How to identify the symptoms of premenstrual dysphoric disorder

Overview

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a more serious form of premenstrual syndrome (PMS). PMS causes bloating, headaches and breast tenderness a week or two before your period.

With PMDD, you might have PMS symptoms along with extreme irritability, anxiety or depression. These symptoms improve within a few days after your period starts, but they can be severe enough to interfere with your life.

How common is PMDD?

PMDD affects up to 10% of women who have periods.

Who might get PMDD?

You may be more prone to PMDD if you have:

  • Anxiety or depression.
  • PMS.
  • Family history of PMS, PMDD or mood disorders.

Symptoms and Causes

What causes PMDD?

Experts don’t know why some women get PMDD. Decreasing levels of estrogen and progesterone hormones after ovulation and before menstruation may trigger symptoms. Serotonin, a brain chemical that regulates mood, hunger and sleep, may also play a role. Serotonin levels, like hormone levels, change throughout your menstrual cycle.

What are the symptoms of PMDD?

PMDD symptoms appear a week or two before menstruation and go away within a few days after your period starts. In addition to PMS symptoms, you may have:

  • Anger or irritability.
  • Anxiety and panic attacks.
  • Depression and suicidal thoughts.
  • Difficulty concentrating.
  • Fatigue and low energy.
  • Food cravings or binge eating.
  • Headaches.
  • Insomnia.
  • Mood swings.

Diagnosis and Tests

How is PMDD diagnosed?

Your healthcare provider will take a medical history and evaluate your symptoms. You may need to track your symptoms through one or two menstrual cycles. To diagnose PMDD, your provider will look for five or more PMDD symptoms, including one mood-related symptom. Your provider will rule out or diagnose other conditions such as anxiety, depression or reproductive disorders.

Management and Treatment

How is PMDD managed or treated?

Your healthcare provider may recommend one or more of these treatments to help manage PMDD:

  • Antidepressants to help manage your brain’s serotonin levels.
  • Dietary changes, such as cutting back on salty, fatty or sugary foods and caffeine.
  • Hormonalbirth controlthat has drospirenone and ethinyl estradiol.
  • Over-the-counterpain medicines to ease cramps (dysmenorrhea), headaches, breast tenderness and other physical symptoms.
  • Regular exercise to improve mood.
  • Stress managementtools, such as deep breathing exercises and meditation.

What are the complications of PMDD?

Untreated PMDD can lead to depression and, in severe cases, suicide. The disorder can cause severe emotional distress and negatively affect relationships and careers.

If you’re experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 1.800.273.8255. This national network of local crisis centers provides 24/7 free and confidential emotional support to people in suicidal crisis or emotional distress.

Prevention

How can I prevent PMDD?

Treating existing depression or anxiety may make it less likely that PMS could become PMDD. But PMDD could be related to the way your hormones work, and you might not be able to prevent it. In that case, treatment can bring relief.

Outlook / Prognosis

What is the prognosis (outlook) for people with PMDD?

With treatment, most people with PMDD get relief from their symptoms and are able to enjoy life more fully. Talking to a mental health specialist or joining a support group may also help.

Living With

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

  • Extreme anxiety and panic attacks.
  • Feeling like you’ve lost control.
  • Severe depression or suicidal thoughts.
  • Thoughts of harming yourself or others.
  • Uncontrolled anger.

What questions should I ask my healthcare provider?

If you have PMDD, you may want to ask your healthcare provider:

  • Why did I get PMDD?
  • What is the best treatment for me?
  • What are the treatment side effects?
  • Should I change my birth control?
  • What lifestyle changes can I make to manage symptoms?
  • Am I at risk for major depression or suicide?
  • What should I do if I feel seriously depressed or suicidal?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

PMDD is a serious disorder that can negatively affect your life, relationships and career. Women with PMDD may harm themselves or others. If you consistently experience severe depression and anxiety or other PMDD symptoms in the weeks leading up to your period, seek help from your healthcare provider. Medications can get hormone or serotonin levels in check so that you feel more like yourself. PMDD isn’t a problem you have to live with. Don’t put off getting the medical and mental health care you need.

Last reviewed by a Cleveland Clinic medical professional on 11/23/2020.

References

  • American Academy of Family Physicians (AAFP). Premenstrual Dysphoric Disorder. (https://familydoctor.org/condition/premenstrual-dysphoric-disorder/) Accessed 11/13/2020.
  • International Association for Premenstrual Disorders. What Is PMDD? (https://iapmd.org/about-pmdd) Accessed 11/13/2020.
  • Planned Parenthood. What Is Premenstrual Dysphoric Disorder (PMDD)? (https://www.plannedparenthood.org/learn/health-and-wellness/menstruation/what-premenstrual-dysphoric-disorder-pmdd) Accessed 11/13/2020.
  • U.S. Department of Health and Human Services (HHS) Office on Women’s Health. Premenstrual Dysphoric Disorder (PMDD). (https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd) Accessed 11/13/2020.

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Doctor’s Notes on Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is the severe form of premenstrual syndrome (PMS). The signs and symptoms are the same as for PMS, but they are severe enough to interfere with daily living and often need physician-directed treatment. Premenstrual syndrome (also termed PMS) is a syndrome that has monthly cycles of symptom changes in mood and behavior and/or physical functioning. Signs and symptoms of mood changes include

  • anxiety,
  • nervousness,
  • mood swings,
  • irritability,
  • depression,
  • forgetfulness,
  • confusion,
  • insomnia, and/or
  • hostility.

Behavior signs and symptoms include

  • increased eating,
  • cravings for sweets,
  • crying,
  • poor concentration and sensitivity to noise changes, and
  • alcohol tolerance.

Physical function signs and symptoms include

  • headache,
  • heart palpitations,
  • fatigue,
  • dizziness,
  • weight gain,
  • bloating,
  • breast swelling and/or tenderness,
  • constipation, or
  • diarrhea.

The syndrome usually occurs immediately after an egg is released from the ovary and may last from day 14 through day 28 for a normal menstrual cycle with day one being that her period starts. Some individuals may have signs and symptoms extend into the period. Most women who have PMS have mild enough symptoms that they may treat them at home. When the above symptoms become severe enough to interfere with daily living, the patient has premenstrual dysphoric disorder (PMDD). PMDD may lead to severe depression and suicidal thoughts (a medical emergency).

PMDD is thought to be caused by the complex changing of hormone levels during the luteal phase of the menstrual cycle (for example, the brain chemical serotonin, which has many functions including mood control and sensitivity to pain, is reduced in some women with PMS and PMDD.

What Are the Treatments for Premenstrual Dysphoric Disorder (PMDD)?

The treatments of PMDD are similar to PMS, but the symptoms may need physician-directed treatments over time and emergency intervention if the patient exhibits self-destructive behaviors. However, the following is a list of treatments that may control or reduce symptoms over time:

  • Decrease sugar, salt, caffeine, and alcohol intake.
  • Exercise regularly.
  • Increase protein and carbohydrates.
  • Practice stress management.
  • Vitamins like B6
  • Calcium and magnesium supplements
  • Anti-inflammatory medicines like NSAIDs
  • Antidepressants: fluoxetine, sertraline, for example
  • Diuretics: spironolactone
  • Combined estrogen and progesterone birth-control pills can prevent mittelschmerz and thus painful ovulation.

Your ob-gyn may also recommend support groups.

What is premenstrual dysphoric disorder (PMDD)?

What causes PMDD?

What are the risk factors for PMDD?

While any woman can develop PMDD, the following may be at 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

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

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 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 the questions you want to be 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.

Premenstrual dysphoric disorder (PMDD) is considered to be a very severe form of premenstrual syndrome (PMS) in women that produces symptoms severe enough to interfere with daily functioning.

Signs and symptoms of PMDD include

  • breast pain,
  • pelvic pain,
  • mood swings,
  • sadness,
  • anger,
  • anxiety,
  • hopelessness,
  • panic attack,
  • excess sleepiness or insomnia,
  • irritability or crying,
  • appetite changes,
  • bloating, or
  • depression.

Symptoms vary and can also include

  • diminished interest in usual activities,
  • economic or social dysfunction due to symptoms,
  • fatigue,
  • feeling overwhelmed,
  • food cravings,
  • headache,
  • a lack of concentration, and
  • self-critical thoughts.

Cause of premenstrual dysphoric disorder

Doctors do not understand the exact cause of PMDD or PMS, and both genetic and environmental factors may have a role in its development.

Other premenstrual dysphoric disorder symptoms and signs

  • Anger
  • Anxiety
  • Appetite Changes
  • Bloating
  • Breast Pain
  • Depression
  • Diminished Interest in Usual Activities
  • Economic or Social Dysfunction Due to Symptoms
  • Excess Sleepiness or Insomnia
  • Fatigue
  • Feeling Overwhelmed
  • Food Cravings
  • Headache
  • Hopelessness
  • Irritability or Crying
  • Lack of Concentration
  • Mood Swings
  • Panic Attack
  • Pelvic Pain
  • Sadness
  • Self-Critical Thoughts

How to identify the symptoms of premenstrual dysphoric disorder

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Main Article on Premenstrual Dysphoric Disorder Symptoms and Signs

  • How to identify the symptoms of premenstrual dysphoric disorder

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is considered a severe form of premenstrual syndrome (PMS). PMDD has also been referred.

How to identify the symptoms of premenstrual dysphoric disorder

SLIDESHOW

Pictures, Images, Illustrations & Quizzes

  • How to identify the symptoms of premenstrual dysphoric disorder

Premenstrual Dysphoric Disorder PMDD Quiz

Premenstrual dysphoric disorder (PMDD) can be serious and debilitating for some women. The good news is that women do not have to.

How to identify the symptoms of premenstrual dysphoric disorder

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How to identify the symptoms of premenstrual dysphoric disorder

Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome. Although it is similar to premenstrual syndrome (PMS), it comparatively leads to more serious symptoms. PMDD causes severe anxiety, depression and irritability, followed by sudden mood swings almost a week prior to the start of the menstrual period. Symptoms usually disappear within two to three days after menstruation starts.

Overview

Mild PMS is common. It affects nearly 75 percent of women having regular menstrual cycles; however, PMDD affects only 3 to 8 percent of women. This condition can occur in women of any cultural, socioeconomic, or ethnic background. PMDD is usually seen as a chronic condition and can have a disturbing and severe impact on the quality of a woman’s life.

Luckily with the help of treatment, most women having PMDD get relief from the symptoms and are able to enjoy life more fully. Talking to a mental health professional or joining a support group might also help in relieving the psychological symptoms of PMDD.

How to identify the symptoms of premenstrual dysphoric disorder

Who gets Premenstrual Dysphoric Disorder ?

PMDD occurs in around 5 percent of women of childbearing age. Many women with PMDD may suffer from depression or anxiety.

Studies have shown an association between PMDD and low levels of serotonin which is a chemical in the brain that helps in the transmission of nerve signals. Many brain cells that use serotonin also control attention, mood, pain, and sleep. Hormonal changes may become a cause of decline in the level of serotonin, leading to PMDD symptoms.

