This article was reviewed by Jessica Shepherd, MD.
From bloating and breast tenderness to irritability and fatigue, it’s normal to feel crummy before your period starts. Researchers estimate that almost half of women experience premenstrual syndrome (PMS) — the physical symptoms and mood changes that happen prior to your period.
However, some women have much more severe symptoms in the time leading up to their periods. Not only can these symptoms be distressing personally, but they can also cause significant problems at home, work, or school. This is called premenstrual dysphoric disorder (PMDD).
In this condition guide, we’ll go over what to know about premenstrual dysphoric disorder. Keep reading to explore PMDD symptoms, what causes it, and how it’s diagnosed and treated.
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What Is PMDD?
PMDD is a condition that has similar symptoms to PMS. But the symptoms of premenstrual dysphoric disorder are much more serious and can go on to affect your personal, social, and professional life.
Up to eight percent of menstruating women with premenstrual symptoms have PMDD.
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Symptoms
When does PMDD start? The symptoms of PMDD typically come on in the seven days before your menstrual period begins. After your period starts, they lessen or go away completely.
PMDD symptoms can be physical, behavioral, and emotional. As noted, they have a lot of overlap with the symptoms of PMS but are more severe.
Symptoms of PMDD
The physical symptoms of PMDD are:
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Breast tenderness
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Bloating
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Headache
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Joint and muscle pain
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Fatigue
Behavioral PMDD symptoms can include:
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Loss of interest in activities that typically bring you joy
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Social withdrawal
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Appetite changes, including overeating or food cravings
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Difficulty sleeping
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Trouble with thinking or paying attention
People with PMDD also have emotional symptoms, such as:
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Depressed mood, like intense feelings of sadness, worthlessness, or hopelessness
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Increased irritability or anger, which can lead to conflicts with others
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Restlessness or anxiety
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Mood changes like mood swings or crying spells
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Feeling out of control
Some may experience all or many of these symptoms, while others may only have a few.
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PMDD Causes
What causes PMDD? It’s still unknown what exactly causes PMDD. However, experts have a few ideas on this topic. Let’s examine them below.
Hormonal changes contribute to PMDD, particularly reproductive hormones like progesterone and estrogen. The levels of these hormones shift naturally throughout the menstrual cycle, including in the luteal phase. This is the time between ovulation and menstruation when women typically have symptoms of PMS or PMDD.
That said, it’s not hormone levels specifically that play a role but rather how your body responds to changes in them. A 2015 review noted that women with PMDD actually have typical levels of reproductive hormones — some experts believe they’re just more sensitive to fluctuations in them.
One compound thought to be a potential cause of PMDD is called allopregnanolone, or ALLO for short. It’s made when the body breaks down progesterone.
ALLO interacts with GABA (gamma-aminobutyric acid) receptors, which you can think of as one of your body’s natural calming switches. Women with premenstrual dysphoric disorder may have GABA receptors that are less sensitive to ALLO, contributing to the emotional symptoms of PMDD.
Estrogen may also play a role. This hormone can impact brain chemicals (aka neurotransmitters) that affect mood and behavior, such as serotonin. Serotonin is one of the brain chemicals affecting mood disorders like major depressive disorder (MDD).
Other things that may have a hand in causing PMDD are altered responses to stress and genetics.
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Risk Factors
There are several risk factors for PMDD — things that boost your risk of having it.
As we dive into the PMDD risk factors, it’s important to remember that having risk factors doesn’t mean you’ll definitely experience the condition. It simply means you may be more likely to have it than people without risk factors.
Risk Factors for PMDD
Since genetics may contribute to PMDD, you could be at a higher risk if you have a family history of it.
Researchers have also linked smoking and traumatic experiences during childhood to a higher risk of PMDD.
An association between higher body mass index (BMI) and the risk of premenstrual symptoms has also been seen. This means those with overweight and obesity may be at a higher risk of PMDD than people within the healthy BMI range.
The Office on Women’s Health notes that many women with PMDD may have existing mental health conditions like depression or anxiety disorders.
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Diagnosing
If you’re having intense physical, behavioral, and emotional symptoms that happen before your period and significantly impact your daily life, make an appointment with a healthcare provider to discuss them.
