Premenstrual dysphoric disorder (PMDD) is recognized as a severe form of premenstrual syndrome (PMS), significantly impacting a woman’s life. While both PMS and PMDD share similar physical and emotional symptoms, PMDD is distinguished by its extreme mood disturbances. These intense mood shifts can disrupt daily routines, strain personal relationships, and significantly impair a woman’s quality of life.
Both PMDD and PMS typically manifest symptoms in the luteal phase of the menstrual cycle, which is generally seven to ten days prior to the onset of menstruation. These symptoms often persist into the first few days of a woman’s period.
While some physical symptoms like bloating, breast tenderness, fatigue, and changes in appetite and sleep patterns are common to both conditions, PMDD is characterized by the prominence and severity of emotional and behavioral symptoms. Specifically, at least one of the following psychological symptoms is markedly pronounced in PMDD:
- Feelings of profound sadness or hopelessness
- Significant anxiety or marked tension
- Extreme mood swings and emotional lability
- Pronounced irritability or anger that is persistent
The exact etiology of PMDD remains unclear. However, it’s frequently observed that individuals with pre-existing conditions like depression and anxiety are more susceptible to both PMS and PMDD. It’s hypothesized that the hormonal fluctuations inherent to the menstrual cycle may exacerbate the symptoms of underlying mood disorders, thus triggering PMDD in vulnerable women.
Management and treatment strategies for PMDD are focused on alleviating and minimizing symptom severity. Effective approaches may include:
- Antidepressant Medications: Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed to manage the emotional symptoms associated with PMDD. Medications such as fluoxetine (Prozac, Sarafem) and sertraline (Zoloft) can effectively reduce feelings of sadness, anxiety, fatigue, food cravings, and sleep disturbances. SSRIs can be administered daily throughout the month or strategically during the luteal phase, between ovulation and the start of menstruation, depending on symptom patterns and individual needs.
- Hormonal Birth Control: Oral contraceptives, particularly those designed for continuous use or with shortened hormone-free intervals, can be beneficial in mitigating both PMS and PMDD symptoms. These formulations help stabilize hormonal fluctuations, thereby reducing symptom severity.
- Nutritional Supplements: Adequate calcium intake, around 1,200 milligrams daily, has been suggested to potentially lessen PMS and PMDD symptoms. Additionally, Vitamin B-6, magnesium, and L-tryptophan are often considered as supportive supplements. However, it’s crucial to consult with a healthcare provider before initiating any supplement regimen to ensure safety and appropriateness.
- Herbal Remedies: Certain herbal remedies, such as chasteberry (Vitex agnus-castus), have shown promise in preliminary research for alleviating irritability, mood swings, breast tenderness, swelling, cramps, and food cravings linked to PMDD. Nevertheless, further research is warranted to fully establish its efficacy. It is important to remember that herbal supplements are not regulated by the U.S. Food and Drug Administration, and therefore, medical advice should be sought before use.
- Lifestyle and Dietary Modifications: Adopting healthy lifestyle habits can significantly impact premenstrual symptoms. Regular physical exercise is often recommended to reduce symptom burden. Dietary adjustments, such as limiting caffeine, abstaining from alcohol, and smoking cessation, can also contribute to symptom relief. Prioritizing sufficient sleep and incorporating relaxation techniques like mindfulness, meditation, and yoga can be valuable tools in managing PMDD. Furthermore, minimizing exposure to stressful situations and emotional triggers, such as financial disputes or relationship conflicts, is advisable.
If you suspect you may be experiencing symptoms of PMDD, it is essential to consult with your healthcare provider to discuss diagnostic evaluation and appropriate treatment options.
References
- Yonkers KA, et al. Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder. https://www.uptodate.com/contents/search. Accessed Jan. 26, 2021.
- Casper RF, et al. Treatment of premenstrual syndrome and premenstrual dysphoric disorder. https://www.uptodate.com/contents/search. Accessed Jan. 26, 2021.
- AskMayoExpert. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Mayo Clinic; 2020.
- Ferri FF. Premenstrual dysphoric disorder. In: Ferri’s Clinical Advisor 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed Feb. 10, 2021.
- Kellerman RD, et al. Premenstrual syndrome. In: Conn’s Current Therapy 2021. Elsevier; 2021. https://www.clinicalkey.com. Accessed Feb. 10, 2021.
- Vitex agnus-castus. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 10, 2021.
