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When it’s NOT PMS: Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a health condition similar to, albeit much worse than, premenstrual syndrome (PMS), typically occurring a week before menstruation. It presents the same set of physical, emotional and psychological symptoms, but with an intensity so severe that they are debilitating and interferes with the woman’s daily life, including work, school, social activities and relationships.

PMDD may pose long-term consequences to the patient’s mental wellbeing if left untreated.

Symptoms of PMDD

The symptoms of PMDD are similar to yet more severe in degree than PMS. They usually begin 7 to 10 days before menstruation and go away a few days after it starts. Symptoms include:

  • mood swings
  • irritability
  • fatigue
  • depression
  • anxiety
  • forgetfulness and difficulty concentrating
  • decreased libido and interest in regular activities
  • changes in appetite

PMDD is also characterized by physical symptoms such as:

  • bloating
  • cramps
  • breast tenderness
  • hot flashes
  • headaches
  • joint or muscle pain
  • sleep problems
  • heart palpitations
  • dizziness and fainting

Causes of PMDD

The exact cause of PMDD is still unclear, but hormonal changes are believed to play a crucial role in triggering symptoms. Studies have shown a link between PMDD and fluctuating levels of serotonin, a brain chemical (neurotransmitter) said to regulate mood, appetite and sleep. Similarly, hormonal changes can lead to reduced serotonin levels, which result in PMDD symptoms.

Diagnosing PMDD

The doctor may conduct tests to rule out other conditions that can cause similar symptoms, such as endometriosis, hormonal imbalance, fibroids, menopause, panic disorder and depression.

A diagnosis for PMDD is typically given if:

  • the patient is exhibiting at least five of the symptoms listed above
  • symptoms start 7 to 10 days before menstruation
  • symptoms stop a few days into the period
  • symptoms interfere with normal daily activities

Treatment for PMDD

A type of antidepressants known as selective serotonin reuptake inhibitors (SSRI) is the main form of treatment for PMDD. It is used to normalize the brain’s serotonin levels, helping alleviate emotional symptoms. Hormone therapy and birth control pills may also be prescribed to address hormonal imbalances that trigger PMDD.

Over-the-counter pain relievers and anti-inflammatory medicines may be taken to relieve physical symptoms of PMDD, including headaches, cramps and breast tenderness. Diuretics or water pills can help prevent fluid retention or bloating.

Additionally, diet and lifestyle adjustments, stress management and relaxation techniques, talk therapy and yoga exercises can help women cope with PMDD.