Signs and symptoms of Premenstrual Dysphoric Disorder (PMDD?)

The symptoms of PMDD usually appear a week before you start your period and last for a few days following the beginning of it. Most of the time they are severe and distressing, and they can keep you from regular activities.

Symptoms of PMDD include:

  • Anxiety, depression or feelings of hopelessness
  • Mood swings
  • Intense aggression and conflicts with others
  • Tension and irritability
  • Loss of interest in your usual activities
  • Concentration issues
  • Fatigue
  • Sudden changes in appetite
  • Feeling overwhelmed or out of control
  • Sleeping problems
  • Cramps and abdominal bloating
  • Breast soreness
  • Migraines and headaches
  • Hot flashes
  • Joint or muscle pain

What causes Premenstrual Dysphoric Disorder (PMDD)?

The exact cause of PMDD and PMS is still unknown.

It is believed that PMDD occurs due to the abnormal response of brain to a woman’s fluctuation of hormones during the menstrual cycle. Consequently this could lead to an insufficiency in the neurotransmitter serotonin.

However some women are more likely than others to experience PMDD, involving those who have had a personal or family history of depression, postpartum depression or mood disorders.

How is Premenstrual Dysphoric Disorder (PMDD) diagnosed?

The symptoms of PMDD can be similar to those of the other psychological conditions, so health care providers will possibly perform a physical exam, ask for a complete medical history, and ask for specific tests to find out other conditions while making a diagnosis.

A symptom chart is also used in the process of diagnosis to determine any association between the symptoms and the menstrual cycle.

Guidelines from the Diagnostic and Statistical Manual 5th Edition (DSM-V) and American Psychiatric Association (APA) require that the symptoms of PMDD should be there for a minimum of two consecutive menstrual cycles before making a diagnosis of PMDD.

According to the given guidelines, symptoms must:

  • be there for a week before the onset of periods
  • resolve after the start and within the first few days of periods
  • disturb normal daily living

For a PMDD diagnosis, a patient must experience at least five symptoms, including at least one of the following:

  • feelings of hopelessness or sadness
  • feelings of tension or anxiety
  • increased sensitivity or mood swings
  • feelings of irritability or aggression

Other symptoms of PMDD can involve:

  • lethargy to routine activities, which may be linked with social withdrawal
  • concentration issues
  • exhaustion
  • changes in appetite
  • sleep problems, (insomnia or hypersomnia)
  • feeling as being overwhelmed or having a sense of a lack of control

Other physical symptoms of PMDD involve:

  • Breast tenderness or swelling.
  • Headaches or muscular pain,
  • Bloating, and weight gain.

How Premenstrual Dysphoric Disorder (PMDD) is treated?

Two types of medications to deal with PMDD impact the central nervous system (CNS) and those that affect ovulation, for example:
• SSRI(s) / anti-depressants such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa)
• Oral contraceptives containing drospirenone and Ethinyl estradiol
• Gonadotropin-releasing hormone analogs such as leuprolide (Lupron), nafarelin (Synarel), and goserelin (Zoladex)

Psychological treatment for PMDD that may be helpful is cognitive behavioral therapy (CBT).

Dietary changes include:

  • limiting your alcohol, salt, caffeine, and sugar intake
  • Increasing protein and the intake of complex carbs

Exercising and stress management techniques might help in viewing the menstrual cycle in a positive way.

How to identify the symptoms of premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) is a health problem that is similar to premenstrual syndrome (PMS) but is more serious. PMDD causes severe irritability, depression, or anxiety in the week or two before your period starts. Symptoms usually go away two to three days after your period starts. You may need medicine or other treatment to help with your symptoms.

What is PMDD?

PMDD is a condition similar to PMS that also happens in the week or two before your period starts as hormone levels begin to fall after ovulation. PMDD causes more severe symptoms than PMS, including severe depression, irritability, and tension.

Who gets PMDD?

PMDD affects up to 5% of women of childbearing age. 1 Many women with PMDD may also have anxiety or depression. 2

What are the symptoms of PMDD?

Symptoms of PMDD include: 3

  • Lasting irritability or anger that may affect other people
  • Feelings of sadness or despair, or even thoughts of suicide
  • Feelings of tension or anxiety
  • Panic attacks
  • Mood swings or crying often
  • Lack of interest in daily activities and relationships
  • Trouble thinking or focusing
  • Tiredness or low energy
  • Food cravings or binge eating
  • Trouble sleeping
  • Feeling out of control
  • Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain

What causes PMDD?

Researchers do not know for sure what causes PMDD or PMS. Hormonal changes throughout the menstrual cycle may play a role. A brain chemical called serotonin may also play a role in PMDD. Serotonin levels change throughout the menstrual cycle. Some women may be more sensitive to these changes.

How is PMDD diagnosed?

Your doctor will talk to you about your health history and do a physical examination. You will need to keep a calendar or diary of your symptoms to help your doctor diagnose PMDD.

You must have five or more PMDD symptoms, including one mood-related symptom, to be diagnosed with PMDD.

How is PMDD treated?

Treatments for PMDD include:

  • Antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs change serotonin levels in the brain. The Food and Drug Administration (FDA) approved three SSRIs to treat PMDD: 4
    • Sertraline
    • Fluoxetine
    • Paroxetine HCI
  • Birth control pills. The FDA has approved a birth control pill containing drospirenone (droh-SPIR-uh-nohn) and ethinyl estradiol (ETH-uh-nil es-truh-DEYE-ohl), to treat PMDD.
  • Over-the-counter pain relievers may help relieve physical symptoms, such as cramps, joint pain, headaches, backaches, and breast tenderness. These include:
    • Ibuprofen
    • Naproxen
    • Aspirin
  • Stress management, such as relaxation techniques and spending time on activities you enjoy 5

Making healthy changes, such as eating a healthy combination of foods across the food groups, cutting back on salty and sugary foods, and getting more physical activity, may also help relieve some PMDD symptoms. But PMDD can be serious enough that some women should go to a doctor or nurse to discuss treatment options. And, if you are thinking of hurting yourself or others, call 911 right away.

Premenstrual dysphoric disorder (PMDD) is considered to be a very severe form of premenstrual syndrome (PMS) in women that produces symptoms severe enough to interfere with daily functioning.

Signs and symptoms of PMDD include

  • breast pain,
  • pelvic pain,
  • mood swings,
  • sadness,
  • anger,
  • anxiety,
  • hopelessness,
  • panic attack,
  • excess sleepiness or insomnia,
  • irritability or crying,
  • appetite changes,
  • bloating, or
  • depression.

Symptoms vary and can also include

  • diminished interest in usual activities,
  • economic or social dysfunction due to symptoms,
  • fatigue,
  • feeling overwhelmed,
  • food cravings,
  • headache,
  • a lack of concentration, and
  • self-critical thoughts.

Cause of premenstrual dysphoric disorder

Doctors do not understand the exact cause of PMDD or PMS, and both genetic and environmental factors may have a role in its development.

Other premenstrual dysphoric disorder symptoms and signs

  • Anger
  • Anxiety
  • Appetite Changes
  • Bloating
  • Breast Pain
  • Depression
  • Diminished Interest in Usual Activities
  • Economic or Social Dysfunction Due to Symptoms
  • Excess Sleepiness or Insomnia
  • Fatigue
  • Feeling Overwhelmed
  • Food Cravings
  • Headache
  • Hopelessness
  • Irritability or Crying
  • Lack of Concentration
  • Mood Swings
  • Panic Attack
  • Pelvic Pain
  • Sadness
  • Self-Critical Thoughts

How to identify the symptoms of premenstrual dysphoric disorder

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Health concerns on your mind?
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Main Article on Premenstrual Dysphoric Disorder Symptoms and Signs

  • How to identify the symptoms of premenstrual dysphoric disorder

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is considered a severe form of premenstrual syndrome (PMS). PMDD has also been referred.

How to identify the symptoms of premenstrual dysphoric disorder

SLIDESHOW

Pictures, Images, Illustrations & Quizzes

  • How to identify the symptoms of premenstrual dysphoric disorder

Premenstrual Dysphoric Disorder PMDD Quiz

Premenstrual dysphoric disorder (PMDD) can be serious and debilitating for some women. The good news is that women do not have to.

How to identify the symptoms of premenstrual dysphoric disorder

Premenstrual Syndrome (PMS): Track and Prevent Symptoms

Premenstrual Syndrome (PMS) can cause from mood swings, munchies, and more. Learn about the symptoms, causes and treatments of.

Affiliations

  • 1 Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China.
  • 2 National Key Subject of TCM Psychology, State Administration of Traditional Chinese Medicine, Jinan, Shandong Province, China.
  • 3 Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
  • 4 School of Preclinical Medical Sciences, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China.
  • 5 The Affiliated Hospital of Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi Province, China.
  • 6 The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
  • 7 The Central Hospital of Jinan City, Jinan, Shandong Province, China.
  • 8 Department of Psychology, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
  • PMID: 28698873
  • PMCID: PMC5494079
  • DOI: 10.1155/2017/4595016

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Authors

Affiliations

  • 1 Key Laboratory of Traditional Chinese Medicine for Classical Theory, Ministry of Education, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China.
  • 2 National Key Subject of TCM Psychology, State Administration of Traditional Chinese Medicine, Jinan, Shandong Province, China.
  • 3 Laboratory of Ethnopharmacology, Institute of Integrated Traditional Chinese and Western Medicine, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
  • 4 School of Preclinical Medical Sciences, Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China.
  • 5 The Affiliated Hospital of Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi Province, China.
  • 6 The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
  • 7 The Central Hospital of Jinan City, Jinan, Shandong Province, China.
  • 8 Department of Psychology, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
  • PMID: 28698873
  • PMCID: PMC5494079
  • DOI: 10.1155/2017/4595016

Abstract

We performed an epidemiological investigation of subjects with premenstrual dysphoric disorder (PMDD) to identify the clinical distribution of the major syndromes and symptoms. The pathogenesis of PMDD mainly involves the dysfunction of liver conveyance and dispersion. Excessive liver conveyance and dispersion are associated with liver-qi invasion syndrome, while insufficient liver conveyance and dispersion are expressed as liver-qi depression syndrome. Additionally, a nonconditional logistic regression was performed to analyze the symptomatic features of liver-qi invasion and liver-qi depression. As a result of this analysis, two subtypes of PMDD are proposed, namely, excessive liver conveyance and dispersion (liver-qi invasion syndrome) and insufficient liver conveyance and dispersion (liver-qi depression syndrome). Our findings provide an epidemiological foundation for the clinical diagnosis and treatment of PMDD based on the identification of different types.

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How to identify the symptoms of premenstrual dysphoric disorder

How to identify the symptoms of premenstrual dysphoric disorder How to identify the symptoms of premenstrual dysphoric disorder

How to identify the symptoms of premenstrual dysphoric disorder

What is premenstrual dysphoric disorder (PMDD)?

PMDD is a severe form of a common problem called premenstrual syndrome, or PMS. About 75% of women of childbearing age have some PMS problems. About 2% to 10% of women in this age group have PMDD.

