Premenstrual Dysphoric Disorder: PMS' Evil Twin

Between 2 and 10% of women of reproductive age experience the severe symptoms and menstrual dysfunction caused by Premenstrual Dysphoric Disorder. If Premenstrual Syndrome is a little tremor in the tectonic plates of our reproductive system, PMDD is a full-blown earthquake.[1]

The symptoms caused by Premenstrual Dysphoric Disorder are severe and can disrupt your work-life, social activities, relationships, and emotional wellbeing for the five- to eleven-day period before your menstruation begins.

Here, we explore what PMDD is, what causes PMDD, how it's diagnosed, and what can be done about it, including some really good methods that could help you to help yourself.

What is PMDD?

PMDD has really similar symptoms to PMS. However, the symptoms are generally much more severe, and include at least one mood-related symptom. Symptoms start about a week before your period is due and continue until a couple of days after your period has started.

Most common symptoms include [2]:

• Anxiety, tension, feelings of being "on edge"
• Lack of interest in daily activities
• Depressed feelings, feelings of hopelessness, negative thoughts about yourself
• Suddenly sad or tearful; sudden sensitivity to criticism or rejection
• Difficulty concentrating
• Lethargy
• Changes in appetite; lack of appetite, increase in appetite, unusual cravings
• Sleeping more or less
• Feeling out of control
• Sudden bouts of anger
• Suicidal thoughts
• Heightened symptoms of PMS: tender breasts, cramping, bloating, muscle pain, and weight gain.

Causes

There's no current consensus on the cause of Premenstrual Dysphoric Disorder. However, it appears that your environment, your genes, your general mental health, and social factors all have a role to play in its development.

On the genetic side, 70% of women whose mothers have PMS have PMS themselves, compared to only 37% of women whose mothers did not have PMS. Similarly, 93% of women who have an identical twin with PMS will also have PMS, compared to only 44% of non-identical twins.[3]

There's also strong evidence that women who are prone to developing depressive disorders will develop PMDD. Various studies have found that between 30% and 76% of women who have PMDD also have lifetime histories of depression. A family history of depression has also been reported in women diagnosed with moderate to severe PMS.[3]

It's possible that serotonin deficiency may also be a cause of PMDD.

Environmentally, it appears being overweight, abusing alcohol or substances, and not taking exercise regularly may also have a role to play in the development in PMDD.

Diagnosis

In order for a diagnosis of PMDD, at least five of the above symptoms must be present. They must only be present in the luteal phase (the period leading up to menstruation, and in the first day or two of menstruation), and should not represent an increase in depression, an anxiety disorder, or a personality disorder already present.[1,2]

READ Foods that Fight PMS

In addition, these symptoms must be present for at least two consecutive menstrual cycles and - in order for PMDD to be diagnosed, rather than another mood disorder - you must be symptom-free during your follicular phase (that is, approximately, the first fourteen days of your cycle).

Next, we look at what can be done for PMDD sufferers.

Treatment and Self-Help

Treatment

Certain medications may be helpful in the treatment of PMDD if the symptoms are especially severe. Here, we examine what your options are and how they may help you.[4]

Antidepressants:- SSRI Antidepressants (such as Citalopram and Fluoxtine) may be taken for either the luteal phase or for the whole cycle (although luteal phase use is preferred to continuous treatment, because studies show that they weren't found to be more effective when taken continuously rather than only during the second half of the cycle). They may be a particular benefit if you're suffering from distressing emotional symptoms. Other resources recommend that you have to take SSRIs for at least three months before they start working.

In addition, women who consider trying antidepressants as an alternative to their PMS and PMDD need to be aware of the side effects they could have, such as nausea, sleep problems and decreased libido.

Birth Control Pills:- A combined oral contraceptive pill, taken continuously, may help reduce PMS symptoms and ease mood swings. A pill containing Drospirenone may be specifically useful for PMDD. However, it's worth noting that combined oral contraceptives may exacerbate mood symptoms in some people and they might also come with other side effects, such as acne, and obvioulsy they are not an appropriate aid if you want to get pregnant.  

Diuretic:- A specific diuretic called Spironolactone (taken in the luteal phase) may help PMDD. Not only does it help reduce physical symptoms (including bloating), but it may ease the psychological symptoms. The downside is that when you stop using them, your body might retain more water than it did before you started using them. 

Ibuprofen:-  Ibuprofen may help relive breast tenderness, headache, and cramping associated with PMDD. To protect your stomach, take it with food.

How Can You Help Yourself?

In addition to the medications outlined above, there are numerous things you can do to help yourself.[4]

• Supplements:- A well-balanced regime of supplements is the ideal way to support any medication your doctor prescribes. You should consider:
  • Vitamin B6:- up to 100mg per day (improves your mood) Shown to be effective for PMS and PMDD.
  • Vitamin E:- Up to 600mcg per day (improves breast tenderness). May be effective, has low risk.
  • Calcium Carbonate:- 1200mg a day (reduced bloating and cramps). Shown to have benefits for moderate to severe PMS and PMDD.
  • Magnesium:- Up to 500mg a day (elevates mood)
  • Tryptophan:- Up to 600mg a day (promotes calm and sleep; converts to serotonin) Very well evidenced; has benefits for PMS and PMDD
• Lifestyle changes: - improvements to your lifestyle could improve your PMDD:
  • Stop smoking
  • Take daily exercise:- Aerobic exercise is particularly beneficial in the reduction of PMDD.
  • Get regular hours for sleep
  • Restrict your alcohol consumption to healthy levels:- no more than 14 units a week for women, with two alcohol-free days.
  • Eat a healthy diet:- limit consumption of caffeine (which decreases irritability) and salt (which reduces bloating); eat complex carbohydrates
• Herbal Remedies:- Certain herbal remedies could help:
  • Evening Primrose Oil:- 500-1000mg, three times a day, from day 17 to day 28 of your menstrual cycle (reduces breast tenderness; may benefit other PMS symptoms)
  • Chaste tree berry: - 30 - 40mg per day, from day 17 to day 28 of your cycle (may improve breast symptoms).
• Cognitive Behavioural Therapy:- Psychological stressors can't be understated, either as a potential cause, or as a result of PMDD. Women who have negative self-views, or who criticise themselves for their condition, may benefit from a course of Cognitive Behavioural Therapy. This treatment can improve self-image, and improve social relationships. CBT's benefits in the treatment of PMS and PMDD have been documented and it's worth considering this therapy as part of your treatment plan.

Conclusion

As you can see, although Premenstrual Dysphoric Disorder can be a debilitating and stressful condition, there are many treatments out there, designed to help improve your quality of life. As with everything, the first step is to admit you need help and to book an appointment with your doctor.

READ Vitamin B Rich Diet Lowers the Risk of Premenstrual Syndrome

Although some people still fear being diagnosed with a mood disorder, PMDD is nothing to be ashamed of. For some women, it's an unavoidable part of their menstrual cycle. So, please, seek the help you need.

Also, if you're having suicidal thoughts, call 911 (111 in the UK), go to your nearest Emergency Room/Accident and Emergency Department, or call a crisis hotline or the Samaritans. There are people who want to help you.

Don't be afraid to reach out.