Premenstrual Dysphoric Disorder

By John M. Grohol, Psy.D.

Most women have a variety of physical or emotional symptoms related to their monthly usuaperiods. Symptoms are usually present during the five days before their period and then disappear within a day or two of the period starting. Most of the time, these symptoms aren’t an indication of a mental disorder or other mental health concern. Such mild symptoms are a normal process of menstruation.

Severe cases of premenstrual syndrome (PMS) can be diagnosed as premenstrual dysphoric disorder (PMDD). PMDD significantly interfere’s with a woman’s ability to function in her everyday, normal life — including with family, at work, or do other activities she normally enjoys.

Symptoms of Premenstrual Dysphoric Disorder

Symptoms of PMDD are similar to those for PMS, except that a woman usually experiences more of them, and they are more severe. In order to be diagnosed with PMDD, a woman must experience at least 4 or more of the following symptoms:

  • Mood swings
  • Depressed mood or feelings of hopelessness
  • Significant feelings of anger
  • Increased interpersonal conflicts
  • Tension and anxiety
  • Irritability
  • Significantly decreased interest in usual activities
  • Great difficulty concentrating
  • Fatigue
  • Change in appetite
  • Feeling out of control or overwhelmed
  • Sleep problems, including sleeping too much, restless sleep, or inability to sleep
  • Physical problems, such as bloating, headaches, joint or muscle pain

Women who have a family or personal history of depression or postpartum depression are at higher risk for developing PMDD. PMDD affects somewhere between five and ten percent of menstruating women.

Keeping a calendar of when symptoms and menstruation occur will help a woman and her doctor decide if she has PMDD.

Why Do Some Women Get Premenstrual Dysphoric Disorder?

The cause of PMDD is unknown at this time. Research suggests that the cause of PMDD may be related to hormonal changes related to the menstrual cycle. Additional research suggests some similarity to that of certain mood disorders with the brain’s ability to properly regulate key neurochemicals, such as serotonin. However, no definitive research has been conducted that has shown a single cause for premsenstrual dysphoric disorder.

A woman may be more likely to suffer from PMDD if she has had a major depressive disorder or has bipolar disorder, or if someone in her family has suffered from one of these conditions. It’s possible that a woman with major depression and PMDD may find her symptoms ease somewhat during her period, but they won’t go away.

Diagnosis of PMDD

Premenstrual Dysphoric Disorder may be diagnosed by a physician or mental health professional, such as a psychiatrist or psychologist. A diagnosis is made based upon the symptoms listed above, their severity, and their level of interference with a woman’s life.

A professional making the diagnosis of PMDD will rule out other possible explanations for the symptoms, including both physical and mental health issues, such as depression. Other underlying medical or gynecological conditions will also be ruled out, such as endometriosis, fibroids, menopause, and hormonal problems that could better account for symptoms.

Treatment of PMDD

For more severe symptoms of PMDD, there are a variety of treatments available that will help reduce the severity of the symptoms (but may not make them go away altogether):

  • Optimal diet and exercise regularly — Cutting out or reducing alcohol, caffeine and chocolate is important, as these ingredients may exacerbate symptoms. Evening primrose is effective, but only to combat breast tenderness and fluid retention. Vitamin B6, calcium, vitamin D and Agnus Castus have been shown to be of benefit in easing mild to moderate PMS. Regular aerobic exercise is a good complement to a healthy diet.
  • Antidepressants Medications like Celexa, Prozac, Zoloft, and Paxil make many women with more severe PMS feel better. Some women take these medications during the second half of their cycle and others need to take it every day of the month. Your doctor will help you decide the course of therapy best for you.
  • Hormone therapy — Estrogen-containing birth control pills can help regulate menstrual cycles and often alleviate severe PMS symptoms. In the most severe cases, in which a woman is incapacitated by depressions around her periods, it may be necessary to stop her cycle completely with hormones.
  • Psychotherapy — Psychotherapy can help a woman learn to better cope with the symptoms and with other challenges in her life. Therapy can also teach stress reduction techniques, meditation and relaxation — exercises that help many women better face the symptoms of PMDD.

If symptoms of premenstrual syndrome (PMS) are more mild, simple changes in lifestyle can alleviate symptoms:

  • Reduce caffeine intake
  • Limit salt and sugar during the second half of your cycle
  • Eat several small meals daily and do not skip meals
  • Eat complex carbohydrates (example: grains, fruits, vegetables)
  • Eat low-protein, low-fat meals
  • Avoid binging
  • Consume adequate calcium — It is recommended that adult women get 1,200 mg of calcium daily, the equivalent of three glasses of milk, which is found in dairy products, fortified orange juice and breakfast cereals, some deep-green leafy vegetables, fish with edible bones (example: canned salmon) and vitamin supplements).
  • Increase in aerobic exercise (example: dancing, jogging)
  • Over-the-counter pain medicines (example: aspirin)
  • Nutritional supplements — Several scientific studies are looking at evening primrose oil and vitamin B6 (Pyridoxine). Some women get relief from these things. If you try the Vitamin B6, you must be careful because it can be toxic in high doses! Be sure to consult your physician before taking any nutritional supplements.

 

APA Reference
Grohol, J. (2009). Premenstrual Dysphoric Disorder. Psych Central. Retrieved on October 2, 2014, from http://psychcentral.com/lib/premenstrual-dysphoric-disorder/0002196
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.

 

 

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