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More Than PMS: Could it Be PMDD?

Sarah has always known she was a “moody” person. Throughout life, she has never been a “go with the flow” laid back kind of gal. It did seem like her anxiety, irritability, and inability to sleep would follow a pattern and arrive at the same time of the month. Since her symptoms would eventually go away, she just brushed them off as PMS or pre-menstrual syndrome. 

Lately, though, it seems like a switch has flipped. Sarah’s thoughts have, admittedly, become very dark. She feels like a tornado of anger and emotion. She can hardly function at work without blowing up at her co-workers or erupting in tears. Her boyfriend feels at a complete loss. Sarah is pretty sure the two of them are going to call it quits soon. Luckily, her best friend, Stacey, notices she’s not her regular self and encourages her to get help.

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-based mood disorder. Symptoms arise during the pre-menstrual or luteal phase of the menstrual cycle. The luteal phase usually occurs 1-2 weeks before menses start. Symptoms resolve once menstrual flow begins.  PMDD is a much more severe form of PMS affecting about 3-6% of women. This statistic may be higher due to misdiagnosis or failure to recognize symptoms.

The symptoms of PMDD are serious and can be life-threatening. To support a diagnosis, patients must have at least five of the following symptoms:

  • Depression (hopeless feelings)
  • Feelings of anxiousness or tension
  • Irritability that increases as period nears
  • Oversleeping or insomnia
  • Lack of interest in favorite things
  • No motivation
  • Loss of energy
  • Difficulty focusing and concentrating
  • Loss of control feelings, feeling overwhelmed

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What Causes PMDD?  

Experts are still unsure of the exact cause of PMDD, but most agree that it is hormonally related. Every month, the hormones estrogen and progesterone perform a carefully orchestrated dance, rising and falling at different phases to prepare the body for a fertilized egg. If that egg is not fertilized, it (along with other uterine tissue) leaves the body in the form of a menstrual cycle. 

This balance of estrogen and progesterone can affect your levels of serotonin, a neurotransmitter that plays an important role in mood regulation.

In 2017, researchers found that patients who have PMDD also have a genetic change that causes their cells to “overreact” to estrogen and progesterone. They believe this overreaction is responsible for the symptoms that accompany PMDD.

Diagnosis of PMDD

Unfortunately, there is not one specific test that healthcare professionals can use to diagnosis PMDD. Diagnosis is made by careful tracking of symptoms related to the menstrual cycle. Symptoms must be present only in the week or two before your period, and they must go away within a few days of starting your period.

If you think you may be suffering from PMDD, contact your primary healthcare provider and track your symptoms every day (for at least two months). Some women use an app on their phone for easy retrieval. Your primary care provider should be able to track changes and rule out other potential causes of mood fluctuations.

Treatment Options for PMDD

Lifestyle Modifications: for some women, making changes in daily habits can be a gamechanger for managing PMDD symptoms. 

Lifestyle changes may include:

  • Getting frequent exercise
  • Stress management strategies
  • Taking a yoga or meditation class
  • Learning to say “no”

Medications for PMDD: some women need more than lifestyle modifications.

A few medications used to treat PMDD symptoms are:

  • Antidepressants
  • Birth Control Pills
  • Nutritional supplements, such as calcium and magnesium

Other Therapy

  • Working with a therapist, especially one trained in cognitive behavioral therapy, has been beneficial in many women who suffer from PMDD
  • Behavioral therapy can be combined with any of the above treatment options

Fast forward six months, and Sarah feels like a different person. It is mind-boggling to think that she was suffering from PMDD and didn’t even know it. Only Stacey and her therapist knew how “dark” her thoughts became. She was slowly sinking into a place that she never wants to go back to. She has been exercising daily, on a new medication, and goes to her therapist weekly. She even signed up for a yoga class. 

PMDD is a debilitating disease that can cause devastating consequences - many who suffer do so in silence. One of the most powerful ways we can fight it as women is to arm ourselves with knowledge and know that there is hope and help - you are not alone.

Further Help For PMDD:

Reference List

What is PMDD? The International Association for Premenstrual Disorders (IAMPD) website. Updated January 14, 2019. Available at https://iapmd.org/about-pmdd. Accessed August 18, 2020.

Living With: Premenstrual Dysphoric Disorder. The Psych Guides.Com website Accessed August 18, 2020. Available at https://www.psychguides.com/neurological-disorders/living-with-premenstrual-dysphoric-disorder/

Watson S. Could Your Severe PMS be PMDD? Healthline Website. Published January 15, 2019. Available at https://www.healthline.com/health/pmdd#causes. Accessed August 18, 2020.

Scaccia A. Serotonin: What You Need to Know. Healthline Website. Published August 19, 2020. Available at https://www.healthline.com/health/mental-health/serotonin. Accessed August 20, 2020.

Sex hormone-sensitive gene complex linked to premenstrual mood disorder-dysregulated cellular response to estrogen and progesterone suspected. National Institutes of Health (NIH) News Release. NIH website. Published January 3, 2017. Available at https://www.nih.gov/news-events/news-releases/sex-hormone-sensitive-gene-complex-linked-premenstrual-mood-disorder. Accessed August 18, 2020.

Thielen J. Premenstrual dysphoric disorder: Different from PMS? Mayo Clinic Patient Care and Health Info. Mayo Clinic website. Published November 29, 2018. Available at https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315. Accessed August 18, 2020.

Martin B. In-Depth: Cognitive Behavioral Therapy. Psych Central website. Published July 19, 2019. Available at https://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy/. Accessed August 21, 2020.

Published September 7th, 2020 by Dr. Betsy Hoida, PharmD, BCPS
Fact Checked by Chris Riley

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