What Premenstrual Dysphoric Disorder (PMDD) Is All About

Putting this article together really opened my eyes to this condition; I had only surface knowledge about what PMDD is all about. Post article, I have gained deeper insights. In this blog post you’ll understand what PMDD is, the symptoms, possible causes, diagnosis and treatment. You will also understand the difference between PMDD and PMS.

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is an extreme form of PMS that’s now officially classified as a depressive disorder.

It is a severe form of premenstrual syndrome (PMS) defined by a cluster of emotionally and physically distressing symptoms that occur in the luteal phase of the menstrual cycle (the two weeks before your period begins) and greatly interfere with daily life.

Many women experience different symptoms a week or so before their periods. They may become melancholy, cry frequently, become angry, develop acne, have sensitive breasts, feel sleepy, have less energy, and feel heavy/bloated.

If you have these symptoms around the same time each month and they disappear when your period arrives, you most likely have premenstrual syndrome (PMS).

However, if your PMS symptoms are so severe that they prevent you from doing typical tasks at work or at home, or if they impair how you respond to the people in your life, you may have premenstrual dysphoric disorder (PMDD), which is a more severe type of PMS.

PMDD Symptoms

Up to 75% of women who have their periods may experience mild PMS, although PMDD is significantly less common. It affects only 3–8% of women. Women with moderate PMS may not require medical treatment to manage their symptoms. However, women with PMDD may need to consult with their doctor about how to improve their symptoms.

Common Symptoms of PMDD:

• Emotional Symptoms:
  • Intense sadness, hopelessness, or anxiety  
  • Irritability, anger, or rage  
  • Feelings of hopelessness, worthlessness, or guilt  
  • Difficulty concentrating  
  • Crying frequently
  • Losing interest in activities and things that you once enjoyed
  • Having suicidal thoughts
  • Social withdrawal
  • Feeling overwhelmed or out of control
• Physical Symptoms:
  • Severe breast tenderness  
  • Fatigue
  • Abdominal bloating and cramping  
  • Headaches  
  • Fatigue  
  • Changes in appetite (increased cravings or decreased appetite)  
  • Sleep disturbances  

The symptoms of PMDD may look like other health conditions, such as a thyroid condition, depression, or an anxiety disorder. Always see a healthcare provider for a diagnosis.

How is PMDD Diagnosed?

The specific diagnostic criteria for PMDD have been outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). To get a formal diagnosis of PMDD from a mental health professional, you need to exhibit at least five signs of PMDD during most menstrual cycles throughout the previous year. Additionally, other mental health and medication conditions that could cause similar symptoms must be ruled out.

PMDD Causes

The exact cause of PMDD is not known. It may be an abnormal reaction to normal hormone changes that happen with each menstrual cycle. The hormone changes can cause a serotonin deficiency. Serotonin is a substance found naturally in the brain and intestines that narrows blood vessels and can affect mood and cause physical symptoms.

DeBarrows says having a history of anxiety, depression, or trauma can make you more likely to develop PMDD. Having a family history of PMDD or even PMS can also increase your risk.

Moreover, PMDD can worsen other mental and behavioral health issues, such as borderline personality disorder, post-traumatic stress disorder (PTSD), and attention-deficit/hyperactivity disorder (ADHD).

PMDD Treatment

Numerous treatments are available to ease the symptoms of PMDD. There is no uniform treatment or unique drug that fits everyone. Instead, your healthcare team—including your OB/GYN, therapist, and psychiatrist—will work together to develop a personalized plan that meets your specific requirements and addresses all of your concerns.

For some, self-care and at-home techniques can significantly help relieve symptoms of both PMS and PMDD.

1. Lifestyle Modifications:

• Diet:
  • Limit: Processed foods, caffeine, alcohol, and sugar, which can worsen symptoms.  
  • Increase: Consumption of whole grains, fruits, vegetables, and lean protein.  
• Exercise: Regular physical activity, such as brisk walking, yoga, or swimming, can help reduce stress and improve mood.  
• Stress Management Techniques:
  • Mindfulness: Practices like meditation and deep breathing can help reduce anxiety and improve emotional regulation.  
  • Yoga: Combines physical postures with breathing exercises and mindfulness, offering a holistic approach to stress reduction.  
  • Relaxation Techniques: Progressive muscle relaxation and guided imagery can help alleviate tension and promote relaxation.  

2. Medications:

• Selective Serotonin Reuptake Inhibitors (SSRIs): These medications are often the first-line treatment for PMDD. They can help stabilize mood and reduce anxiety.  
• Hormonal Therapies: Birth control pills or other hormonal therapies may be effective in some cases.  

