Many girls and women suffer from period cramps and abdominal pain during the menstruation cycle. Some women suffer bloating, pain, and heaviness or tenderness in the breast a few days before starting their menstrual cycle, known as premenstrual syndrome (PMS). In addition to these symptoms, many women experience intense mood fluctuation, anxiety, and depression, leading to premenstrual dysphoric disorder (PMDD). They mostly ignore these symptoms, but it can cause significant distress.
What is premenstrual dysphoric disorder (PMDD)?
Premenstrual dysphoric disorder (PMDD) is a serious form of premenstrual syndrome, which also exhibit mood instability. A premenstrual dysphoric disorder is an emotional, behavioral, and cognitive disorder that occurs during the luteal phase (the period between ovulation and periods). It can cause significant distress and impairment that interfere with women’s everyday life.
The symptoms of PMDD appear during the luteal phase, improve after periods start, and disappear within a week after menstruation. Many women have severe mood and emotional distress, which leads to increased suicidal thoughts and even suicidal attempts.
How common is premenstrual dysphoric disorder (PMDD)?
It is relatively common for women of reproductive age to experience mild mood fluctuations before the menstruation cycle. However, 5-8% of women have severe PMDD symptoms, causing functional impairments. It can occur anytime during reproductive age but is common in ages 25-35.
What are the causes of premenstrual dysphoric disorder (PMDD)?
The exact cause of PMDD is still unknown, but many researchers have suggested the following are the potential causes of PMDD:
- Premenstrual syndrome
- Mood disorder, anxiety, or depression
- Fluctuation in sex hormones during the luteal phase
- Changes in serotonin hormone levels also play a role in mood instability.
- Family history: If you have close relatives, such as your mother, grandmother, or sibling sister, with PMS, PMDD, or mood disorder, it increases your chances of having one too.
- According to research at the National Institutes of Health held in 2017, women with PMDD have encountered genetic changes that cause increased neuro-sensitivity to estrogen and progesterone, which may be responsible for PMDD development.
What are the symptoms of the premenstrual dysphoric disorder (PMDD)?
Symptoms of PMDD usually appear a few days before the onset of the menstruation period and go away after cessation of menses. The symptoms of premenstrual dysphoric disorder vary in women. In association with PMS symptoms, it also includes neurological symptoms, such as:
- Mood fluctuation
- Anger and increased conflicts with partners and family members
- Agitation and uneasiness
- Irritability
- Anxiety
- Depression
- Difficulty in concentration and memory retention
- Change in appetite
- Tenderness in breasts
- Headaches
- Change in sleeping pattern, such as insomnia or hypersomnia
- Fatigue and decreased energy level
- Swelling and pain in joints
- Decrease interest in activities you enjoyed most
- Reduce interest in sexual activities
- Tachycardia
- Suicidal thoughts and sometimes, suicidal attempt
- Decrease productivity
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How can we diagnose premenstrual dysphoric disorder?
To rule out PMDD from other depressive disorders, your healthcare provider may ask you to track or write your symptoms, their onset timing, and duration. Daily charting helps to distinguish PMDD, as PMDD mood swings have a cyclic nature, arising one or two weeks before the menstruation cycle and decreasing or absent after the cessation of menses.
A woman may have five or more PMDD symptoms with one mood instability symptoms for more than two consecutive ovulation cycles to confirm the premenstrual dysphoric disorder.
How can we manage or treat premenstrual dysphoric disorder?
Your doctor may recommend one or a combination of the following treatment modalities to help treat and manage premenstrual dysphoric disorder symptoms:
- Over-the-counter pain relievers:
They may help manage physical symptoms, such as period cramps, headache, body and joint pain, and breast tenderness.
- Antidepressants:
The healthcare provider may recommend selective serotonin reuptake inhibitors (SSRIs) to control the brain’s serotonin levels and manage mood-related symptoms.
- Hormonal therapy:
Birth control pills containing Ethinyl estradiol and drospirenone improve PMDD symptoms.
- Stress management:
The healthcare provider may recommend various stress-bursting tools to reduce mood-related symptoms. You can practice meditation, yoga, deep breathing exercises, and music therapy to cope with anxiety and depression.
- Dietary changes:
Eating healthy, nutrient-rich food and cutting back on processed, salty, and sugary food can help improve PMDD symptoms.
- Regular exercises:
Indulge yourself in regular physical activities to improve mood-related symptoms.
PMDD is a mood-related disorder that can negatively affect your personal and social relationships and impact the quality of your life. Women with PMDD disorder may harm themselves. Therefore early detection and treatment may relieve their symptoms.
Dr. Dimple Bordoloi | Consultant Obstetrics & Gynaecology | Dharamshila Narayana Superspeciality Hospital, Delhi