Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a chronic condition that affects a subset of women during their childbearing years. It is a more severe and debilitating form of premenstrual syndrome (PMS), with symptoms that can significantly disrupt daily life, social interactions, and personal relationships. The symptoms of PMDD typically occur during the luteal phase of the menstrual cycle. Understanding the nature and impact of PMDD is crucial for those affected by the condition and their loved ones.

What is Premenstrual Dysphoric Disorder?

PMDD is a mental health disorder characterised by severe emotional and physical symptoms that occurs before menstruation. It affects approximately 10% of women of reproductive age. Unlike PMS, which is relatively common and less severe, PMDD symptoms are more intense and can be highly debilitating.

It is characterised by intense mood changes, anxiety, depression, and physical symptoms that occur in the week or two before menstruation. These symptoms typically improve within a few days after the onset of menstruation. But, they can significantly interfere with a woman's personal and professional life during the symptomatic period. The DSM-5-TR, a widely used manual for mental health disorders, recognises PMDD as a distinct condition. This highlights its significance and the need for proper diagnosis and treatment.

The symptoms of PMDD are more severe and debilitating compared to those of PMS. These symptoms can be classified into emotional and physical categories:

Emotional Symptoms:

• Feelings of sadness, hopelessness, or low self-worth

• Heightened anxiety, tension, or a constant sense of unease

• Fluctuations in mood

• Increased self-criticism and sensitivity to rejection

• Occasional or unexpected tearfulness

• Greater irritability or anger

• Conflicts with family, colleagues, or friends

• Reduced interest in usual activities

• Difficulty concentrating

• Feelings of being overwhelmed or lacking control

Physical Symptoms:

• Swelling or tenderness in the breasts

• Headaches

• Aches in joints or muscles

• Weight increase

• Bloating

• Changes in appetite, such as continuous eating, overeating, or craving certain foods

• Changes in sleep patterns, such as over-sleeping or difficulty sleeping

• Fatigue, lethargy, or lack of energy

Premenstrual dysphoric disorder (PMDD) typically occurs during the luteal phase of the menstrual cycle. This is the period between ovulation and the start of menstrual bleeding. This phase usually lasts about two weeks but can be longer or shorter for some individuals. The stages of PMDD are as follows:

• Luteal Phase: Symptoms of PMDD typically appear during this phase and improve within a few days after menstruation starts.

• Symptom Onset: Symptoms usually start 10 to 14 days before menstruation and can last until the first few days of the menstrual period.

• Duration: Symptoms can last throughout the luteal phase and may vary in intensity and duration among individuals.

While the exact causes of PMDD remain unclear, research suggests that a combination of factors may contribute to the development of this condition. Some of the potential causes include:

• Hormonal Changes: Decreasing levels of oestrogen and progesterone after ovulation and before menstruation may trigger symptoms.

• Sensitivity to Hormonal Changes: Some individuals may be more sensitive to these hormonal fluctuations, which can lead to PMDD symptoms.

• Serotonin Levels: Changes in serotonin levels throughout the menstrual cycle may also play a role in PMDD. Serotonin is a brain chemical that regulates mood, hunger, and sleep.

• Genetic Factors: Research suggests that genetic variations may contribute to increased sensitivity to hormonal changes, leading to PMDD.

• Stress and Trauma: Past traumatic events and stress may also be linked to PMDD in some cases.

While the exact causes remain unclear, it is evident that a combination of hormonal, neurochemical, and genetic factors may contribute to the development of PMDD. Identifying the potential causes can help in developing targeted treatments for managing the symptoms of this condition.

While any individual who menstruates can potentially develop PMDD, certain factors may increase the risk of experiencing this condition. Some of the known risk factors for PMDD include:

• Genetic Predisposition: There may be a genetic component to PMDD, as some research suggests that increased sensitivity to hormonal changes may be inherited.

• History of Depression or Anxiety: Individuals with a history of depression or anxiety may be more prone to developing PMDD.

• Trauma and Stress: Past traumatic events or ongoing stress may contribute to the development of PMDD or worsen its symptoms.

• Smoking: Smoking may affect hormone sensitivity and potentially contribute to PMDD.

Premenstrual dysphoric disorder (PMDD) can lead to several complications that significantly impact a woman's quality of life. Some of the key complications associated with PMDD include:

• Disruption of Relationships: PMDD symptoms can strain relationships with partners, family members, and friends due to increased irritability, anger, and mood swings.

• Impaired Work and Social Functioning: The disorder can affect work productivity and social interactions, leading to decreased productivity and difficulties in maintaining usual roles and responsibilities.