Symptoms of PMDD

Many women may wonder if they have PMS or if it is PMDD because the symptoms are similar. The symptoms for both begin about 10-14 days before your period. But the symptoms of PMDD are more extreme and can spill over into other areas of your life. You may feel they are uncontrollable.

The symptoms of PMS and PMDD are:

  • Sadness and crying
  • Feeling nervous or anxious
  • Anger or irritability
  • Strong cravings for certain foods
  • Problems paying attention and concentrating
  • Fatigue
  • Physical problems such as breast tenderness, headaches, joint or muscle pain, and swelling or bloating
  • Trouble sleeping

It is largely the emotional symptoms that are more severe when you have PMDD. You may have more severe depression symptoms, irritability and tension, according to the National Institutes of Health (NIH).

These symptoms can affect your relationships and ability to do your job. If you have some of these symptoms a few weeks before your period and they improve when your period starts, you may have PMDD.

What causes PMDD?

The exact cause of PMDD is not known. Changes in hormones related to your period may cause PMDD.

How is PMDD diagnosed?

Your doctor will check your symptoms and the way they relate to your menstrual cycle. You might fill out a symptom chart for several weeks. There is no test that can diagnose PMDD.

To help diagnose PMDD, your family doctor may ask you to chart your symptoms (see sample chart below).

How to identify the symptoms of premenstrual dysphoric disorder

Daily Symptom Report

Severity scoring for each symptom:

1= Minimal or slightly apparent to you

2 = Moderate, awareness of symptom but does not affect your daily routine

3 = A lot, continuously bothered by the symptom and/or symptoms interferes with your daily routine

4 = Severe, symptom is overwhelming and/or unable to carry out your daily routine

Day 1 is first day of menses

Adapted with permission from Freeman EW, DeRubeis RJ, Rickels K. Reliability and validity of a daily diary for premenstrual syndrome. Psychiatry Res 1996; 65:97-106.

Can PMDD be prevented or avoided?

Stressful life events and a family history of PMS or PMDD may increase your chances of getting PMDD. Major depression is common in women who have PMDD. However, not all women who have PMDD have major depression.

PMDD treatment

Your doctor will ask you about your symptoms and will discuss different treatments with you. For mild to moderate symptoms, your doctor may suggest changes in your diet and lifestyle. You might talk to a counselor about your PMDD symptoms and life stresses. Medicines may help with severe symptoms.

What medicines are helpful?

Certain medicines used to treat depression also treat PMDD. Selective serotonin reuptake inhibitors (SSRIs) help by increasing the effect of a brain chemical called serotonin. Using these medicines can even help ease fatigue, food cravings, and sleep problems.

Does that mean I have depression?

No. SSRIs work for both conditions.

How often do I have to take these medicines?

Some of these medicines you take for 10 to 14 days before each period.

What if these medicines do not work?

Your doctor knows about other treatments. After talking with you, your doctor might have you try something else.

Living with PMDD

Trying to cope with the severe symptoms of PMDD without treatment can make you miserable. It can also make those around you miserable.

Do not feel as though it is up to you to manage PMDD by yourself. Your symptoms are real and you are not alone. If you believe you have PMDD, the best thing you can do is talk to your doctor.

PMS (premenstrual syndrome) is the name for the symptoms women can experience in the weeks before their period. Most women have PMS at some point. You can get help if it affects your daily life.

Symptoms of PMS

Each woman’s symptoms are different and can vary from month to month.

The most common symptoms of PMS include:

  • mood swings
  • feeling upset, anxious or irritable
  • tiredness or trouble sleeping
  • bloating or tummy pain
  • breast tenderness
  • headaches
  • spotty skin
  • greasy hair
  • changes in appetite and sex drive

Things you can do to help

eat a healthy, balanced diet – you may find that eating frequent smaller meals (every 2-3 hours) suits you better than eating 3 larger meals a day

get plenty of sleep – 7 to 8 hours is recommended

try reducing your stress by doing yoga or meditation

take painkillers such as ibuprofen or paracetamol to ease the pain

keep a diary of your symptoms for at least 2 to 3 menstrual cycles – you can take this to a GP appointment

do not drink too much alcohol

Non-urgent advice: See a GP if:

  • things you can do to help are not working
  • your symptoms are affecting your daily life

A GP can advise you on treatments that can help.

Treating PMS

As well as changes to your lifestyle, a GP can recommend treatments including:

  • hormonal medicine – such as the combined contraceptive pill
  • cognitive behavioural therapy – a talking therapy
  • antidepressants
  • dietary supplements

If you still get symptoms after trying these treatments, you may be referred to a specialist.

This could be a gynaecologist, psychiatrist or counsellor.

Complimentary therapies and dietary supplements

Complimentary therapies and dietary supplements may help with PMS, but the evidence of their effectiveness is limited.

They can include:

  • acupuncture
  • reflexology
  • supplements such as vitamin B6, calcium and vitamin D and magnesium (check with a GP or pharmacist if you are also taking medicines before starting to take regular supplements)

Causes of PMS

It’s not fully understood why women get PMS.

But it may be because of changes in their hormone levels during the menstrual cycle.

Some women may be more affected by these changes than others.

Premenstrual dysphoric disorder (PMDD)

A small number of women may experience more severe symptoms of PMS known as premenstrual dysphoric disorder (PMDD).

Symptoms of PMDD are similar to PMS but are much more intense and can have a much greater negative impact on your daily activities and quality of life.

Symptoms can include:

  • physical symptoms such as cramps, headaches and joint and muscle pain
  • behavioural symptoms such as binge eating and problems sleeping
  • mental and emotional symptoms, such as feeling very anxious, angry, depressed or, in some cases, even suicidal

If you need urgent advice you can:

  • call a GP and ask for an emergency appointment
  • call 111 out of hours (they will help you find the support and help you need)
  • call a helpline, such as the Samaritans (call free on 116 123)

If you feel that you may be about to harm yourself, call 999 for an ambulance or go straight to A&E. Or you can ask someone else to call 999 or take you to A&E.

The exact causes of PMDD are unknown but it has been linked to sensitivity to changes in hormones or certain genetic variations (differences in genes) you can inherit from your parents.

Page last reviewed: 09 June 2021
Next review due: 09 June 2024

Premenstrual dysphoric disorder (PMDD) causes emotional and physical symptoms far beyond those of PMS.

How to identify the symptoms of premenstrual dysphoric disorder

Amanda Gardner is a freelance health reporter whose stories have appeared in cnn.com, health.com, cnn.com, WebMD, HealthDay, Self Magazine, the New York Daily News, Teachers & Writers Magazine, the Foreign Service Journal, AmeriQuests (Vanderbilt University) and others. In 2009, she served as writer-in-residence at the University of Wisconsin School of Medicine and Public Health. She is also a community artist and recipient or partner in five National Endowment for the Arts grants.

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Premenstrual dysphoric disorder (PMDD) is the more severe cousin of premenstrual syndrome (PMS). While some 75% of women report having mild PMS symptoms like bloating, irritability, and fatigue, PMDD rests on the other end of the spectrum, causing debilitating emotional and physical symptoms that can interfere with daily life in about 5% of women. Typically, mood symptoms are the most dominant in PMDD, and in 2013, PMDD was added to the diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the medical “bible” used by doctors to diagnose and treat mental health conditions.

“PMS is a milder form and PMDD is diagnostic, the more severe form,” says Kara McElligott, MD, an obstetrician and gynecologist at Duke Health in Durham. “The difference is how it affects quality of life. For some people it’s debilitating. Adding it to the DSM made it a diagnosis. You can’t dismiss it.”

PMDD causes

No one really knows what causes PMDD or why some women get milder PMS while others end up with PMDD. Clearly, both are related to hormonal changes that occur during your menstrual cycle, but it may not be the hormones themselves causing PMDD. In fact, estrogen and progesterone levels are similar in women with PMS and women with PMDD.

Some research suggests that fluctuations in hormones influence a chemical in the brain called serotonin, which is important in determining mood. “The notion is that it’s not simply hormones or hormone levels but an interaction between changes in hormone levels and the human brain,” says Kimberly Yonkers, MD, a member of the PMDD subcommittee of the DSM-5 Task Force and a professor of psychiatry at Yale School of Medicine. “Some people are vulnerable while some people are not, just like some people are vulnerable to depression or anxiety.”

Many women with PMDD may also have depression and anxiety, conditions that can involve altered serotonin, too.

PMDD symptoms

Symptoms of PMDD usually show up about a week before your period and go away two to three days after bleeding starts.

Not surprisingly, given that PMDD is now on the list of mental disorders, emotional symptoms like mood swings and anxiety tend to be the most pronounced.

“The reason that PMDD is in the DSM-5 is because of the emotional symptoms,” says Dr. Yonkers. “For example, obligatory symptoms for PMDD are mood symptoms like low mood, anger, and irritability, which are not obligatory for PMS.”

In order to be diagnosed with PMDD, you have to experience at least five PMDD symptoms, including one mood symptom. PMDD symptoms include:

  • Depressed mood
  • Anger or irritability
  • Trouble concentrating
  • Lack of interest in activities you once enjoyed
  • Mood swings
  • Appetite changes
  • Trouble sleeping
  • Low energy
  • Feeling out of control or overwhelmed

Women may also have physical symptoms like hot flashes, breast tenderness, bloating, and cramps. PMDD is diagnosed when these symptoms interfere with work, school, or relationships–or otherwise keep you from daily activities.

PMDD treatment

Many of the strategies used to treat PMDD are similar to treatments for PMS, often starting with some kind of hormonal regulation of your cycle.

“We do know the trigger is the hormonal fluctuations, so it makes sense physiologically that the first-line treatment is stabilizing hormonal fluctuations in your cycle,” says Dr. McElligott.

This is typically done using oral contraceptives, particularly those containing drospirenone (Yaz) and ethinyl estradiol, which are approved by the FDA specifically to treat PMDD. Instead of taking the pills for three weeks, then breaking for a week, women with PMDD often take birth control pills without any breaks (or with shorter breaks).

Antidepressants, particularly those known as selective serotonin reuptake inhibitors (SSRIs), which modulate serotonin levels in your brain, are increasingly used for both PMS and PMDD. Three are approved to treat PMDD: fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil).

“They can be administered for half of the menstrual cycles or even at symptom onset,” says Dr. Yonkers. She and her colleagues published a study showing that even when women take them for just three to five days, SSRIs helped. “There’s this immediacy of action that’s unique for PMDD,” she says.

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Lifestyle strategies can also help treat PMDD. Start by getting regular exercise, managing stress, and limiting high-salt and high-sugar foods, caffeine, and alcohol.

Those healthy habits can help you feel better overall, Dr. McElligott says. “The symptoms you’re experiencing are triggered by some hormonal fluctuation, but at baseline, if you’re feeling really good, then it’s not going to hit you as much.”

Some women also find relief for symptoms like breast tenderness or headaches in aspirin and other over-the-counter pain relievers.

“Most women will find relief but not a cure, so I think that there’s still more work to be done,” Dr. Yonkers says. “Right now, we are borrowing from other conditions [like depression]. There’s a lack of treatments that have specifically been engineered for PMDD. Understanding the basic biology will lead to additional treatments.”

Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS).

PMS refers to a wide range of physical or emotional symptoms that most often occur about 5 to 11 days before a woman starts her monthly menstrual cycle. In most cases, the symptoms stop when, or shortly after, her period begins.

Causes

The causes of PMS and PMDD have not been found.

Hormone changes that occur during a woman’s menstrual cycle may play a role.

PMDD affects a small number of women during the years when they are having menstrual periods.

Many women with this condition have:

Other factors that may play a role include:

  • Alcohol or substance abuse
  • Thyroid disorders
  • Being overweight
  • Having a mother with a history of the disorder
  • Lack of exercise

Symptoms

The symptoms of PMDD are similar to those of PMS. However, they are very often more severe and debilitating. They also include at least one mood-related symptom. Symptoms occur during the week just before menstrual bleeding. They most often get better within a few days after the period starts.

Here is a list of common PMDD symptoms:

  • Lack ofВ interest in daily activities and relationships
  • Fatigue or low energy
  • Sadness or hopelessness, possibly thoughts of suicide
  • Anxiety
  • Out of control feeling
  • Food cravings or binge eating
  • Mood swings with bouts of crying
  • Panic attacks
  • Irritability or anger that affects other people
  • Bloating, breast tenderness, headaches, and joint or muscle pain
  • Problems sleeping
  • Trouble concentrating

Exams and Tests

No physical exam or lab tests can diagnose PMDD. A complete history, physical exam (including a pelvic exam), thyroid testing, and psychiatric evaluation should be done to rule out other conditions.

Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times when they are likely to occur. This information may help your health care provider diagnose PMDD and determine the best treatment.

Treatment

A healthy lifestyle is the first step to managing PMDD.

  • Eat healthy foods with whole grains, vegetables, fruit, and little or no salt, sugar, alcohol, and caffeine.
  • Get regular aerobic exercise throughout the month to reduce the severity of PMS symptoms.
  • If you have problems sleeping, try changing your sleep habits before taking medicines for insomnia.

Keep a diary or calendar to record:

  • The type of symptoms you are having
  • How severe they are
  • How long they last

Antidepressants may be helpful.

The first option is most often an antidepressant known as a selective serotonin-reuptake inhibitor (SSRI). You can take SSRIs in the second part of your cycle up until your period starts. You may also take it the whole month. Ask your provider.

Cognitive behavioral therapy (CBT) may be used either with or instead of antidepressants. During CBT, you have about 10 visits with a mental health professional over several weeks.

Other treatments that may help include:

  • Birth control pills typically help reduce PMS symptoms. Continuous dosing types are most effective, especially those that contain a hormone called drospirenone.В With continuous dosing, you may not get a monthly period.
  • Diuretics may be useful for women who have significant short-term weight gain from fluid retention.
  • Other medicines (such as Depo-Lupron) suppress the ovaries and ovulation.
  • Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramps, and breast tenderness.

Most studies have shown that nutritional supplements, such as vitamin B6, calcium, and magnesium are not helpful in relieving symptoms.

It’s a very severe form of PMS.

How to identify the symptoms of premenstrual dysphoric disorder

How to identify the symptoms of premenstrual dysphoric disorder

PMDD, or premenstrual dysphoric disorder, is not your average bout of PMS. Cramps, mood swings, sore boobs, tiredness – around 90% of people with uteruses experience PMS to some extent, and there are more than 100 symptoms on record.

It can feel like armageddon in your lower belly at the time, but can often be solved by taking painkillers and indulging in some self care without any major inconvenience. PMDD is not so simple, however. For sufferers of premenstrual dysphoric disorder, pre-period symptoms can become so severe that they start to impact every single area of their life.

“Up to one million women in the UK are affected with the most severe form of PMS, called premenstrual dysphoric disorder (PMDD),” Dr Nick Panay, consultant gynaecologist and chairman of the National Association for Premenstrual Syndrome, tells Cosmopolitan. “That’s around 5-10% of the population.

“The most distressing and common symptoms include: mood swings, depression, irritability, symptoms of aggression and loss of self-confidence.”

You may think these symptoms sound familiar, but women with PMDD have them much worse than most – to the extent that in extreme cases, some women attempt suicide.

Just recently in the news, Great British Bake Off winner John Whaite appealed to help find his sister, Victoria Cunningham, who has gone missing in Portugal. As he explains in a video on Twitter, Victoria’s diagnosis of PMDD (along with depression) means she may be a risk to herself.

“She has been diagnosed by a consultant specialist in the field of female hormonal health as having PMDD, or premenstrual dysphoric disorder, which is a disorder whereby she will go pretty much insane during the week before and during the week of her period,” John explains in the video.

“A result of these illnesses is that she sometimes goes on binges of drink and drugs, during which she will often show signs of self-harm and attempt suicide. She is vulnerable and at risk to herself.”

Sophie Claus, who has blogged about living with PMDD since her diagnosis in 2016, says the hardest thing about having the condition is lack of understanding.

“It’s so easily passed off as ‘time of the month’,” she says. “The lack of awareness means there are so many inconsistencies in the way women are treated, many being investigated for mental health disorders initially, thus delaying the correct treatment.

“I have worked out that throughout 2014, 2015 and 2016 [when she was eventually diagnosed] my family, friends and work lost me for at least 12 weeks each year. That’s 12 weeks each year where the world would just stop for me, where I would just shut down, I wouldn’t talk, eat, go to work or see my friends.”

How to identify the symptoms of premenstrual dysphoric disorder

When she first tried to get help for her symptoms, Sophie was referred to a mental health team and incorrectly diagnosed with delayed PTSD.

“The realisation hit me after speaking to my female friends about how I felt – none of them seemed to be experiencing the extremities and symptoms that I was, nor did any of them feel relief when their period started, they felt quite the opposite.”

“I remember sitting on the floor, with my mood diary and work absence logs spread-out, and I just sat there joining all the dots together. When I eventually read about severe PMS/PMDD, I sobbed. It wasn’t just me, I wasn’t going insane and no longer did I feel so alone.

“My advice to anyone who thinks they might have PMDD is to track your symptoms,” Sophie adds. “I recorded my symptoms, dates I was ovulating, dates I began to feel awful and the date and time I started to feel better, as well as the date my period started. Then speak to your GP – I asked to see one with an understanding of premenstrual disorders.”

How to identify the symptoms of premenstrual dysphoric disorder

“Ideally, PMS is diagnosed through a symptom diary although often, when we first see patients, we initially have to rely on retrospective recall,” Dr Nick agrees.

“If women keep a symptom diary it will clearly show the fluctuations in symptoms through the months. There may be background symptoms throughout the month, but the key factor is whether there is a worsening of symptoms premenstrually. Although the first stop should be primary care (your GP), referral to a specialist PMS clinic may be required.”

The cause of PMDD is currently unknown, but with so many women affected, researchers are working hard to find answers so that they can provide more tailored help.

“There is interesting work taking place at Harvard, in the USA, trying to unravel the genetics of why some women are vulnerable to PMS whereas others, with the same hormone changes, don’t seem to suffer symptoms,”
says Nick.

“The work is looking at the way the oestrogen receptors are coded in PMDD, the most severe form of PMS. A recent breakthrough has led to the discovery of a PMDD gene and work is continuing to further characterise this and develop a diagnostic test.”

In the meantime, Sophie suggests joining a group specifically tailored for women with PMDD.

“I found these invaluable,” she says. “Speaking to other women who are going through the same thing is such a huge support.”

Most women of reproductive age are well aware of premenstrual symptoms. Premenstrual syndrome, also known as PMS, includes changes in mood as well as physical signs that occur in the days to two weeks before a woman’s menstrual period starts. Symptoms typically go away shortly after the period begins.

Premenstrual dysphoric disorder, also known as PMDD, is a more severe form of PMS, affecting about 3–6% of women. PMDD can interfere with daily life and make it hard for a woman to maintain relationships. Women who have had major depression are more likely than others to have PMDD.

Disorders that mimic PMS and PMDD:

  • Mood and anxiety disorders
  • Menopausal transition
  • Thyroid disorders
  • Substance abuse
  • Some medical disorders can worsen before menses (migraines, irritable bowel syndrome, ME-CFS)

Doctors are still searching for the exact cause of premenstrual syndrome or PMDD. Hormone levels are the same in women with or without PMS/PMDD. But it is thought that women with PMS/PMDD have a greater response to the fall in hormones that occurs in the days before a period. There may also be changes in neurotransmitters in the brain. Some women have a genetic risk factor for PMDD. Undiagnosed depression or anxiety can also lead to problems.

PMDD and PMS symptoms are the same, but the severity is different. Physical signs can include fatigue and problems with sleep. Women may also experience joint and muscle pain, headaches and breast tenderness. Temporary weight gain and bloating, changes in appetite and constipation or changes in bowel function can also affect women with premenstrual syndrome.

Premenstrual symptoms can also include tension, anxiety, depression, anger, irritability and feelings of hopelessness. Women may experience crying spells and mood swings, have trouble concentrating or face a desire to withdraw from family and friends. Women with PMDD may feel depressed, extremely anxious, have high levels of irritability, and feel overwhelmed or out of control. Suicidal thoughts may occur with severe depression.

Lifestyle changes and medication can both be used to treat these conditions, and often a combination of these is needed. Women may be able to lessen their symptoms by eating small, frequent meals that are low in salt but high in fruits, vegetables, and whole grains.

Exercise can lessen the symptoms of the syndrome. Aim for a healthy average of 30 minutes a day, five days a week. Stress reduction techniques, healthy sleep habits, and decreased caffeine and alcohol use can also help.

Some women report improvement in symptoms with calcium as well as vitamin D, vitamin E, vitamin B6, and magnesium supplements but there are limited data on the utility of these supplements for PMS and PMDD.

Medications for PMS symptoms include SSRIs, a type of antidepressant that is thought to be the most effective treatment for PMS/PMDD. Some women take the medication every day. It can also be given less frequently, by starting on day 14 of the cycle until day 1 of the period, or by starting on the first day that symptoms develop until the onset of the period. Anti-inflammatory medications such as ibuprofen and naproxen can decrease pain. Birth control pills help regulate hormone levels by blocking ovulation and may make PMS less intense.

PMS is part of life for most women. While the symptoms can be uncomfortable, they should not be life-altering. If you are experiencing PMS symptoms that are affecting your daily life, talk to your doctor to discuss the possibility that you might have PMDD and need treatment.

If your PMS has become so debilitating that you’re struggling to cope, you may be suffering from PMDD. We investigate the crippling effects of this mood disorder and ways you can alleviate symptoms.

How to identify the symptoms of premenstrual dysphoric disorder

For most women of reproductive age, premenstrual symptoms (PMS) are simply part and parcel of the monthly cycle – an inconvenience you could do without, but an anticipated occurrence in the days leading up to your period. Symptoms can include mood swings, sadness or irritability, bloating, abdominal pain, headaches and spotty skin.

For some women, however, the symptoms of PMS can become so severe and disabling, it can drastically affect their quality of life. In these instances, it is known as premenstrual dysphoric disorder (PMDD).

