An Overview of Premenstrual Dysphoric Disorder

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Premenstrual dysphoric disorder is a mood disorder that occurs during the premenstrual phase of the menstrual cycle. While similar to that of premenstrual syndrome (PMS), the symptoms of PMDD are much more severe and can lead to extreme mood changes that can disrupt daily life and functioning.

Research indicates that women with premenstrual dysphoric disorder may have alterations in the genes that influence how the body processes stress and sex hormones. These differences mean that women with PMDD have a greater sensitivity to the hormones that influence both mood and general well-being.

While PMS can have an impact on a woman's life and functioning, it is not classified as a disorder and the symptoms can usually be self-managed. Premenstrual dysphoric disorder is classified as a mental disorder by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Premenstrual irritability and PMS are quite common, but approximately 3—8% of all menstruating women will experience symptoms of PMDD. 

Symptoms

Some of the major symptoms of PMDD include:

  • Severe mood swings
  • Physical symptoms including breast tenderness, bloating, and headaches
  • Feelings of sadness
  • Thoughts of suicide
  • Irritability and anger that is directed toward others
  • Lack of interest in activities
  • Lack of energy and fatigue
  • Sleep disturbances
  • Food cravings and binges
  • Trouble concentrating or thinking

Symptoms begin during the luteal phase, or after ovulation, and end shortly after menstruation starts. 

Causes

Research on the causes and treatments of PMDD is emerging, but the evidence has shown that the condition is heavily influenced by a genetic sensitivity to sex hormones. While PMDD is believed to have biological causes, research has shown that environmental variables such as stress can also increase the risk and severity of the condition. 

The condition is 56% heritable. 

Research suggests that PMDD may be related to alterations in a specific gene complex that are involved in the metabolism of estrogen and progesterone. 

Diagnosis

The diagnosis of premenstrual dysphoric disorder usually begins with your doctor taking a health history and doing a physical exam. In most cases, you will need to keep a calendar to track your symptoms over at least two menstrual cycles. 

In order to be diagnosed with PMDD, women must experience at least five symptoms across different criterion, one of which must be mood-related. Women must experience these symptoms during the premenstrual phase and symptoms must be mostly absent within the week following menses. These symptoms must also interfere with functioning in work, school, relationships, and other important life areas and must not be related to an existing condition or caused by substance use.

Treatment

Treatments for PMDD are focused on minimizing and managing the symptoms of the condition. Some of the treatment options include:

  • Antidepressants, such as selective serotonin-reuptake inhibitors (SSRIs), have been shown to be effective for treating PMDD symptoms
  • Birth control
  • Vitamin supplements including B6 and magnesium
  • Lifestyle adaptations including changes in diet, exercise, and stress management techniques
  • Medications to treat physical symptoms including diuretics for fluid retention and anti-inflammatory drugs for pain
  • Changes in menstrual products, particularly if these tend to cause discomfort or irritation

In 2010, the FDA approved a birth control pill (sold under the brand-name Beyaz) to treat PMDD. This oral contraceptive contains a combination of drospirenone and ethinyl estradiol that may help alleviate symptoms of this condition, but you should talk to your doctor to determine if this option is right for you.

Cognitive-behavioral therapy (CBT) may also be used alone or in conjunction with other treatments. 

Coping

The mood changes and physical symptoms of PMDD can make it difficult to cope with daily life and manage your relationships. You might feel irritable, depressed, and angry, which can lead to taking out those feelings on the people around you. In addition to getting treatment from a medical professional, there are self-care steps you can take to help manage the symptoms of this condition.

  • Natural treatments such as meditation, regular exercise, and yoga can be effective for helping manage stress. Such practices may also help you cope with symptoms of anxiety and depression. 
  • You should use caution and talk to your doctor before you try using any herbal remedies to alleviate your symptoms. Some herbal supplements such as St. John’s wort, can have adverse reactions when taken with other medications.
  • Getting plenty of rest and eating a healthy diet can also help. Avoiding high-salt foods may help prevent bloating and water retention. Minimize sugar and simple-carbohydrate consumption in order to prevent fluctuations in blood sugar levels. Focus on eating complex carbs, getting plenty of fiber and protein, and drinking enough fluids.

One study also found that acupuncture may be a promising treatment for reducing the symptoms associated with PMDD, but further research is needed.

A Word From Verywell

Coping strategies can be helpful, but you should contact your healthcare provider if your symptoms do not improve with self-treatment or if your symptoms interfere with your daily functioning including your mental well-being, your relationships, or your job. 

You can call the National Suicide Prevention Lifeline at 1-800-273-8255 if you are experiencing thoughts of suicide. Or you can reach out to the Crisis Text Line for 24-hour support via text by sending a message to 741-741.

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