• Exacerbation of Mental Health Issues: Untreated PMDD can worsen existing mental health conditions such as depression and anxiety. In severe cases, it may lead to suicidal thoughts or behaviours.

• Debilitating Physical Symptoms: While the primary symptoms of PMDD are mood-related, physical symptoms like bloating, breast tenderness, headaches, and joint or muscle pain can also be debilitating.

• Increased Healthcare Utilisation: Women with PMDD may have increased use of healthcare services. This includes more clinician visits and the use of prescription medications and over-the-counter preparations.

Preventing PMDD can be hard because it has many different causes. However, some measures can help manage or reduce the risk of developing severe symptoms:

• Early Detection and Treatment: Identifying and treating underlying mental health conditions such as depression and anxiety may help mitigate the severity of PMDD symptoms.

• Lifestyle Modifications: Regular exercise, practising stress-reducing techniques like yoga or meditation, and maintaining a balanced diet can help alleviate some symptoms.

• Avoiding Triggers: Avoiding alcohol or substance abuse and managing other risk factors such as being overweight or having a lack of exercise may also be beneficial.

Diagnosing PMDD involves a comprehensive evaluation of symptoms and medical history. The following steps are involved in the diagnostic process:

• Medical History: The doctor will take a thorough medical history to identify any underlying conditions that may be contributing to the symptoms.

• Symptom Tracking: Prospective symptom charting for at least two consecutive menstrual cycles is required to confirm the diagnosis. This involves daily recording of symptoms, their severity, and their impact on daily functioning.

• Physical Examination: A physical exam may be performed to rule out other medical conditions that could be causing the symptoms.

• Psychological Evaluation: A mental health professional may conduct a psychological evaluation to assess the presence of other mental health disorders and determine the severity of PMDD symptoms.

• Laboratory Tests: Blood tests may be ordered to check for hormonal imbalances, thyroid disorders, or other underlying medical conditions, contributing to the symptoms.

Treatment for premenstrual dysphoric disorder (PMDD) typically involves a combination of medications and non-pharmacological approaches. The primary goal is to alleviate the severe mood symptoms and physical discomfort associated with PMDD.

• Medications: Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine, sertraline, citalopram, and escitalopram are considered the first-line treatment for PMDD. These medications can be taken daily or intermittently during the luteal phase of the menstrual cycle. Combined Oral Contraceptives (COCs) may also be prescribed to control or stop ovulation, although their effectiveness is mixed. Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs) like venlafaxine are another option for managing PMDD symptoms.

• Non-Pharmacological Treatments: Cognitive behavioural therapy (CBT) has proven effective in addressing the psychological symptoms of PMDD. For physical symptoms like headaches and joint pains, painkillers or anti-inflammatory drugs such as ibuprofen may be recommended. Lifestyle changes, including dietary modifications, regular exercise, and stress management techniques like yoga and meditation, can also provide relief.

• Alternative Therapies: Some studies suggest that nutraceuticals like calcium supplements may improve PMDD symptoms, although further research is needed to confirm their efficacy. Complementary and alternative medicine techniques such as acupuncture and yoga have shown promise, but the quality and methods of studies vary.

Living with PMDD can be challenging, but various strategies and support systems can help you deal with the symptoms and improve your overall well-being.

• Self-Care: Making dietary changes, such as opting for healthier food choices and reducing salt intake to manage bloating, can be beneficial. Regular physical activity, even gentle exercises like walking or yoga, can help alleviate physical and emotional symptoms. Stress management techniques, including meditation, deep breathing exercises, and counseling, can provide a sense of control and emotional balance.

• Support Systems: Joining support groups, either in-person or online, can be a valuable source of emotional support and understanding. Connecting with others who share similar experiences can help you feel less alone and provide practical tips for managing PMDD. Communicate openly with your loved ones about your condition, so they can offer support and understanding during challenging times.

Remember, living with PMDD is a unique journey for each individual. It's crucial to be patient with yourself, prioritise self-care, and seek professional help when needed. By combining medical treatment, lifestyle modifications, and a strong support network, you can develop effective coping strategies and improve your overall quality of life.

If you suspect that you may have PMDD, it's important to consult with a healthcare provider for an accurate diagnosis and appropriate treatment. Here are some signs that it's time to seek medical attention:

• Severe Symptoms: If your premenstrual symptoms are severe enough to interfere with your daily life, including your ability to work, study, or maintain relationships, it's crucial to seek medical help. This is especially important if you experience extreme irritability, anxiety, depression, or suicidal thoughts.

• Symptom Tracking: Keeping a symptom journal can help you track your symptoms over one or two menstrual cycles. This information can be valuable to your doctor in making an accurate diagnosis and developing an effective treatment plan.