Mr Narendra Pisal, consultant gynaecologist at London Gynaecology, looks at the most common causes of PMDD and explains how to alleviate symptoms:

What is PMDD?

PMDD stands for premenstrual dysphoric disorder. It is characterised by severe psychological and physical symptoms, which start a few days to two weeks before the period and improve during periods. Milder forms of PMDD are also described as premenstrual syndrome (PMS) or premenstrual tension (PMT).

How to identify the symptoms of premenstrual dysphoric disorder

How common is PMDD?

Most women get some symptoms during the premenstrual two-week phase. Around 20 to 30 per cent of women will get significant PMS symptoms, while five to eight per cent of menstruating women are thought to suffer with PMDD.

What causes PMDD?

PMDD is thought to be attributed to hormonal changes caused by ovarian function, affecting the neuroregulators (particularly serotonin) in the brain. With ovulation, the ovaries produce increasing levels of progesterone, while oestrogen levels go down. This is thought to affect the serotonergic pathway in the brain, leading to mood-related symptoms.

How to identify the symptoms of premenstrual dysphoric disorder

How does PMDD differ from PMS?

PMDD is the most severe form of PMS and is characterised by significant mood symptoms. Feelings of anxiety and depression are much more intense and some women may even feel suicidal. Behavioural changes with PMDD may also affect your work and relationships to a significant degree.

PMDD symptoms

Symptoms of PMDD are similar to symptoms of depression, differing only in their cyclical nature and associated physical symptoms. Common symptoms of PMDD include:

  • Mood swings
  • Feelings of extreme anxiety, sadness and increased irritability
  • Depression, with feeling of hopelessness
  • Aggressive, angry feelings
  • Decreased performance in work and sports
  • Lack of concentration and inability to perform to usual standards
  • Poor quality of sleep
  • Possible suicidal feelings
  • Physical symptoms, including abdominal cramps, headaches, breast tenderness and hot flushes

How to identify the symptoms of premenstrual dysphoric disorder

When does PMDD occur?

PMDD symptoms occur up to two weeks before the period starts. Symptoms begin with the onset of ovulation and improve during menstruation. Keeping a symptoms diary and demonstrating the cyclical nature of symptoms with respect to periods is an important part of diagnosis.

Risk factors associated with PMDD

Some women may be more likely to suffer with PMDD than others. Potential risk factors include:

  • A stressful lifestyle
  • A history of depression and anxiety
  • Obesity (a BMI of more than 30)
  • Smoking
  • Genetic risk factors
  • Your age: women between 20 to 35 years have stronger ovulation, and therefore have more symptoms

How to identify the symptoms of premenstrual dysphoric disorder

Treatment for PMDD

If your PMDD symptoms are affecting your well-being, quality of life, work or relationship, it is important to see your GP or gynaecologist. It can be helpful to start keeping a diary of symptoms, which will help your doctor assess the severity and cyclical nature of your symptoms.

Your doctor may suggest going on the contraceptive pill, which evens out the hormonal levels by blocking ovulation. Sometimes, interventions such as cognitive behavioural therapy (CBT) may be helpful. For severe mood-related symptoms, your doctor may suggest taking an SSRI (selective serotonin reuptake inhibitor) medication, which also works as an anti-depressant. Hormonal injections(GnRH) and surgery may be considered in extreme cases.

How to identify the symptoms of premenstrual dysphoric disorder

Self-care tips for managing PMDD

There are several steps you can take to help manage your PMDD symptoms. Keeping a diary of symptoms can help, to allow you to understand the cyclical nature of your symptoms and plan accordingly. The following can also be useful:

✔️ Minimise stress, through lifestyle changes.

✔️ Actively practise mindfulness, yoga and meditation.

✔️ Avoid caffeine and sugar.

✔️ Avoid alcohol.

✔️ Get eight hours of sleep each night.

✔️ Get regular exercise.

✔️ Eat a balanced diet.

✔️ Manage physical symptoms through painkillers, which can also help the severity of psychological symptoms.

✔️ Take vitamin B-6 Pyridoxine – studies are mixed but some show improvement of symptoms (this is available over the counter).

Mood Matters: What you need to know about PREMENSTRUAL DYSPHORIC DISORDER (PMDD) and PREMENSTRUAL SYNDROME

  • What is Premenstrual Syndrome (PMS)?
  • What is Premenstrual Dysphoric Disorder (PMDD)?
  • How prevalent are PMS and PMDD?
  • Who is at risk for developing PMDD?
  • What are the symptoms of PMS and PMDD?
  • What do I need to tell my doctor?
  • What are the treatment options for PMDD?
  • What are the things I need to do to get well?
  • What else can I read about PMDD?
  • Where else can I go to learn more about PMDD?

PMS is characterized by troublesome physical and/or emotional symptoms that are present in the last seven to 10 days of the menstrual cycle (before the menstrual flow).

PMDD is a condition associated with predominantly severe psychological symptoms which cause disruption of the daily lives of affected women. Dysphoria is derived from the Greek word dusphoros, which means hard to bear. The symptoms of PMDD are recurrent. They usually start seven to 10 days before menstruation and decrease within a few days of the onset of menstrual flow. Then, they disappear completely until the next premenstrual phase.

PMS is present in about 30% of women in their child bearing years.

Studies have found that up to 8% of women with PMS meet the criteria for PMDD.

A few studies suggest that women with a personal or family history of postpartum depression,unipolar depression, and mood changes induced by oral contraceptives may be at greater risk of developing PMDD.

Some of the symptoms of PMS include:

  • Bloating
  • Headaches
  • Irritability
  • Weight gain
  • Food cravings
  • Mood swings
  • Fatigue
  • Breast tenderness
  • Tearfulness.

Each affected woman presents a different combination of some of these symptoms, which may also differ from month to month.

Unlike PMS, PMDD symptoms are very severe, completely disrupting the lives of women affected by it. Women diagnosed with PMDD usually present 5 or more of the following symptoms:

  • Very depressed mood, feelings of hopelessness
  • Marked anxiety,tension, feelings of being “on edge”
  • Marked mood shifts (e.g., suddenly feeling tearful orextremely sensitive)
  • Persistent or marked anger or irritability or increased interpersonal conflicts
  • Decreased interest in usual activities (e.g., work,school,friends, hobbies)
  • Difficulty concentrating
  • Fatigue,tiredness, loss of energy
  • Marked change in appetite, overeating, food cravings
  • Insomnia (difficulty sleeping) or sleeping too much
  • Feeling out of control or overwhelmed
  • Physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain, “bloating”, weight gain

These symptoms do not necessarily occur every cycle, but they are present in the majority of the cycles. Some months may be worse than others. For an accurate diagnosis of PMDD, it is important to keep a mood chart for at least two consecutive months.

Also, it is important to have a complete medical evaluation and laboratory tests in order to rule out other possible medical problems

  • Write down symptoms you’ve had and when
  • Write down key personal information
  • Make a list of all medications you are taking
  • Write down questions to ask your doctor
  • Take a family member or friend along

Discuss all of your symptoms with your doctor and describe how they are affecting your life (e.g. depressed mood making it difficult for you to get to work or appointments in time). Your doctor can suggest or provide appropriate therapy.Based on your symptoms, discuss all of the available treatments and medications and their benefits and side effects before making any decisions.

There are three main approaches that can be used to alleviate the symptoms of PMDD:

Stress reduction (e.g., rearranging schedule to decrease stress during the premenstrual week)

Take a daily dose of vitamin B6, calcium (speak with your health care provider about this and other dietary supplements)

Dietary changes: reduce salt, alcohol, caffeine

Reduce or stop smoking

  • Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.
  • Set realistic expectations. Be kind to yourself. Don’t pressure yourself to do everything. Ask for help when you need it.
  • Learn about PMS and PMDD. Empower yourself by learning about your condition.
  • Pay attention to the warning signs. Find out what may trigger your symptoms, or make them worse. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.
  • Get exercise. Physical activity may help reduce symptoms.
  • Maintain an adequate diet. The Canada Food Guide is a useful reference in helping you choose how to eat well.
  • Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but in the long run, they generally worsen symptoms.
  • Get adequate sleep. This is especially important. Speak to your doctor if you are having trouble sleeping.

Concise Guide to Women’s Mental Health. Vivien Burt and Victoria Hendrick. American Psychiatric Publishing Inc., Second Edition, 2001.

DSM-IV-TR– Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Fourth Edition, 2000.

PMDD: A guide to coping with Premenstrual Dysphoric Disorder.

James E. Houston & Lani C. Fujitsubo. New Harbinger Publications, Inc., First Edition, 2000.

Published online by Cambridge University Press: 14 February 2017

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Abstract

Women who experience significant premenstrual symptoms differ in the extent to which these symptoms cause cyclical impairment. This study clarifies the type and number of symptoms that best predict premenstrual impairment in a sample of women undergoing prospective assessment for premenstrual dysphoric disorder (PMDD) in a research setting. Central research goals were to determine (1) which emotional, psychological, and physical symptoms of PMDD are uniquely associated with premenstrual impairment, and (2) how many cyclical symptoms optimally predict the presence of a clinically significant premenstrual elevation of impairment.

A total of 267 naturally cycling women recruited for retrospective report of premenstrual emotional symptoms completed daily symptom reports using the Daily Record of Severity of Problems (DRSP) and occupational, recreational, and relational impairment for 1–4 menstrual cycles ( N = 563 cycles).

Multilevel regression revealed that emotional, psychological, and physical symptoms differ in their associations with impairment. The core emotional symptoms of PMDD were predictors of impairment, but not after accounting for secondary psychological symptoms, which were the most robust predictors. The optimal number of premenstrual symptoms for predicting clinically significant premenstrual impairment was four.

Results enhance our understanding of the type and number of premenstrual symptoms associated with premenstrual impairment among women being evaluated for PMDD in research contexts. Additional work is needed to determine whether cognitive symptoms should receive greater attention in the study of PMDD, and to revisit the usefulness of the five-symptom diagnostic threshold.

Journalist, HuffPost Australia

For many women, the days leading up to their period can be fraught with unwelcome physical and psychological symptoms.

Fluid retention, mood changes, weight gain, breast tenderness and swelling — these are just a few of the unpleasant features that can be associated with the menstrual cycle.

Premenstrual Syndrome (PMS) is so prevalent in women that research shows around 90 percent of women experience at least one symptom of PMS every month and around 50 percent of women identify with having several symptoms.

However, a significant number of menstruating women, between five to eight percent, experience much more severe symptoms during this time — a condition that is now recognised as Premenstrual Dysphoric Disorder, also known as PMDD.

The psychological symptoms of the disorder can be so debilitating that PMDD was recognised as a depressive disorder in the fifth edition of the Diagnostic And Statistical Manual of Mood Disorders (DSM-5), published by the American Psychiatric Association in 2013.

“I see often the worst cases. It’s not unusual for a woman [with PMDD] to come in with a partner, to sit down and start weeping, and say ‘I want everything out. I want my uterus, tubes and ovaries out.'” Director of the WHRIA and Associate Professor of Reproductive Endocrinology at UNSW John Eden told HuffPost Australia.

