Before a woman gets her monthly period, she may experience some physical and emotional symptoms that can interfere with daily activities. We usually think of this as being premenstrual syndrome, or PMS. But sometimes, it can be more severe than that, causing what is known as premenstrual dysphoric disorder, or PMDD.
It is important to understand the difference in symptoms to determine if your severe PMS symptoms may be something more and, if so, what the treatment options are. Sarah Schutte, MD, gynecologist at the Banner Health Center Fort Collins, Colorado, is here to share key information about PMDD.
What is premenstrual dysphoric disorder?
PMDD is a more severe form of PMS that is caused by a variety of genetic and environmental factors. PMDD and PMS both show physical or behavioral symptoms before or during the first few days of your menstrual cycle and sometimes both.
The level of pain that often comes with PMDD or PMS can severely impact different areas of your life, such as personal relationships or your work life. This level of pain and how much it affects your life can help determine whether you have PMDD, or just PMS.
Although it is common to have one or a few premenstrual symptoms, PMDD affects only two percent of women. Premenstrual dysphoric disorder can be set apart from premenstrual syndrome by the presence of at least five symptoms, including one emotional symptom such as mood swings, irritability or depression.
What are the symptoms?
Through experience, women become familiar with the many symptoms that accompany their menstrual cycle, and it can be different for each woman.
In fact, over 150 physical, behavioral, emotional and cognitive symptoms have been linked to PMS. However, not all of them are dealt with by every woman.
One or more of the following behavioral (emotional & cognitive) symptoms must be present:
- Mood swings
- Sudden sadness
- Anger and irritability
- Sense of hopelessness
- Depressed mood
- Self-critical thoughts
One or more of the following physical symptoms must be present to reach a total of five symptoms overall:
- Difficulty concentrating
- Change in appetite
- Diminished interest in usual activities
- Decreased energy levels
- Breast tenderness
- Bloating or weight gain
- Joint or muscles aches
- Sleeping too much or not sleeping enough
If you have one or more of these symptoms, talk to your doctor about the possibility of having PMDD.
According to the American Psychiatric Association, these are the PMDD diagnosis criteria:
- Documentation of physical and behavioral symptoms (using diaries) for about a year.
- Five or more of these symptoms must be present during the week prior to your period and stopping within a few days after your period begins.
- Symptoms must have been present in most menstrual cycles that occurred the previous year, and the symptoms must be associated with significant distress or interference with daily activities.
It is important to note that although PMDD will continue throughout reproductive age, it will completely resolve following menopause.
How is PMDD treated?
Oral contraceptives are one way to treat PMDD and are usually the main course of treatment before trying other medications.
If oral contraceptives don’t work for you, the next step would be to try a selective serotonin reuptake inhibitor (SSRI). This is an antidepressant that is used to increase the serotonin levels in your brain. Many women prefer trying the oral contraceptive first, rather than an SSRI, especially if contraception is a priority. However, if the oral contraceptive does not help symptoms, an SSRI can be added.
When both SSRI and oral contraceptives have been unsuccessful, then a treatment that suppresses the menstrual cycle entirely can be given to see if that helps reduce symptoms.
Some alternative options are out there as well, even though they aren’t guaranteed to help your symptoms. Acupuncture is sometimes used to improve mood and physical symptoms. Another alternative option is incorporating daily exercise, which can help alleviate symptoms. Several vitamins and dietary supplements have also been studied to help PMDD, including vitamin B6, vitamin E, calcium, magnesium and a few others.
If you think you might have PMDD, visit your doctor to talk about treatment options.