3. Cognitive Behavioral Therapy (CBT): CBT can help individuals identify and challenge negative thought patterns and develop coping strategies for managing symptoms.  
4. Support and Communication:

• Open Communication: Talk openly with your partner, family, and friends about your experiences with PMDD.
• Support Groups: Connecting with other women who experience PMDD can provide valuable support and understanding.

Therapy is highly beneficial for individuals with PMDD, aiding in symptom management and overall mental health improvement. A qualified therapist provides stress management techniques and coping strategies for the emotional challenges associated with menstruation.

What is PMS?

Premenstrual Syndrome (PMS) is the changes in mood, emotions, physical health, and behavior that can occur between ovulation and the start of your period. It typically lasts until a few days after your period begins and can have a negative impact on your life.

These symptoms typically disappear once menstrual bleeding starts.  As many as three in four women report experiencing some form of PMS symptoms at some point in their lifetime.  Up to 75% of women of childbearing age experience some form of PMS symptoms at some point in their lifetime. The severity of PMS symptoms varies greatly from woman to woman.  

Common PMS symptoms can include:

• Mood swings  
• Irritability  
• Fatigue  
• Bloating  
• Breast tenderness  
• Cramps  
• Headaches  
• Food cravings  

On average, the menstrual cycle lasts about 28 days. If you have an average-length cycle:

• Ovulation, or the egg’s release from the ovaries, will occur around day 14, or the midpoint of the cycle.
• PMS symptoms can begin any time after ovulation (though they typically begin in the week before your period) and last until 5 or so days after menstruation begins.
• Menstruation, or bleeding, will begin on day 28 of the cycle.

What Causes PMS

The exact cause of PMS is not fully understood, but it’s believed to be linked to the fluctuations in hormone levels that occur during the menstrual cycle.  

Here are some of the key factors:

• Hormonal Fluctuations:
  • Estrogen and Progesterone: These hormones play a crucial role in the menstrual cycle.
    • Estrogen levels rise in the first half of the cycle (follicular phase) and then peak before ovulation.  
    • Progesterone levels rise after ovulation and then begin to decline sharply if pregnancy does not occur.  
  • These hormonal fluctuations can affect the levels of other neurotransmitters, such as serotonin, which plays a key role in mood regulation.  
• Serotonin Levels: Some research suggests that decreased levels of serotonin, a neurotransmitter that helps regulate mood, may contribute to PMS symptoms like irritability and depression.  
• Other Factors:
  • Genetics: Some women may have a genetic predisposition to experiencing more severe PMS symptoms.  
  • Lifestyle Factors: Stress, lack of sleep, and poor diet can worsen PMS symptoms.  
  • Underlying Medical Conditions: Certain medical conditions, such as thyroid disorders or vitamin deficiencies, can also contribute to PMS.  

Difference between PMDD and PMS

Many symptoms are the same for PMS and PMDD. However, the critical difference lies within the severity of symptoms and the impact that these symptoms have on your life.

Feature	PMS	PMDD
Severity	Mild	Severe
Impact	Minimal impact on daily life	Significant impact on daily life, relationships, and work
Emotional Symptoms	Mild mood swings, irritability	Intense sadness, anxiety, rage, hopelessness
Physical Symptoms	Bloating, cramps, breast tenderness	Similar to PMS, but often more severe

Difference between PMDD and depression

PMDD and depression share some overlapping symptoms, such as sadness and even suicidal thoughts. However, they differ significantly in their relationship to the menstrual cycle.

• PMDD: Symptoms emerge and worsen specifically in the week or two before menstruation and typically subside within a few days of the period starting.
• Depression: Symptoms are persistent and not tied to the menstrual cycle.

For a diagnosis of major depressive disorder, symptoms must significantly impair daily functioning for at least two weeks. In contrast, PMDD symptoms occur during most menstrual cycles throughout the year.

When people talk about depression, they usually refer to the mood disorder formally known as major depressive disorder (MDD), which is associated with ongoing feelings of sadness and a loss of interest and joy in activities. Just as there are similarities between PMS and PMDD, there is also a significant overlap between depression symptoms and PMDD symptoms.

Symptoms of major depressive disorder 

They include:

• Depressed or sad mood
• Lack of interest and pleasure with activities or things you used to like
• Difficulty sleeping or sleeping excessively
• Appetite and weight changes
• Fatigue
• Moving or speaking slowly
• Experiencing guilt
• Feeling like you’re worthless
• Having trouble with concentration, decisions, and thinking
• Thinking about death
• Having suicidal thoughts

Helplines for suicidal thoughts

• Talk: Call the National Suicide Prevention Lifeline at 800-273-8255.
• Text: Text HOME to 741-741 to reach the Crisis Text Line.

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Sources(.com):

growtherapy

healthline

hopkinsmedicine

webmd

psychcentral