A much more severe form of the collective symptoms known as premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) affects approximately 3 percent to 8 percent of women of reproductive age and is considered a severe and chronic medical condition that requires attention and treatment.
Although the exact cause of PMDD is not known, several theories have been proposed. One theory states that women who experience PMDD may have abnormal reactions to normal hormone changes that occur with each menstrual cycle. This may include fluctuation of estrogen and progesterone levels that normally occurs with menstruation, causing a serotonin deficiency, in some women (serotonin is a substance found naturally in the brain and intestines that acts as a vessel-narrowing substance, or vasoconstrictor). Additional research is necessary.
While any woman can develop PMDD, the following women may be at an increased risk for the condition:
Women with a personal or family history of mood disorders
Women with a personal or family history of postpartum depression
Women with a personal or family history of depression
Consult your health care provider for more information.
The primary symptoms that distinguish PMDD from other mood disorders (i.e., major depression) or menstrual conditions is the onset and duration of PMDD symptoms—with symptoms appearing during the week before and disappearing within a few days after the onset of menses—and the level by which these symptoms disrupt daily living tasks. Symptoms of PMDD are so severe that women have an impaired level of functioning at home, at work, and in interpersonal relationships during this symptomatic time period. This diminished level of functioning is generally in great contrast with the same woman's interactions and abilities at other times during the month.
The following are the most common symptoms of premenstrual dysphoric disorder. However, each individual may experience symptoms differently. Symptoms may include:
Neurologic and vascular symptoms
The symptoms of PMDD may resemble other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Always consult a health care provider for a diagnosis.
Aside from a complete medical history and physical and pelvic examination, diagnostic procedures for PMDD are currently very limited. Your health care provider may consider recommending a psychiatric evaluation to, more or less, provide a differential diagnosis (to rule out other possible conditions). In addition, he/she may ask that you keep a journal or diary of your symptoms for several months, to better assess the timing, severity, onset, and duration of symptoms. In general, in order for a PMDD diagnosis to be made, the following symptoms must be present:
Over the course of a year, during most menstrual cycles, five or more of the following symptoms must be present:
Anger or irritability
Difficulty in concentrating
Lack of interest in activities once enjoyed
Insomnia or hypersomnia
Feeling overwhelmed or out of control
Other physical symptoms
Symptoms that disturb social, occupational, or physical functioning
Symptoms that are not related to, or exaggerated by, another medical condition
Specific treatment for PMS will be determined by your health care provider based on:
Your age, overall health, and medical history
Extent of the condition
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
PMDD is a serious, chronic condition that does require treatment. Several of the following treatment approaches may help alleviate or decrease the severity of PMDD symptoms:
Dietary modifications (to increase protein and carbohydrates and decrease sugar, salt, caffeine, and alcohol intake)
Vitamin supplements (i.e., vitamin B6, calcium, and magnesium)
Selective serotonin reuptake inhibitors (SSRI)
Oral contraceptives (ovulation inhibitors)
For some women, the severity of symptoms increase over time and last until menopause (when menses ceases). For this reason, a woman may require treatment for an extended period of time, and may require several reevaluations to adjust medication dosages throughout the course of treatment.