“That’s often the opening line, that’s how desperate they are. It’s devastating for many, many women. It’s affecting their relationships severely. Many women find it’s difficult, if not impossible, to work. It’s really, really destructive.”

So what exactly is PMDD? Why are some women more likely to experience it than others, and what treatments are available?

What Causes Premenstrual Dysphoric Disorder?

The short answer is, we don’t know definitively. However, experts have been able to determine that there are several key factors involved.

“We certainly don’t have the whole picture. It’s definitely a brain syndrome. Earlier this year [the US National Institutes of Health and the University of North Carolina] found a gene for PMDD. It was clear that these women had a vulnerability that other women didn’t have,” Eden told HuffPost Australia.

“Clearly there’s a brain component, they have a particular mood centre that seems to react to the cycle in an abnormal way,” Eden said.

How to identify the symptoms of premenstrual dysphoric disorder

Eden explained that a woman’s menstrual cycle typically become less regular as they move into their late 30s and 40s. While typically peaks and troughs of estrogen remain the same month-on-month between 20 and 25, as a woman ages her cycle becomes more erratic. This means estrogen levels vary dramatically, setting off the mood centre.

“And then you have what I call the black box, which is everything else in life. Living in a so called post-modern life — too busy, too tired, too much on your plate. All that stuff, greatly emphasises the problem as well.”

“So there we have the triad, this particular type of mood centre and probably genetic vulnerability, the cycle getting much more variable as women go from their 30s towards 50. And the black box, all the other stresses in your life, good or bad,” Eden said.

What Are The Symptoms of PMDD?

“Many of the women I would see would have severe breast pain, headaches, fluid retention and abdominal bloatedness. And that can vary from mild, moderate to severe. From the psychological side, it’s symptoms such as depression, anxiety, rage, anger and confusion,” Eden said.

Sydney based Dr Brad McKay agreed that many of the physical symptoms of PMS are present for PMDD sufferers, though sometimes exacerbated in the latter. He explained that the mood symptoms are really what highlight PMDD, citing symptoms such as feeling really depressed or suicidal, feeling irritable, anxious or stressed out and having a very short fuse.

Rogerio A. Lobo, JoAnn Pinkerton, Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD), The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 4, 1 April 2010, Page E1, https://doi.org/10.1210/jcem.95.4.9998

What are premenstrual syndrome and premenstrual dysphoric disorder?

Premenstrual syndrome, also called PMS, includes both emotional and physical signs and symptoms. It affects a woman for a week or two before the start of her menstrual period. Symptoms go away shortly after her period starts. About 75 percent of women have PMS at some time before menopause.

Premenstrual dysphoric disorder, also called PMDD, is a more severe form of PMS, affecting about 3 to 6 percent of women. PMDD can interfere with daily life and make it hard for a woman to maintain relationships. Women who have had major depression are more likely than others to have PMDD.

What are the signs and symptoms of PMS and PMDD?

PMS and PMDD share the same physical signs and symptoms. The mood symptoms of PMDD, however, predominate and are more severe than those of PMS.

How are PMS and PMDD diagnosed?

PMS and PMDD cannot be diagnosed by blood tests or other laboratory tests. Instead, health care providers rely on a woman’s record of both mood and physical symptoms over two or three menstrual cycles, and when they occur in relation to her period.

For a diagnosis of PMDD, at least five mood symptoms must be present during most cycles in a year. They must interfere with everyday activities or relationships, and improve within a few days of the start of each period.

What causes PMS and PMDD?

Doctors continue to search for the exact causes. Both PMS and PMDD might be related to changes in hormone levels during the menstrual cycle. Levels of brain chemicals called neurotransmitters, such as serontonin, may also play a part in causing PMS. Recent research shows that some women inherit a gene that raises their risk for PMDD. Other possible causes are undiagnosed depression and anxiety problems. If a woman has symptoms that don’t stop shortly after her period starts, she may have another condition, such as depression.

What is the treatment for PMS and PMDD?

PMS and PMDD may be treated with lifestyle changes and medicines (if needed). Some women also take vitamins and minerals. Many women find that a combination of treatments works best.

Lifestyle changes

Eat small, frequent meals.

Cut down on salt and salty foods.

Choose fruits, vegetables, and whole grains.

Eat plenty of high-protein foods.

Try to exercise about 30 minutes a day, most days of the week.

Take steps to reduce stress, such as massage, meditation, and learning to relax.

Get enough sleep.

Decrease caffeine, which may worsen breast tenderness.

Vitamins and minerals

Consuming about 1,200 milligrams of calcium (in food and, if needed, in supplements) might help relieve symptoms. Some doctors also recommend vitamin D, vitamin E, vitamin B6, and magnesium.

Medicines

Diuretics (“water pills”)—medicines that increase urination and help relieve bloating.

Painkillers, such as ibuprofen or naproxen.

Birth control pills, also called oral contraceptives. They suppress the release of the egg from the ovary (ovulation) and keep hormone levels from changing during each month. However, some kinds of birth control pills cause mood problems and make symptoms worse.

Gonadotropin-releasing hormone (GnRH) agonists. This type of medicine, given by injection monthly or every three months, temporarily stops the production of estrogen (a hormone) and prevents ovulation. This approach is reserved for very severe cases.

Antidepressants, usually a selective serotonin reuptake inhibitor (SSRI).

Anti-anxiety drugs such as alprazolam.

What should you do if you suspect you have PMS or PMDD?

Note when your period starts and stops, and keep a daily record for two or three menstrual cycles of when symptoms occur and how severe they are. Discuss your symptoms with your health care provider, who can then offer advice about diagnosis and treatment.

How to identify the symptoms of premenstrual dysphoric disorder How to identify the symptoms of premenstrual dysphoric disorder

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  • Abnormal Pain and Menstrual Bleeding
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Many women experience a few uncomfortable symptoms in the days leading up to their periods. Normally these are fairly easy to cope with. However, if you are having symptoms that are severe enough to interfere with your daily life and prevent you from doing the things you normally do, you have PMS – premenstrual syndrome. While PMS is common, it can take a toll on you, as physical and emotional symptoms of PMS can be challenging to manage. Leading a healthy lifestyle, and working with your doctor to manage your symptoms can dramatically improve PMS.

Explore Premenstrual Syndrome (PMS):

What is PMS?

Most women experience some symptoms in the days before their period starts. Most commonly these include tender breasts, changes in bowel habits and menstrual cramps, and you may be a little moody. Usually these symptoms are mild and can be eased with dietary modification, perhaps a warm pack, and over the counter pain relievers. If your symptoms are severe, or are affecting your usual activities, you may have Premenstrual Syndrome (PMS). It is important to see your doctor if you suspect you may have PMS. PMS is related to the hormonal changes that happen in the days leading up to your period. PMS can affect your body, your mood, and your behaviour.

How to identify the symptoms of premenstrual dysphoric disorder

What are the symptoms of PMS?

Physical symptoms:

  • Tender breasts
  • Bloating, fluid retention
  • Muscle aches
  • Joint pain
  • Headaches
  • Abdominal cramps
  • Diarrhea or constipation
  • Lower back pain
  • Hot flashes
  • Trouble sleeping
  • Sleeping too much
  • Low energy, fatigue
  • Low sex drive
  • Changes in appetite
  • Food cravings – sweet, salty

Mood and behaviour-related symptoms:

  • Irritability
  • Anxiety
  • Difficulty focusing
  • Sadness
  • Crying spells
  • Anger
  • Not wanting to talk to anyone

What causes PMS?

Your period is controlled and regulated by a complex orchestra of hormones, secreted by your pituitary gland, hypothalamus, and ovaries. These hormones also interact with the hormones that regulate mood in the brain, and can have effects on many of your bodily functions, contributing to the uncomfortable symptoms of PMS. Your brain chemistry changes in response to different hormone levels. For example fluctuations in the mood-related neurotransmitter serotonin can cause changes in mood and sleep. However, there are many other factors at play, and it isn’t clear why some women have very severe premenstrual symptoms and others do not.

How is PMS diagnosed?

To diagnose PMS it is important to keep a symptom diary .

The symptom diary will enable your doctor to not only identify the typical pattern of PMS, it will also help to determine the type of PMS symptoms – there is more than one type. PMS symptoms occur in the latter half of the menstrual cycle, resolve within a few days of the onset of menstruation, and do not return until the second half of the next cycle.

Women who are suffering with other mental health disorders may notice symptoms throughout the month, but that some symptoms worsen premenstrually. Keeping a symptoms diary will help to sort these out.

How can you manage PMS?

Leading a healthy lifestyle can make a big difference in how your body reacts to menstruation. Your symptoms may improve if you eat a healthy diet, exercise regularly, and cut down on caffeine, alcohol, and salt. A healthy diet means eating more vegetables, fruit, whole grains, dairy, seafood, legumes and nuts, and less red and processed meats, less sugary drinks and fewer refined grain products (white bread and rice/cookies/donuts/cakes etc.). Many women experience cravings for sugar pre-menstrually. Avoid those cravings by eating regular balanced meals with snacks, avoiding sweet foods and choosing foods with low glycemic index.

How to identify the symptoms of premenstrual dysphoric disorderIn addition to taking note which days of the month are more symptomatic, take note of the time of day. Many women find late afternoon difficult. This may be a time when you yourself are tired and hungry. Planning a balanced snack before you become symptomatic, or a rest, a walk or other restorative activity may help. Advanced planning and understanding your own personal needs may make all the difference.

The hormones of the second half of the menstrual cycle can cause many women to have constipation, and around the time of the period, diarrhea. Having plenty of fibre and fluid in your diet will help with these symptoms.

Getting enough sleep and doing what you can to reduce stress can also help alleviate some of the mood and behaviour-related symptoms. Pain symptoms can be treated with ibuprofen. Some women require prescription medications to help cope with either physical or mood-related symptoms.

When should I talk to my doctor about PMS symptoms?

If a healthy lifestyle and over-the-counter pain relief medications are not enough to prevent PMS from disrupting your daily life, it’s a good idea to talk to your doctor. Birth control pills or other hormonal birth control methods (e.g., the patch, shot, vaginal ring, or IUD) can help provide some relief. There are medications available that can treat various physical and mental symptoms, such as selective serotonin reuptake inhibitors (SSRIs), diuretics, or nonsteroidal anti-inflammatory drugs. It will be helpful to your doctor if you bring your symptom diary, tracking your symptoms and bleeding for 2-3 cycles (see this ‘menstrual diary‘ ).

What is premenstrual dysphoric disorder?

Premenstrual dysphoric disorder (PMDD) is a rare, very severe form of PMS where women experience severe disruptions in mood (depression, irritability, anxiety) prior to menstruation. There are several options for treatment of PMDD, including medications like antidepressants or birth control pills, and cognitive behavioural therapy.

If you are having thoughts of suicide, phone 911 or a local crisis line.

