Premenstrual Dysphoric Disorder (PMDD)- Obstetrics and Gynecology

Premenstrual dysphoric disorder (PMDD) is a condition that occurs exclusively in women of reproductive age. It causes wide ranges of physical and emotional symptoms in the weeks before their period. While most women experience symptoms like headaches, abdominal cramps, and mood swings before their menstrual period, PMDD is a more serious condition affecting a smaller percentage of women.

The symptoms of PMDD is somewhat similar to premenstrual syndrome (PMS), however, it’s a more severe and distressing condition. PMDD causes issues with mood and behavior in addition to physical symptoms. Furthermore, PMDD is less common than PMS and affects only 5% of women of reproductive age.

Women having this condition experience more severe symptoms including depressed mood, sleep problems, lack of energy, anger, nervousness, headache, and abdominal cramps. Some women may even have suicidal thoughts. These symptoms can often affect their day-to-day life and cause problems at work and in family and society.

Symptoms Of Premenstrual Dysphoric Disorder (PMDD)

PMDD usually causes disturbed mood and behavioral problems along with physical symptoms in women before their period. Symptoms start a week or two before menstrual period and subside after menstruation.

Symptoms that can be seen in affected women include:

• Headache
• Abdominal cramps
• Food cravings
• Breast tenderness
• Low mood
• Lack of energy
• Difficulty sleeping
• Difficulty concentrating
• Crying spells
• Suicidal thoughts
• Anger outbursts
• Anxiety and nervousness
• Mood swings
• Hot flashes

What Causes Premenstrual Dysphoric Disorder (PMDD)?

The underlying cause of PMDD is still not clearly understood. Researchers believe PMDD could be related to fluctuations in hormone levels in the body during menstrual cycles. Changes in hormone levels cause serotonin deficiency. Serotonin is a chemical that is produced by the brain and gut and influences mood and behavior in the human body.

Low levels of serotonin may be responsible for PMDD symptoms. Women with personal or family history of depression and psychological problems are at greater risk for having this condition. Genetic factors, obesity, smoking, and alcohol intake are also linked with the development of PMDD symptoms in women.

Treatment Options For Premenstrual Dysphoric Disorder (PMDD)

PMDD is a serious condition that impacts the daily life of affected women. The goal of treatment is to help reduce the physical and psychological symptoms to improve the overall quality of life.

Medications

Medications that can help relieve PMDD symptoms include:

• Antidepressants: Antidepressants such as selective serotonin re-uptake inhibitors (SSRIs) are effective treatment options for relieving symptoms of  PMDD.
• Hormone therapy: Hormonal pills containing drospirenone and ethinyl estradiol have been found to alleviate psychiatric symptoms of PMDD.
• Pain-killers: NSAIDS like paracetamol or ibuprofen can be used to relieve the abdominal cramps and pain associated with this condition.

Lifestyle Changes

Leading an active and healthy lifestyle can be helpful if you are suffering from PMDD.

• Dietary modifications: Eating a healthy and nutritious diet containing green vegetables,  fruits, and proteins is beneficial for health.
• Stress management: Knowing how to handle stressful situations and getting adequate sleep is particularly important in managing this condition.
• Regular exercises: Physical and breathing exercises like yoga will certainly help in reducing anxiety and maintaining good health.
• Stop smoking and alcohol intake: One needs to consider stopping smoking and alcohol intake in order to relieve the symptoms.

Cognitive Behavior Therapy:

Another way to cope with this condition is cognitive behavior therapy. It is a type of talk therapy that helps you recognize negative thoughts and behavior patterns.

Seek Help from a Healthcare provider or Doctor

If you are experiencing PMDD symptoms every month and it is affecting your social life and work, you must seek help from a healthcare provider. Only an expert in this field will understand your symptoms and can provide ways to treat this condition. Managing stress, exercising daily, eating healthy food, and stopping alcohol intake are some of the lifestyle modifications that you can implement to alleviate PMDD symptoms.

References:

• Epperson C, Steiner M, Hartlage SA, Eriksson E, Schmidt PJ, Jones I, et al. Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry.
• Hantsoo L, Epperson CN. Premenstrual dysphoric disorder: epidemiology and treatment. Curr Psychiatry Rep. 2015;17:87.
• Teri Pearlstein. Treatment of Premenstrual Dysphoric Disorder: Therapeutic Challenges
• Andrea J Rapkin & Sharon A Winer. Premenstrual syndrome and premenstrual dysphoric disorder: quality of life and burden of illness
• American College of Obstetricians and Gynecologists. Premenstrual syndrome. ACOG Pract. Bull.15, 1–9 (2000).

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