Your primary care provider is a good place to start. Other medical professionals that can help diagnose or treat PMDD include OB/GYNs and mental health professionals.
Diagnosing PMDD
A healthcare provider will start by getting your medical history. They’ll ask you about your symptoms, when they happen, and how they affect your day-to-day life. They may also do a physical exam.
In order to diagnose PMDD, your healthcare provider will want to rule out other medical conditions like thyroid disease or mental health issues like major depressive disorder, bipolar disorder, or anxiety.
Your provider may order lab tests. Surveys or questionnaires may also be used to gauge how your symptoms align with those of PMDD.
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), PMDD can be diagnosed when the following are true:
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You have at least five PMDD symptoms, including at least one mood-related symptom.
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Your symptoms are present the week before you start your menses and improve or go away completely after your period begins.
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Your symptoms are severe enough to significantly impact your personal or social life or your performance at work or school.
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Your symptoms are directly tied to your menstrual cycle and aren’t due to another existing medical condition or mental health disorder.
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You’ve met the criteria above for at least two consecutive menstrual cycles.
If you think you may have premenstrual dysphoric disorder, make an appointment with a medical provider to get the diagnosis process going.
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Treatment
Premenstrual dysphoric disorder treatments typically involve medications and lifestyle changes. The overall aim of treatment for PMDD is to reduce or eliminate symptoms and improve quality of life.
Let’s explore the PMDD treatment options now.
Treatments for PMDD
When it comes to how to treat PMDD, medications play a critical role. The FDA (U.S. Food and Drug Administration) has approved two types of medications for PMDD: certain antidepressants and a specific type of oral contraception.
Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that increase levels of serotonin in the brain. SSRIs approved for PMDD include:
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Fluoxetine (Prozac)
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Paroxetine (Paxil)
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Sertraline (Zoloft)
Birth control pills approved for treating premenstrual dysphoric disorder contain the active ingredients drospirenone and ethinyl estradiol (Yaz). These are synthetic versions of the hormones progesterone and estrogen, respectively.
Besides prescription medications, over-the-counter medications like ibuprofen (Advil, Motrin) and naproxen (Aleve) can help ease premenstrual symptoms like breast tenderness, headaches, and joint and muscle pain.
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Lifestyle changes can also make a big difference when managing PMDD. These include:
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Learning relaxation techniques like deep breathing, meditation, or yoga
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Focusing on complex carbohydrates, like whole grains, brown rice, beans, and lentils, which may help reduce food cravings and mood symptoms
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Reducing intake of foods high in salt, fat, and added sugar
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Limiting caffeine and alcohol
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Engaging in regular exercise to help boost mood and energy
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Getting enough sleep at night to lower fatigue and improve mood
There’s also evidence that certain supplements may help with premenstrual symptoms. Examples of PMDD supplements include calcium, vitamin B6, and magnesium. However, be sure to consult with your healthcare provider before adding new supplements to your diet.
Your provider can offer personalized advice on how to help PMDD, suggest medication or supplements, and go over possible side effects of anything you decide to take.
Since PMDD often happens to people who have existing depression or anxiety, psychotherapy (talk therapy) can also be beneficial. A commonly used type of therapy for these mental health conditions is cognitive behavioral therapy (CBD).
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Prevention
There’s no way to prevent PMDD for sure. But there are some things you can do that may reduce your risk.
PMDD Prevention Tips
A higher BMI and smoking have been tied to PMDD. With that in mind, you may be able to lower your risk of PMDD by working with a healthcare provider to lose weight if you have overweight or obesity or to quit smoking.
If you’ve already been diagnosed with PMDD, here’s what might help reduce your symptoms:
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Finding ways to lower stress levels
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Getting exercise most days of the week
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Eating a healthy diet
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Getting enough good-quality sleep
Don’t hesitate to reach out to your healthcare provider if your PMDD symptoms are persisting or getting worse. If you’re already being treated, your PMDD treatment plan just may need to be adjusted slightly.
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This article originally appeared on Forhers.com and was syndicated by MediaFeed.org
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