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). PMDD can cause depression, anxiety, and other physical and mental health symptoms during the two weeks leading up to your period. These symptoms can be so extreme that they get in the way of your daily life, like work, school, or your relationships. PMDD symptoms usually go away once your period starts, or a day or two after.

What causes PMDD?

It’s not yet known what exactly causes PMDD, but scientists think it’s connected to the hormonal changes that happen during your menstrual cycle and a chemical in your brain that affects mood called serotonin.

What are the symptoms of PMDD?

Most people who menstruate have some PMS symptoms, like cramps, bloating, breast tenderness, or mood changes before or during their period. Often times, PMS just takes a little extra self care to manage. With PMDD, the symptoms are much worse, causing big problems in your daily life. If you have any of the following symptoms, and they consistently happen to you in the week or two leading up to your period (or become a lot worse then), talk with your doctor or nurse about PMDD.

Symptoms of PMDD include:

Nervousness or anxiety

Feeling very tired

Not being able to sleep

Trouble staying focused

How is PMDD treated?

If you think you have PMDD, your doctor or nurse will likely ask you to keep track of your period symptoms over the course of a few months. When you visit your doctor or nurse, they may do a blood test or other tests or exams to rule out other causes of your symptoms. They may also ask you questions about any history with anxiety or depression you might have had in the past.

There is no one PMDD treatment or PMDD medication that works for everyone. Your doctor or nurse will talk with you about your options, which may include:

Antidepressants called SSRIs (selective serotonin reuptake inhibitors)

Over-the-counter pain medicine (like ibuprofen or aspirin)

Diet changes and regular exercise

Stress management tools (like meditation and other self care)

If you’re having a hard time dealing with emotional symptoms like depression or anxiety, it’s a good idea to get help right away from a mental health professional. You can find local help at SAMHSA, or reach out to a counselor, your insurance company, or a doctor or nurse. It may also be helpful letting a close friend or family member know how you’re feeling.

If you’re thinking about hurting yourself:

Go to the emergency room

PMDD can be overwhelming, but you don’t have to face it alone. Help from a counselor or therapist is a good start, and working with a doctor or nurse to manage your symptoms can make things easier. The staff at your nearest Planned Parenthood health center can help.

Premenstrual dysphoric disorder (PMDD) is a more serious type of Premenstrual Syndrome. It is a diagnosable psychiatric disorder and characterised by debilitating physical and psychological symptoms occurring during the late luteal phase (phase 4) which have a significantly negative impact on a woman’s ability to live everyday life.

To be diagnosed with PMDD an individual must suffer from at least 5 different premenstrual psychological symptoms. It is believed to be caused by an abnormal response (likely an increased sensitivity) to the normal fluctuations of gonadal steroid hormones during the menstrual cycle. В

For PMDD, the symptoms must occur in the last week of the luteal phase (phase 4 – just prior to menstruation),decrease during menstruation (phase 1) and then vanish during the follicular phase (phase 2). As they are linked to your menstrual cycle, often during pregnancy, a woman will not experience symptoms.В

There are both psychological and physical symptoms.

Psychological symptoms include:

В·В В Mood swings

В·В В Fatigue and lethargy

В·В В Decreased interest inactivities you normally enjoy

В·В В Increased anxiety

В·В В Increased anger or irritability

В·В В Suicidal feelings

В·В В Feeling overwhelmed

В·В В Inability to concentrate

В·В В Increased anxiety over rejectionВ

Physical symptoms include:

В·В В Breast tenderness or swelling

В·В В Muscle and joint pain

В·В В Weight gain

В·В В Changes to appetite (over eating or cravings)

В·В В В Changes to sleep (hypersomnia or insomnia)В

Diagnosis is complex and requires a thorough physical and psychological assessment.В

Before diagnosis, an individual will be asked to record their daily symptoms over two months. They will be assessed to rule out the potential of other mood disorders, substance abuse or pre-existing medical conditions contributing to their symptoms. They will then be assessed against the DSM-5 criteria where they must experience at least 5 of the 11 symptoms with at least one being a key mood system.

These symptoms must be bad enough to prevent the individual from doing their daily activities. The symptoms must occur in the last week of the luteal phase, reduce during menstruation and then stop during the follicular phase.В

5 of these criteria must be met for a diagnosis of PMDD:

В· В В В В Mood swings

В· В В В В Marked irritability/anger

В· В В В В Marked depressed mood

В· В В В В Marked anxiety/tensionВ

One or more of the following must also be present as well as from those above

В· В В В В Decreased interest in normal activity

В· В В В В Difficulty concentrating

В· В В В В Lethargy

В· В В В В Change in appetite (cravings or overeating)

В· В В В В Changes to sleep (hypersomnia or insomnia)
В

*Managing PMDD:
A key way to manage is to track the menstrual cycle. Noting all symptoms during a cycle can help identify what triggers certain symptoms and work out strategies to prevent them. If you suffer from PMDD, tracking enables you to plan life events more effectively around your cycle, if you know that symptoms typically happen a week before your period you can avoid putting stressful things in that week and instead plan activities that you enjoy/help you to relax.В

-Exercise is recommended to alleviate some of the symptoms such as bloating, fatigue and depressive mood.В

-Dietary changes have also been recommended such as decreasing alcohol, sugar and caffeine during the luteal phase. Maintaining a healthy balanced diet throughout the menstrual cycle is also suggested.В

-There is mixed evidence that supplements such as calcium and magnesium, Vitamin D and Vitamin B6 can alleviate symptoms. Calcium may decrease low mood and somatic symptoms. However it is suggested this is only for mild symptoms and that they may have little effect on more severe cases.

-Chasteberry has also been found effective in reducing somatic symptoms as well as reducing some of the psychological effects of PMDD such as emotional lability, irritability and anger.

-Keeping a regular sleep pattern throughout the month (using a night time routine to establish this and good sleep hygiene).В

-Stopping smoking entirely or reducing the frequency is recommended as it can make people more sensitive to hormone changes.В

-There are different treatment options available including pharmacological, psychological and surgical (or a mixture).Typically lifestyle changes are recommended first before other interventions.В

-Selective Serotonin Reuptake Inhibitors(SSRIs) are a type of antidepressant and are effective at treating the psychological symptoms associated with PMDD.В

-Cognitive Behavioural Therapy (CBT) is a psychological intervention designed to help sufferers identify negative thoughts and develop coping strategies to deal with them. Weekly sessions with a qualified CBT specialist are recommended.В

-Oral Contraceptives (OC)can be effective by preventing hormonal fluctuations and/or ovulation to reduce symptoms. But, there is mixed evidence that oral contraceptives can help, with some women reporting it decreases symptoms, however others saying it makes them worse. Continuous dosing or a shortened period of the hormone-free interval (e.g four days) is recommended.В

-Gonadotropin releasing hormone (GnRH) analogues injections are usually only suggested if SSRIs or OCs have been ineffective. These injections prevent ovulation and reduce symptoms by causing a temporary menopause. However, these can cause decreased bone density, so women should receive hormonal replacement therapy alongside this to protect bone density. The injections are usually monthly.В

-Surgery: In severe cases where no other treatments have been successful surgery may be recommended to remove the uterus(total hysterectomy) and ovaries and fallopian tubes. This would stop the monthly cycle completely and get rid of symptoms. However, it is irreversible so is usually used as a last resort.В

*Disclaimer: Information and content from FitrWoman are intended as general information only and should not be substituted for medical advice, diagnosis or treatment.

Imagine PMS so bad you can barely function. That’s the reality for women suffering from this crippling disorder – but help is out there and you are not alone.

Cranky, teary, tired – all common tell-tale signs in the lead up to a period.

But for one in 20 women the onset of menstruation causes days of wild mood swings, rage, depression, or intense anxiety.

Premenstrual dysphoric disorder is a little-known, debilitating condition and many women who have it go undiagnosed for years.

What is premenstrual dysphoric disorder or PMDD?

Dr Rosie Worsley, an endocrinologist and clinical advisor for Jean Hailes, says PMDD is similar to PMS but far more severe.

“Women will have symptoms in the week leading up to their period to a degree that significantly impairs their ability to function in the day-to-day,” Dr Worsley says.

Dr Worsley says women suffering from PMDD can experience a range of extreme symptoms.

“These include severe irritability, fatigue to the point of not being able to get out of bed, migraines, mood swings, sadness or despair, panic attacks, anxiety.”

Other symptoms include trouble focussing, insomnia, feeling out of control, and physical symptoms such as bloating, cramping, breast tenderness, and joint or muscle pain.

“Some women get aches and pains they liken to having the flu every month,” Dr Worsley says.

What causes PMDD?

PMDD is believed to be the result of a sensitivity to the spikes in hormones before menstruation.

Recent research suggests there could also be a genetic component.

“Essentially, PMDD is a negative reaction to a by-product of progesterone called allopregnanolone,” Dr Worsley says.

“This sensitivity can change over time, and a lot of women only develop PMDD after pregnancy.”

How is PMDD diagnosed and treated?

PMDD is diagnosed when a woman has five or more PMDD symptoms, including one mood-related symptom.

Consultant psychiatrist at the Royal Women’s Hospital, Dr Yasaman Rezaei Adli, says a range of treatments are available.

“Serotonin reuptake inhibitors (SSRIs) are a group of antidepressants that have been proven to be effective,” Dr Rezaei Adli says.

“The other group of medications used in PMDD addresses the body’s hormonal activity, like oral contraceptive pills and ovulation suppression treatments.”

Making healthy choices such as maintaining a balanced diet low in sugar, salt and caffeine, abstaining from alcohol and cigarettes, and getting plenty of sleep can reduce symptoms.

“Psychological treatments such as mindfulness-based exercises and cognitive behavioural therapy may also be helpful,” she says.

Kelly’s story: I thought I might have bipolar

Kelly Hobday, 42, battled PMDD for decades before she was diagnosed.

“I would feel like cement was being pumped through my veins; aches, anxiety, crying all the time; and then that feeling of rage,” Kelly says.

“It’s horrible to feel that way and it made me withdraw from other people just so I could stay in control.”

After the birth of her second child, her symptoms intensified.

“I started to notice something wasn’t right, so I went to the doctor but I was told there was nothing wrong, that it was all in my head,” she says.

“I just didn’t know where to turn – I began to think I might have bipolar.”

Kelly says it wasn’t until she stumbled upon the Australian PMDD Facebook group while doing her own research that she realised what the problem might be.

“I started reading other women’s stories, and I thought ‘Oh my God – that’s me’,” she says.

She then sought a referral to a women’s clinic for treatment, and says seeking help is vital.

“Just to have an answer is such a relief – to know you’re not going crazy,” she says.

If you are struggling, talk to your GP or contact Beyond Blue on 1300 224 636.

Premenstrual dysphoric disorder (PMDD)

PMDD is considered to be a severe form of premenstrual syndrome (1).

Premenstrual dysphoric disorder (PMDD) is term adopted by the American Psychiatric Association (APA) to describe a severe, debilitating form of premenstrual disorder (1).

