What’s Worse Than PMS? PMDD

If premenstrual symptoms are so severe in the days before your period that they interrupt your life, you might have a more debilitating form of PMS called PMDD (premenstrual dysphoric disorder.)

Women with PMDD experience serious and chronic physical and emotional symptoms, including feelings of being overwhelmed, anxious and depressed. What makes PMDD different from other mood disorders and menstrual conditions is that symptoms come and go with a woman’s menstrual cycle.

While the exact cause of PMDD is not known, doctors believe it is related to changes in the brain chemical serotonin and hormone levels throughout the menstrual cycle.

Symptoms Can Be Severe

Symptoms generally start one or two weeks before your period begins, as hormone levels fall. They may include:

  • Irritability or anger 
  • Depressed mood
  • Feelings of tension or anxiety 
  • Panic attacks
  • Mood swings or crying often
  • Lack of interest in activities you enjoy
  • Trouble concentrating
  • Fatigue
  • Increased appetite
  • Trouble sleeping
  • Feeling out of control
  • Physical symptoms, such as:
    • Cramps
    • Bloating
    • Breast tenderness
    • Headaches
    • Joint or muscle pain

Most women begin to feel like themselves two or three days after their period begins, as hormones return to their normal levels.

PMDD’s Cause Based In Biology

Premenstrual Dysphoric Disorder small

While the exact cause of PMDD is not known, doctors believe it is related to changes in the brain chemical serotonin and hormone levels throughout the menstrual cycle.

Serotonin affects your mood. The hormone changes that come with the menstrual cycle can cause a drop in serotonin, affecting how you feel physically and emotionally. Some women may be more sensitive to the rise and fall of serotonin and hormone levels.

About 5 percent of women of childbearing age are diagnosed with PMDD. Your doctor will make a diagnosis by talking to you about your symptoms and by doing a physical exam. If mental health symptoms are a big concern, you may also see a psychologist or psychiatrist. 

Your doctor may ask you to keep a calendar or diary of your symptoms. Most women with PMDD have five or more symptoms with every menstrual cycle for at least a year. For some women, symptoms increase and get worse over time, lasting until menopause.

Treatment Options Do Help

How you manage PMDD depends on your specific symptoms. Your doctor will recommend the best treatments for you. Common treatments include lifestyle changes, medicines and counseling.

Treatments for PMDD may include:

  • Regular exercise
  • Healthy diet rich in protein 
  • Avoiding sugar, salt caffeine and alcohol
  • Stress management
  • Antidepressants to regulate serotonin levels 
  • Birth control pills to regulate menstrual hormones
  • Over-the-counter pain relievers and anti-inflammatory medicines

Be sure to talk with your doctor if you feel worse or if you have thoughts of hurting yourself or others. 

PMDD Still Not Fully Understood

PMDD is designated as a disorder in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), used by doctors to make a mental health diagnosis.

There is debate over whether this accurately portrays the condition, says the American Psychological Association. Some do not believe PMDD is a real disorder. Others wonder why women must be diagnosed with a mental health condition for their symptoms to be believed.

Whatever the case may be, the symptoms of PMDD are very similar to major depressive disorders  – and medicines do help women who use them for treatment, says the American Psychological Association. The main difference is that PMDD is cyclical and related to menstrual hormone changes.

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