Premenstrual Syndrome (PMS) & Premenstrual Dysphoric Disorder (PMDD)
The Menstrual Cycle
For most women, physical and emotional symptoms of PMS such as abdominal bloating, breast tenderness, irritability, depressed mood, and difficulty concentrating are manageable aspects of the menstrual cycle. But in 3-8% of women, these symptoms are so severe that they impair ability to function. This syndrome is called Premenstrual Dysphoric Disorder (PMDD). Many women with PMDD respond successfully to medications that have traditionally been used for depression.
Premenstrual Syndrome (PMS)
PMS refers to a wide range of physical or emotional symptoms that typically occur about 5-11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when, or shortly after, her period begins.
Premenstrual Dysphoric Disorder (PMDD)
PMDD is a condition in which a woman has severe depressive symptoms, irritability, and tension before menstruation . The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS).
Causes of PMS and PMDD
- PMS and PMDD are caused by fluctuations in ovarian hormones during the menstrual cycle.
- Hormonal changes that occur during a woman's menstrual cycle cause fluctuations in brain chemicals called neurotransmitters. They include serotonin, dopamine and norepinephrine.
- These brain chemicals are responsible for mood.
- There is a genetic component to PMDD, it tends to run in families.
- Women with PMDD have brains that are sensitive to rapid fluctuations in hormone levels.
- Women with PMDD are more likely to develop postpartum depression and depression during perimenopause.
- PMDD affects between 3% and 8% of women during the years when they are having menstrual periods .
Many women with PMDD also have:
- Seasonal Affective Disorder (SAD)
- Mood Swings
The symptoms of PMDD are similar to those of PMS. However, they are generally more severe and debilitating and include a least one mood-related symptom. Symptoms occur during the week just before menstrual bleeding and usually improve within a few days after the period starts.
Five or more of the following symptoms must be present to diagnose PMDD, including one mood-related symptom:
- No interest in daily activities and relationships
- Fatigue or low energy
- Feeling of sadness or hopelessness, possible suicidal thoughts
- Feelings of tension or anxiety
- Feeling out of control
- Food cravings or binge eating
- Mood swings with periods of crying
- Panic attacks
- Irritability or anger that affects other people
- Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
- Problems sleeping
- Trouble concentrating
How is PMDD diagnosed?
No physical examination or lab tests can diagnose PMDD. A complete history, physical examination (including a pelvic exam ), 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 can help diagnose PMDD and determine the best treatment.