  • introduced in the American Psychiatric Association in Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV, PMDD was described in the appendix since additional research was needed to confirm the distinctiveness of the diagnosis from other disorders. However in DSM-V, PMDD has been moved to the full diagnostic category (1)

It is believed to affect around 3-8% of women of reproductive age (1,2)

  • one study has reported that up to 18% of women lacked only one of the requisite symptoms for a PMDD classification, indicating that many women are “near threshold” for the diagnosis (2)

Women with PMDD have a 50-78% lifetime incidence of other psychiatric disorders (1).

A substantial impairment of productivity in the workplace and a higher rate of absenteeism have been documented in women with PMDD.

  • in addition, adverse effects of the condition were found to be greater than chronic back pain, and comparable to debilitating conditions, such as osteoarthritis and rheumatoid arthritis.
  • women suffering from PMDD were significantly more likely to report suicidal ideation when compare to women without PMS (1)

Note that bth premenstrual syndrome (PMS) and PMDD fall under the umbrella of “core PMD” (1).

it is important to exclude premenstrual exacerbations of other disorders such as major depression or anxiety disorders, which commonly co-exist with PMDD

  • prospective diary records will usually distinguish PMDD from major depression, since only in PMDD do the symptoms remit completely during the follicular phase of the cycle o for diagnosis of PMDD, above three criteria must be confirmed prospectively by means of daily diary ratings of symptoms – this is undertaken over at least two consecutive cycles
  • the diary should show reveal evidence of worsening during the 14 days preceding onset of menses (i.e. in the luteal phase) with at least 1 week free from symptoms in the follicular phase
  • note that retrospectively recalled symptoms are unreliable and should not be used to make the diagnosis

Last edited 09/2018 and last reviewed 12/2018

Millions of women suffer from this cyclical mood disorder, but awareness is low.

Key points

  • Premenstrual Dysphoric Disorder (PMDD) is a cyclical mood disorder experienced by millions of women worldwide.
  • Primary symptoms of PMDD include irritability, anxiety, and mood lability in the one to two weeks prior to menses.
  • Awareness of PMDD is growing, thanks to its recent addition to the DSM-V.

This past year has not been easy for anyone. There has been constant uncertainty, disruptions in routines, and a dampening of the connections, traditions, and seasonal joys we may have taken for granted prior to the global pandemic.

Women, in particular, are facing considerable challenges as they attempt to nurture careers with little childcare support, take on significant caregiving roles they may not have anticipated, and manage their own emotional upheaval from political unrest, health fears, and natural disasters.

It is not surprising that rates of depression, anxiety, and alcohol use have been on the rise for women in their 20s, 30s, and 40s. There are only so many opportunities to take a step back from the increased stress they face, and access to treatment is patchy at best.

In addition to these challenges, women in this age group are also at risk of a cyclical worsening of their mood, anxiety, or irritability, as well as physical pain in the form of premenstrual dysphoric disorder (PMDD).

Is Premenstrual Dysphoric Disorder (PMDD) Real?

PMDD, which affects millions of women worldwide, was recently added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), providing important diagnostic support for insurance coverage of treatment.

Though the prevalence of PMDD is between 1.8% to 5.8% of menstruating women, which is comparable or greater than national rates of men and women with panic disorder or obsessive-compulsive disorder (OCD), awareness of the diagnosis can be a primary barrier to treatment, even for individuals seeing a psychiatric provider.

What Symptoms Should I Be Looking For?

PMDD is a cyclical mood disorder characterized by recurrent symptoms in the final week before menstruation (menses), referred to as the luteal phase, with improvement within a few days of menses onset, and minimal or absent symptoms in the first 2 weeks post-menses, during the follicular phase. Importantly, this cyclical pattern needs to have occurred repeatedly over at least the prior 12 months.

The experiences that women with PMDD have during this one- to two-week timeframe before menses typically include at least one of the following primary symptoms:

  1. Mood swings and increased emotional sensitivity
  2. Increased irritability, anger, or conflict
  3. Significant depressed or hopeless mood
  4. Noticeable anxiety, physical tension, or feeling “on edge”

In addition, they may also notice decreased interest in their activities, poor concentration, lethargy or low energy, significant change in appetite, increased or decreased sleep, feeling out of control or overwhelmed, and physical symptoms such as breast tenderness, joint or muscle pain, or bloating.

Wait, Is This the Same Thing as Premenstrual Syndrome (PMS)?

Differentiation between a diagnosis of PMDD and premenstrual syndrome (PMS), which is not a DSM-IV diagnosis, is a matter of the degree and number of these symptoms. For example, women with PMS may experience irritability, low mood, and physical bloating in the days just prior to menses, but do not reach the criteria for PMDD due to fewer than five of the described symptoms, or perhaps they have not been experiencing these for a full year.

Understanding Your Symptom Pattern

An important component of a PMDD assessment involves asking women to keep a record of their symptoms throughout the month in the form of prospective daily ratings, for at least two symptomatic cycles. Often I ask them to complete the Daily Record of Severity of Problems (DRSP).

A crucial part of this kind of prospective tracking is the review of symptoms that may persist into the follicular phase, or throughout the entire month. Continued symptoms outside of the one to two weeks prior to menses suggest a different diagnosis, such as major depressive disorder or generalized anxiety disorder.

In subsequent posts, I will share some of the recommended treatments for this illness, including medication and psychotherapy. For now, let’s just agree that it warrants our field’s attention, investigation, and care. The monthly suffering women with PMDD experience does not need to continue, and we can make a huge difference in their lives.

Epperson C, Steiner M, Hartlage SA, Eriksson E, Schmidt PJ, Jones I, et al. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry. 2012;169:465–75.

Hantsoo L, Epperson C. Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Curr Psychiatry Rep (2015) 17: 87. DOI 10.1007/s11920-015-0628-3.

What Is Premenstrual Dysphoric Disorder?

A woman who has premenstrual dysphoric disorder (PMDD) experiences severe depression, irritability, and/or mood swings that interfere with relationships, social functioning, and work or school. The symptoms of PMDD start seven to 14 days before menstruation, and they resolve a few days after menstruation starts.

The term premenstrual dysphoric disorder is a medical term that makes sense when broken down into its individual parts. Disorder is a term used to describe a group of symptoms that impair health. The symptoms are described as premenstrual because they occur before menstruation. The word dysphoric is a Greek word, which literally means “ill-being.” Dysphoria is the opposite of a more common word, euphoria (or “well-being”).

How Is PMDD Different From Premenstrual Syndrome?

Premenstrual syndrome (PMS) is a condition that affects some women before they menstruate each month. Physical symptoms—such as breast tenderness, cramps, abdominal bloating, headaches, and cravings for starchy foods—are common. Mood symptoms include depression, anger, irritability, and anxiety. Other problems include social withdrawal and difficulty concentrating and thinking.

Many women have one or more of these symptoms before they menstruate, but the symptoms usually are mild and do not interfere with their ability to function. Making lifestyle changes—such as getting regular exercise, quitting smoking, drinking less caffeine, and learning how to manage stress—may help relieve symptoms. For some women who have PMS, physicians may prescribe birth control pills or select a different birth control pill, which can relieve some symptoms. The physician also may prescribe diuretics, which help the body eliminate the excess water that causes bloating.

Although the mood symptoms associated with PMS sound similar to PMDD, they are different in one key respect: PMDD is much more severe. Premenstrual dysphoric disorder should be diagnosed only when mood symptoms seriously impact relationships and impair functioning at work or school. Depending on how broadly it is defined, between 20 percent and 50 percent of women live with PMS, but only 3 percent to 8 percent of women are estimated to have PMDD.

The term PMDD was added to the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, in 1994. (The DSM-IV is the standard text of mental disorders published by the American Psychiatric Association). The psychiatrists who developed the DSM-IV added PMDD to the appendix to provide a common definition of the problem so scientists could study whether some women with premenstrual symptoms suffer so seriously that their symptoms should be considered a disease. Adding a condition to the appendix of the DSM-IV does not mean it is a disease. Only further study and scientific evidence can establish whether PMDD is a disease.

What Are the Symptoms of PMDD?

According to the research criteria in the DSM-IV, a woman may have PMDD if she has five or more of the following symptoms during the week before menstruating for most of her menstrual cycles in the last year. (It is important to note that a woman may have PMDD only if the symptoms are tied to the menstrual cycle. If they are not, then she may have another condition.)

• Depression (hopelessness; more than just feeling sad or blue)

• Anxiety (feeling “keyed up” or “on edge”)

• Severe mood swings (feeling suddenly sad or extremely sensitive to rejection)

• Anger or irritability

• Decreased interest in usual activities (work, school, friends, and hobbies)

• Appetite changes (overeating or cravings for certain foods)

• Sleep problems (insomnia, early morning waking, or oversleeping)

• Feeling overwhelmed or out of control

• Physical symptoms, such as bloating, breast tenderness, and headaches

The symptoms of PMDD end with menopause, when menstruation stops and the levels of hormones in the body that regulate menstruation no longer rise and fall each month.

How Is PMDD Diagnosed?

According to the appendix of the DSM-IV, a psychiatrist or other physician can diagnose PMDD only if the woman has five or more of the symptoms described above for most menstrual cycles and if those symptoms seriously impair her relationships with others and her ability to be productive at work or school.

A psychiatrist or other physician also will need to consider and rule out other possible causes of the symptoms—such as thyroid problems or lupus—or another mental disorder, such as depression or an anxiety disorder. The symptoms of all these conditions may worsen before menstruation and so could be confused with PMDD.

To determine if a woman has PMDD, she will be asked to keep a mood and symptom journal every day for at least two months. It is easy in hindsight to think symptoms occurred around the time of menstruation. For this reason, keeping a journal over time is necessary to show with more certainty if the mood or functioning problems truly began one to two weeks before menstruation and improved within a few days of menstruation starting. Also, without the information provided in the journal, it could be difficult to identify another medical or mental health condition causing the symptoms.

In some cases two separate records may be suggested: a calendar marking the days of menstruation and a journal of mood and behavior throughout the entire month. Keeping these two records separate helps prevent incorrectly associating mood changes with the menstrual cycle.

How Is PMDD Treated?

The same lifestyle changes that sometimes help women with PMS may help relieve the symptoms of PMDD. In most cases, however, PMDD symptoms will persist despite such efforts.

Studies show some women with PMDD may benefit from treatment with antidepressants called selective serotonin reuptake inhibitors (SSRIs). These medications also are prescribed commonly for depression, but for women with PMDD they usually work more quickly and are prescribed in lower dosages to be taken for just part of each month.

The U.S. Food and Drug Administration has approved one SSRI, Sarafem (fluoxetine), for the treatment of PMDD. Sarafem is the same chemical compound as Prozac, but the manufacturer renamed it for the treatment of PMDD. Recent studies have found that other SSRIs used to treat depression—such as sertraline, citalopram, and paroxetine—also are effective for treating PMDD. Because different women will tolerate some medications better than others, a physician might prescribe one of these other SSRIs. It is a legal and common practice for physicians to prescribe medications “off-label,” which means that a medicine approved by the FDA to treat one illness can be prescribed to treat another illness.

With treatment, most women with PMDD will be able to lead more satisfying lives, without the cycles of severe distress and limited functioning caused by the disorder.