Premenstrual dysphoric disorder

  • Definition
    • Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS).

      PMS refers to a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when, or shortly after, her period begins.

  • Alternative Names
    • PMDD; Severe PMS

  • Causes
    • The causes of PMS and PMDD have not been found.

      Hormone changes that occur during a woman's menstrual cycle may play a role.

      PMDD affects a small number of women during the years when they are having menstrual periods.

      Many women with this condition have:

      Other factors that may play a role include:

      • Alcohol or substance abuse
      • Thyroid disorders
      • Being overweight
      • Having a mother with a history of the disorder
      • Lack of exercise
  • Symptoms
    • The symptoms of PMDD are similar to those of PMS. However, they are generally more severe and debilitating and include at least one mood-related symptom. Symptoms occur during the week just before menstrual bleeding and usually improve within a few days after the period starts.

      Here is a list of common PMDD symptoms:

      • Lack of interest in daily activities and relationships
      • Fatigue or low energy
      • Sadness or hopelessness, possibly thoughts of suicide
      • Anxiety
      • Out of control feeling
      • Food cravings or binge eating
      • Mood swings with bouts of crying
      • Panic attacks
      • Irritability or anger that affects other people
      • Bloating, breast tenderness, headaches, and joint or muscle pain
      • Problems sleeping
      • Trouble concentrating
  • Exams and Tests
    • No physical examination or lab tests can diagnose PMDD. A complete history, physical examination (including a pelvic exam), thyroid testing, and psychiatric evaluation should be done to rule out other conditions.

      Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times when they are likely to occur. This information may help your health care provider diagnose PMDD and determine the best treatment.

  • Treatment
    • A healthy lifestyle is the first step to managing PMDD.

      • Eat healthy foods with whole grains, vegetables, fruit, and little or no salt, sugar, alcohol, and caffeine.
      • Get regular aerobic exercise throughout the month to reduce the severity of PMS symptoms.
      • If you have problems sleeping, try changing your sleep habits before taking medicines for insomnia.

      Keep a diary or calendar to record:

      • The type of symptoms you are having
      • How severe they are
      • How long they last

      Antidepressants may be helpful.

      The first option is usually an antidepressant known as a selective serotonin-reuptake inhibitor (SSRI). You can take SSRIs in the second part of your cycle up until your period starts, or for the whole month. Ask your health care provider.

      Cognitive behavioral therapy (CBT) may be used either with or instead of antidepressants. During CBT, you have about 10 visits with a mental health professional over several weeks.

      Other treatments that may help include:

      • Birth control pills typically help reduce PMS symptoms. Continuous dosing types are most effective, especially those that contain a hormone called drospirenone.
      • Diuretics may be useful for women who have significant short-term weight gain from fluid retention.
      • Other medicines (such as Depo-Lupron) suppress the ovaries and ovulation.
      • Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramps, and breast tenderness.

      Most studies have shown that nutritional supplements, such as vitamin B6, calcium, and magnesium are not helpful in relieving symptoms.

  • Outlook (Prognosis)
    • After proper diagnosis and treatment, most women with PMDD find that their symptoms go away or drop to tolerable levels.

  • Possible Complications
    • PMDD symptoms may be severe enough to interfere with a woman's daily life. Women with depression may have worse symptoms during the second half of their cycle and may need changes in their medication.

      Some women with PMDD have suicidal thoughts. Suicide in women with depression is more likely to occur during the second half of their menstrual cycle.

      PMDD may be associated with eating disorders and smoking.

  • When to Contact a Medical Professional
    • Call 911 or a local crisis line right away if you are having thoughts of suicide.

      Call for an appointment with your health care provider if:

      • Symptoms do not improve with self-treatment
      • Symptoms interfere with your daily life
  • References
    • Dog LT. Premenstrual syndrome. In: Rakel D, ed. Integrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 53.

      Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 36.

      Vigod SN. Understanding and treating premenstrual dysphoric disorder: an update for the women's health practitioner. Obstet Gynecol Clin North Am. 2009;36:907-924, xii.

      Yonkers KA, O'Brien PM, Ericksson E. Premenstrual syndrome. Lancet. 2008; 371(9619):1200-1210.