or impact the central nervous system (CNS) may work best.

Examples of medication may include:

• Selective serotonin reuptake inhibitors (SSRIs): Antidepressants such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram have proven effective for some women. One study found that 60–70% of women responded well to SSRIs.
• Birth control pills: Birth control pills containing drospirenone and ethinyl estradiol have proven effective. Yaz specifically has been FDA-approved to treat symptoms of PMDD.
• Gonadotropin-releasing hormone analogs: These include leuprolide (Lupron), nafarelin (Synarel), and goserelin (Zoladex).
• Danazol (Danocrine)

Cognitive behavioral therapy (CBT) may also help those with PMDD. A study published in Psychotherapy and Psychosomatics involved 174 women that participated in online cognitive behavioral therapy for 8 weeks. A 6-month follow-up indicated that online cognitive behavioral therapy helped reduce symptoms of PMDD.

Supplements

Some people may use supplements to manage premenstrual symptoms, including PMDD. Additional research is necessary to determine the efficacy of some supplements in managing PMDD.

Examples of supplements some people use for PMDD include:

• chasteberry extract
• evening primrose oil
• magnesium oxide
• dietary supplementation with calcium, vitamin B6, magnesium, and vitamin E

A 2016 meta-analysis published in the Journal of Chemical and Pharmaceutical Science (JCPS) concluded that vitamin B6 could serve as an affordable and efficient treatment for symptoms of PMS.

According to the American College of Obstetricians and Gynecologists, taking 1200 milligrams of calcium can decrease the mood and physical symptoms associated with PMS, such as bloating and breast tenderness.

Chasteberry supplements are available for online purchase, but interested persons should speak with a health professional before taking supplements.

Alternative remedies

Although studies have not fully determined their effectiveness, possible alternative remedies that may help with PMDD include the following:

• yoga
• qi therapy
• breathing exercises
• self-hypnosis
• massage therapy
• guided imagery
• acupuncture

Diet and exercise

Lifestyle changes, including exercise and diet changes, may also help reduce some PMDD symptoms. Dietary changes include:

• decreasing intake of sugar, salt, caffeine, and alcohol
• increasing protein and intake of complex carbohydrates

Exercise, stress management techniques, and doing activities a person enjoys may also help.

Getting regular exercise appears to improve emotional symptoms, such as anger and anxiety. It can also have a positive effect on physical symptoms, such as breast tenderness, cramps, and constipation.

Other tips

Other strategies that may help include:

• taking it easy on the days leading up to menstruation
• talking to a partner or trusted friend
• finding relaxing activities that relieve tension, such as reading, watching a movie, going for a walk, or having a bath

People with PMDD should speak with a healthcare professional to find the right combination of treatment to reduce symptoms.

Summary

PMDD involves severe symptoms of premenstrual syndrome that can interfere with a person’s life and overall well-being. Symptoms include both emotional and physical problems, such as depression, headaches, and mood shifts. Treatment often involves a combination of lifestyle modifications and possibly medication to ease symptoms.