What is Premenstrual Dysphoric Disorder?

If you are a woman reading this, you know how common is it to have mood swings, cramps and irritability during the menstruation period but only a few know that these symptoms could be observed even a week or 10 days before the menstrual cycle starts. This is because of Premenstrual Syndrome (PMS). However, this could take a bigger form and have a drastic impact on your life in the form of Premenstrual Dysphoric Disorder (PMDD).

What is Premenstrual Dysphoric Disorder?

Premenstrual Dysphoric Disorder is a depressive disorder and can be considered as a severe form of Premenstrual Syndrome (PMS). It has a wide variety of signs and symptoms, including mood swings, food cravings, fatigue, irritability, and depression. In PMDD these symptoms are similar but their impact is severe that it starts interfering with your life including school, work, social life, and relationships.

Although the cause of PMS and PMDD is still not clear, experts say it occurs because of the response of the brain to the sudden fluctuation of normal hormones in women’s body leading to the deficiency of serotonin. Serotonin is a neurotransmitter that contributes to a good mood, social behaviour, appetite, sleep cycle, and body’s internal clock.

Around 20 to 40 percent of women experience PMS and between 3 to 8 percentage of them suffer from PMDD.

The symptoms can be seen a week or 10 days before the start of the menstrual cycle.

Symptoms of PMDD include:

Psychological:

• Nervousness
• Irritability
• Depression
• Agitation
• Poor self-image
• Emotional sensitivity
• Sleeping problems such as hypersomnia or insomnia
• Confusion
• Anxiety
• Difficulty in concentrating
• Paranoia
• Mood swings

Physiological:

• Abdominal cramps
• Nausea
• Vomiting
• Backache
• Pelvic heaviness or pressure
• Acnes
• Skin inflammation with itching
• Headaches
• Dizziness
• Numbness or prickling sensation in arms and legs
• Fainting
• Muscle Spasms
• Breast pain
• Periodic weight gain
• Diminished urine output
• Painful menstruations
• Swelling of the hands, feet, and ankles
• Appetite changes
• Hot flashes

American Psychiatric Association (APA) and Diagnostic and Statistical Manual 5th Edition (DSM-V), requires the symptoms to be observed in two consecutive menstrual cycles to fall under the category of PMDD.

Also, the following conditions should be met to be diagnosed under PMDD:

• The symptoms must be present one week before the start of menses.
• The symptoms must resolve after the start date and within the first few days of  menstruation
• And it must interfere with normal life.

Diagnosis of PMDD

As the psychological symptoms of PMDD cannot be directly observed and the symptoms may seem very similar to those of other disorders, physicians perform a physical examination, obtain a medical history, and do certain tests. They also ask the patients to evaluate their own mental health and keep a diary or a journal for several months.

How is PMDD treated?

The severity of the PMDD can be relieved through lifestyle changes and medication following:

•  Diet and lifestyle changes: An increase of protein and carbohydrates, a decrease of salt, sugar, caffeine, and alcohol are very effective in decreasing the symptoms. Regular exercising, getting proper sleep and relaxing techniques including meditation, mindfulness, and yoga may also help.
• Taking Vitamin and nutrient supplements: Taking dietary and supplemental calcium may help in reducing the symptoms in some women. Vitamin B-6, Vitamin E, and magnesium are effective too. However, it is necessary to consult your physician before taking these supplements.
• Taking oral contraceptives or birth pills containing drospirenone and Ethinyl estradiol.
• Cognitive Behavioural Therapy when combined with medication has also been effective.
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem, others) and sertraline (Zoloft), may reduce symptoms such as emotional symptoms, fatigue, food cravings, and sleep problems. As these antidepressants can have severe side effects, it’s necessary them only after the prescription of the doctor.
• Herbal remedies such as the use of chasteberry extract evening primrose oil may also help in reducing mood swings, food cravings, and breast tenderness. Again, it’s necessary to consult an expert before taking these remedies.

Some alternative treatments whose effectiveness still needs to be proved through more research are mentioned below:

• Qi therapy
• Acupuncture
• Saffron therapy
• Photic Stimulation
• Guided imagery

Things you need to consider while going to a clinician for treatment:

• Write down the questions that you want to get answered before going to the clinician.
• Know why you decided to have the visit and what you expect further.
• Make a note of medicine, diagnosis, tests, and the given instructions.
• Know what medicines you will be taking, how are they going to work, and also their side effects.
• Know what the results of the tests conducted mean
• Note down the time and date of the next appointment
• Know how to contact your physician if you have more questions in the future.
• Ask if there are any alternative ways of treatment if you are not comfortable with the one recommended.

PMDD is a  problem that should be considered very seriously. It is very necessary for women to consult a doctor if suffering from the same. These symptoms should not be ignored as ” common mood swings”.

References:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd#:~:text=The%20exact%20cause%20of%20PMDD,can%20cause%20a%20serotonin%20deficiency.

https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315

https://www.medicalnewstoday.com/articles/308332#treatment