What is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual dysphoric disorder, or PMDD, is a severe form of premenstrual syndrome (PMS) that usually occurs a week or two before the start of the period with symptoms resolving around two to three days after the period starts.

Premenstrual dysphoric disorder affects between 3% to 8% of menstruating women. Also, those who might get PMDD are often those who already suffer from depression or anxiety, experience PMS, or have a family history of premenstrual dysphoric disorder or mood disorders.¹

PMS vs. PMDD

The difference between PMS and PMDD is mainly based on the severity of mood symptoms. While some may experience depression and anxiety with premenstrual syndrome, those who suffer from premenstrual dysphoric disorder exhibit much more severe symptoms of depression and anxiety that may include thoughts of suicide and feelings of detachment. ²

What are the Symptoms of PMDD?

Premenstrual dysphoric disorder symptoms typically appear a week before the period and are likely to end a few days after the start of the period. Symptoms are often so severe that they cause disruption in the lives of the women who experience PMDD. The premenstrual dysphoric disorder symptoms may include:³

Psychological symptoms: Psychological symptoms of PMDD may be irritability, nervousness, anxiety, panic attacks, depression, suicidal thoughts, mood swings, difficulty concentrating, anger, poor self-image, insomnia, and paranoia.
Physical symptoms: PMDD physical symptoms may include bloating, nausea, abdominal cramping, headache, dizziness, fainting, weight gain, heart palpitations, breast tenderness, and pelvic pressure.

In order for these symptoms to determine a diagnosis of PMDD, they must cause significant distress, interruption, and impairments in the individual’s life. The symptoms must be severe enough to disrupt regular functioning.

What Causes PMDD?

Experts do not fully understand the causes of premenstrual dysphoric disorder. However, there are a few theories as to the causes of PMDD. These will be detailed below.

Cyclic Changes in Hormones

Most researchers think that one of the primary causes of premenstrual dysphoric disorder has to do with abnormal reactions to hormone changes that occur during menstruation. The decreasing levels of estrogen and progesterone, after ovulation and before menstruation, may cause these symptoms.

Chemical Changes in the Brain

There are also some theories that premenstrual dysphoric disorder symptoms may be caused by chemicals in the brain. Studies have shown a link between PMDD and low levels of the neurotransmitter serotonin. Serotonin has been shown to control mood, sleep, and pain. The hormonal changes that occur during menstruation may decrease the level of serotonin in the brain, which may cause the symptoms of PMDD.⁴

Depression

PMDD and depression have shown to be linked. Therefore, individuals who already experience a mood disorder, like depression, may be at an increased risk of developing PMDD.

Diagnosis of Premenstrual Dysphoric Disorder

There is no formal test to determine if an individual has premenstrual dysphoric disorder. However, for an accurate PMDD diagnosis, it is important to talk with your primary care physician.

Comprehensive Physical Examination

In order to diagnose premenstrual dysphoric disorder, your medical doctor will typically have you complete a comprehensive health history and physical exam. The physical exam may include blood tests in order to rule out any physical conditions that may be causing the symptoms.

Your medical provider may also ask you to record or track your symptoms in a diary or journal through one or two menstrual cycles to get a better understanding of the severity, length, and duration of the symptoms.

Diagnostic Criteria

A PMDD diagnosis is made if your medical provider determines that you have five or more of the premenstrual dysphoric disorder symptoms, such as the physical or emotional symptoms. One of the symptoms must include a mood-related symptom in order to receive a PMDD diagnosis.⁵

How is Premenstrual Dysphoric Disorder Managed or Treated?

Premenstrual dysphoric disorder treatment looks similar to premenstrual syndrome treatments. There are several ways that you can treat both the physical and the psychological PMDD symptoms. Treatment may involve a combination of medications and stress management techniques. Treatment options for PMDD are detailed below.

Antidepressants

The use of antidepressants can help treat PMDD and depression. This medication can alleviate the low mood associated with depression.

Dietary Changes

Cutting back on salty and sugary foods can help manage symptoms such as bloating, fluid retention, and weight gain. Increasing calcium intake can also help decrease joint aches and pain. Similarly, regularly taking vitamins such as vitamin B, vitamin D, and magnesium can help to provide essential vitamins and minerals that your body may lack before and during menstruation.

Hormonal Birth Control Pills

If you experience PMDD and use birth control pills that contain drospirenone and ethinyl estradiol, this often helps to regulate hormonal changes and stop ovulation.⁶

Over-the-Counter Pain Medicines

Other medications that can be useful in managing symptoms of pain and cramping are over-the-counter pain medications such as ibuprofen and aspirin.

Regular Exercise to Improve Mood

Another premenstrual dysphoric disorder treatment can involve getting regular exercise. Engaging in at least thirty minutes of exercise a few days per week can improve mood and help alleviate PMDD fatigue.

Stress Management Tools

Treatment for PMDD anxiety, tension, and nervousness may involve the use of stress management tools like deep breathing, meditation, yoga, or whatever healthy premenstrual dysphoric disorder self-care techniques you may find useful.

What are the Complications of PMDD?

Untreated PMDD can oftentimes lead to severe depression and even suicide. The severity of premenstrual dysphoric disorder symptoms can increase over time and usually lasts until menopause.

Treating depression or anxiety that previously existed may help prevent premenstrual syndrome from developing into premenstrual dysphoric disorder. However, since it is not known what causes PMDD, there may be no way to prevent it from occurring. In this instance, getting treatment as soon as possible and engaging in premenstrual dysphoric disorder self-care activities can help improve prognosis by alleviating and managing symptoms.⁶

Get Treatment For PMDD At Pacific Beach Health

Looking for treatment for premenstrual dysphoric disorder? The experienced professionals at Pacific Beach Health offer evidence-based therapy services that can help address a variety of mental health and behavioral concerns. Contact Pacific Beach Health at 858-295-8694 to find out if our treatment facility is right for you.

What is Premenstrual Dysphoric Disorder (PMDD)?

Learn more about what premenstrual dysphoric disorder is, its symptoms, and available treatment options.