Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder is a severe form of premenstrual syndrome wherein symptoms of depression and irritability occur prior to menstruation.


Both premenstrual syndrome and premenstrual dysphoric disorder causes emotional and physical symptoms. However, in PMDD, the symptoms may be so severe that is causes disruption in the woman’s activities of daily living as well as problems with relationships. Around 8 percent of all women with PMS may progress to PMDD.

Usually, symptoms of both PMS and PMDD occurs in the menstrual cycle’s last week. But symptoms usually improve during or a few days after menstruation. Furthermore, both disorders also results to changes in eating and sleeping habits, fatigue, breast tenderness, and bloating. However, behavioral and emotional symptoms such as persistent irritability and anxiety may stand out in PMDD.

Causes of Premenstrual Dysphoric Disorder

The exact cause of premenstrual dysphoric disorder and premenstrual syndrome is unknown. Studies have shown that certain interaction with the hormones produced by the woman’s ovaries such as progesterone and estrogen and neurotransmitters in the brain causes the disorders. In PMDD, the levels of hormone may be normal which means that the problem may lie within how the brain response with these hormones.

Furthermore, certain factors may predispose a women in developing PMS and PMDD. This includes: seasonal affective disorder, major depression, anxiety, alcohol abuse, obesity, high caffeine intake, family history of the disorder, and lack of exercise.

Symptoms of Premenstrual Dysphoric Disorder

The symptoms of premenstrual disorder and premenstrual dysphoric disorder are relatively similar. However, the symptoms of PMDD are generally more debilitating and severe, and usually involve mood-related symptoms. The symptoms may occur a week before menstrual bleeding and usually improves a few days be after the start of the period.

To diagnose the occurrence of PMDD in a woman, she should manifest at least five symptoms or more, and must include one mood-related symptom. Symptoms include: disinterest in relationships and daily activities, low energy or fatigue, suicidal ideation, hopelessness, sadness, anxiety, tension, binge eating or food cravings, mood swings, panic attacks, persistent anger or irritability, trouble concentrating or sleeping, and physical symptoms such as muscle or joint paint, headaches, breast tenderness and bloating. These symptoms of PMDD usually affect the woman’s relationship with other people as well as daily function.

Diagnosis of Premenstrual Dysphoric Disorder

The first part of PMDD diagnosis usually involves performing physical examination and taking medical history. Since there are no physical findings that can help in the diagnosis of the disorder, this is done to rule out other diseases or conditions that may result for the occurrence of symptoms or mimic the disease, such as pregnancy.

The diagnosis of PMDD and the woman’s menstrual cycle should also be correlated. In order to associate the two, the woman may be required to complete a symptom calendar or chart. They will be asked to record the symptoms they manifest in a given period of time. In this manner, the symptoms may easily be correlated with the woman’s menstrual period and menstrual cycle.

Treatment of Premenstrual Dysphoric Disorder

The goal for the treatment of PMDD is to minimize or prevent the occurrence of symptoms. It includes different methods including lifestyle changes, medications, and many more. It is also essential to keep a calendar or diary of the symptoms experienced, severity, and the duration. This is to help track or monitor the effectiveness of the treatment.

The first step to PMDD management is to have a healthy lifestyle. This includes eating a well-balanced diet preferably eating more fruits, vegetables, and whole grains and less or no intake of caffeine, alcohol, sugar, and salt. Increasing carbohydrates in the diet helps improve memory and mood, and avoiding caffeine reduces irritability and anxiety. It is also essential for a woman with PMDD to have a regular aerobic exercise to reduce the severity of symptoms. Changing sleep habits, which includes avoiding taking drugs for insomnia may help.

Antidepressants are also used to reduce symptoms such as: sleep problems, food cravings, and fatigue. The most common type of antidepressants used in patients with PMDD is SSRI or selective serotonin-reuptake inhibitor. This is usually taken for the whole month, on the start of the period, or only in an interval between ovulation. Psychotherapy such as cognitive behavioral therapy may also be used instead or with antidepressants. Cognitive behavioral therapy is done with the help of a mental health professional and may last for several weeks.

Other treatment for premenstrual dysphoric disorder may include the use of birth control pills, diuretics, nutritional supplements, and other medications. Birth control pills are used to stabilize hormone fluctuations as well as stop ovulation. This helps control PMDD symptoms such as depression. Diuretics are used to solve problems with regards to gaining weight due to fluid retention. The use of nutritional supplements such as: magnesium, calcium, and vitamin B6 may also help reduce both emotional and physical symptoms. Medications such as pain relievers may also be used for breast tenderness, menstrual cramping, backache, and headache.

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