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What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women of childbearing age. It’s a severe and chronic medical condition that needs attention and treatment. Lifestyle changes and sometimes medicines can help manage symptoms.

What causes PMDD?

The exact cause of PMDD is not known. It may be an abnormal reaction to normal hormone changes that happen with each menstrual cycle. The hormone changes can cause a serotonin deficiency. Serotonin is a substance found naturally in the brain and intestines that narrows blood vessels and can affect mood and cause physical symptoms.

What are the risk factors for PMDD?

While any woman can develop PMDD, the following may be at an increased risk:

            Women with a family history of PMS or PMDD  

            Women with a personal or family history of depression, postpartum depression, or other mood disorders

Other possible risk factors include lower education and cigarette smoking

Talk with your healthcare provider for more information.

What are the symptoms of PMDD?

Symptoms of PMDD appear during the week before menstruation and end within a few days after your period starts. These symptoms disrupt daily living tasks. Symptoms of PMDD are so severe that women have trouble functioning at home, at work, and in relationships during this time. This is markedly different than other times during the month.

The following are the most common symptoms of PMDD:

Psychological symptoms

            Irritability

            Nervousness

            Lack of control

            Agitation

            Anger

            Insomnia

            Difficulty in concentrating

            Depression

            Severe fatigue

            Anxiety

            Confusion

            Forgetfulness

            Poor self-image

            Paranoia

            Emotional sensitivity

            Crying spells

            Moodiness

            Trouble sleeping

Fluid retention

            Swelling of the ankles, hands, and feet

            Periodic weight gain

            Diminished urine output

            Breast fullness and pain

Respiratory problems

            Allergies

            Infections

Eye complaints

            Vision changes

            Eye infection

·       

Gastrointestinal symptoms

            Abdominal cramps

            Bloating

            Constipation

            Nausea

            Vomiting

            Pelvic heaviness or pressure

            Backache

Skin problems

            Acne

            Skin inflammation with itching

            Aggravation of other skin disorders, including cold sores

Neurologic and vascular symptoms

            Headache

            Dizziness

            Fainting

            Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs

            Easy bruising

            Heart palpitations

            Muscle spasms

Other

            Decreased coordination

            Painful menstruation

            Diminished sex drive

            Appetite changes

            Food cravings

            Hot flashes

·       

The symptoms of PMDD may look like other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Always talk with a healthcare provider for a diagnosis.

How is PMDD diagnosed?

Aside from a complete medical history and physical and pelvic exam, there are very few diagnostic tests. Because there are mental health symptoms, your healthcare provider may want you to be evaluated for mental health concerns. In addition, your healthcare provider may ask that you keep a journal or diary of your symptoms for several months. In general, to diagnose PMDD the following symptoms must be present:

            Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:

            Depressed mood

            Anger or irritability

            Trouble concentrating

            Lack of interest in activities once enjoyed

            Moodiness

            Increased appetite

            Insomnia or the need for more sleep

            Feeling overwhelmed or out of control

            Other physical symptoms, the most common being belly bloating, breast tenderness, and headache

            Symptoms that disturb your ability to function in social, work, or other situations

            Symptoms that are not related to, or exaggerated by, another medical condition

How is PMDD treated?

PMDD is a serious, chronic condition that does need treatment. Several of the following treatment approaches may help relieve or decrease the severity of PMDD symptoms:

            Changes in diet to increase protein and carbohydrates and decrease sugar, salt, caffeine, and alcohol

            Regular exercise

            Stress management

            Vitamin supplements (such as vitamin B6, calcium, and magnesium)

            Anti-inflammatory medicines

            Selective serotonin reuptake inhibitors (SSRI)

            Birth control pills

For some women, the severity of symptoms increases over time and lasts until menopause. For this reason, a woman may need treatment for an extended time. Medicine dosage may change throughout the course of treatment.

Key points about PMDD

PMDD is a much more severe form of t premenstrual syndrome (PMS).

The exact cause of PMDD is not known.

            The main symptoms that distinguish PMDD from other mood disorders or menstrual conditions is the when symptoms start and how long they last.

            Symptoms of PMDD are so severe that it affects your ability to function at home, work and in relationships.

            Aside from a complete medical history and physical and pelvic exam, there are very few tests to diagnose the condition.

            Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:

            Depressed mood

            Anger or irritability

            Trouble concentrating

            Lack of interest in activities once enjoyed

            Moodiness

            Increased appetite

            Insomnia or feeling very sleepy

            Feeling overwhelmed or out of control

            PMDD is a serious, chronic condition that does need treatment that may include lifestyle changes and sometimes medicines.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

            Know the reason for your visit and what you want to happen.

            Before your visit, write down questions you want answered.

            Bring someone with you to help you ask questions and remember what your provider tells you.

            At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

            Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

            Ask if your condition can be treated in other ways.

            Know why a test or procedure is recommended and what the results could mean.

            Know what to expect if you do not take the medicine or have the test or procedure.

            If you have a follow-up appointment, write down the date, time, and purpose for that visit.

        Know how you can contact your provider if you have questions.