What Is Premenstrual Dysphoric Disorder (PMDD)?

Hormonal fluctuations causing minor physical discomfort or emotional disturbances are common throughout the menstrual cycle. However, if you experience symptoms leading up to and during your period (menstruation) that are so severe they adversely impact your work, academic, and social life, then you might have premenstrual dysphoric disorder (PMDD).

Between 1.3% and 5.3% of menstruating people meet the rigorous diagnostic criteria for PMDD.

This article will discuss PMDD symptoms, diagnosis, risk factors, self-care options, and medical treatment.

Symptoms of Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder begins during ovulation (the luteal phase) and resolves shortly after your period ends. It can occur at any age, from your first period until menopause. PMDD symptoms include the following:

• Feelings of loneliness, sadness, moodiness, anxiety, irritability, restlessness, or elevated self-criticism
• Depressed mood and interest in usual activities
• Feelings of hopelessness
• Feeling overwhelmed
• Appetite changes (e.g., overeating or food cravings)
• Insomnia or hypersomnia (sleeping too much)
• Forgetfulness
• Confusion
• Difficulty concentrating
• Water retention
• Weight gain
• Painful or tender breasts
• Swelling or bloating of breasts or abdomen
  

Talk to a healthcare provider, such as a gynecologist, if you experience such symptoms the week before and during your period.

Why Do Some People Experience PMDD?

The exact cause of PMDD is unknown. Some researchers theorize that fluctuations in estrogen and progesterone (sex hormones that play a crucial role in menstruation) cause an adverse reaction in the brain, generating the physical and emotional symptoms associated with PMDD.

However, studies have not shown higher levels of estrogen or progesterone in people with PMDD compared to the general population. There is also a lack of scientific evidence that people with PMDD are more sensitive to the cyclical changes of estrogen and progesterone.

Science has shown PMDD can be caused or worsened in the following ways:

• Estrogen and progesterone interactions with mood-regulating hormones (serotonin, y-aminobutyric acid, and dopamine)
• Estrogen and progesterone fluctuations alter the hormone system (which can cause bloating and swelling)
• Genetic differences in how genes process certain sex hormones suggest PMDD could be inherited.
• Brain reactions to allopregnanolone (ALLO, a byproduct of progesterone) may cause increased agitation, anxiety, and negative mood changes in people with PMDD.

PMDD can mimic symptoms of other diseases but does not cause or worsen any of the following conditions:

• Endometriosis
• Polycystic ovary syndrome (PCOS)
• Adrenal system disorders
• Hyperprolactinemia

Diagnostic Criteria for PMDD

There are no laboratory or imaging tests for diagnosing PMDD. However, depending on your symptoms, a healthcare provider may order lab testing to rule out any underlying medical issues.

A provider may instruct you to track your daily symptoms over two menstrual cycles. The diagnosis is made based on the symptoms persisting over three prior menstrual cycles.

The timing of the symptoms is as important as the symptoms themselves. A provider will want to know whether they are present during the week before your period, improve within the first few days, and decline or resolve in the week after your period.

The criteria for a PMDD diagnosis include at least five baseline symptoms or additional symptoms that are hurting your social, academic, or work performance or interpersonal relationships.

PMDD Relief: Self-Care at Home

PMDD can cause physical and emotional symptoms. You can manage some of the symptoms through self-care techniques, including the following:

• Cognitive behavioral therapy
• Aerobic exercise
• Supplementation (calcium)

Other supportive measures are not as well studied but are lower-risk and worth considering, including the following:

• Dietary modifications such as low salt, low caffeine, and no alcohol
• Stress management
• Journaling your symptoms
• Discussing symptoms with family members and friends
  

PMDD Medical Treatment

The severity of physical and emotional symptoms, which often requires medication management, differentiates PMDD from PMS. If you have PMDD, a healthcare provider may prescribe medication to relieve the physical and emotional symptoms associated with the disorder.

Medications for PMDD aim to manage symptoms by enhancing the effectiveness of neurotransmitters (chemical messengers in the brain) tied to mood regulation. Others aim to manage hormonal activity by suppressing ovulation. Treatments may include the following:

• Selective serotonin reuptake inhibitors (SSRIs): SSRIs are the primary approved medication for PMDD. Some of the most effective SSRIs for PMDD are Zoloft (sertraline), Paxil (paroxetine), Prozac (fluoxetine), Celexa (citalopram), and Lexapro (escitalopram).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Although less common, healthcare providers consider off-label use of Effexor (venlafaxine) for people with significant psychological symptoms.
• Seroquel (quetiapine): Some people benefit from the medication quetiapine in combination with SSRIs or SNRIs to improve their effectiveness with symptoms such as mood changes, anxiety, and irritability.
• Oral contraceptives: Several studies show that oral contraceptives can relieve physical and emotional symptoms associated with PMDD.
• Gonadotropin-releasing hormone agonists (GnRH agonists): GnRH agonists suppress estrogen production, which stops menstruation (period bleeding) or induces menopause. Because long-term use of GnRH agonists increases cardiovascular and osteoporosis risks, they are not indicated for long-term use.
  

Thinking About PMDD Holistically

Holistic approaches to managing PMDD physical and emotional symptoms are available:

• Cognitive behavioral therapy (CBT): Various scientific studies have shown that CBT improves quality of life and depression scores for people with PMDD. Although these studies did not define frequency or duration, they did highlight that mindfulness-based exercises and acceptance-based CBT might be helpful in the management of PMDD symptoms.
• Herbal preparations and acupuncture: Some people may use herbs or acupuncture to relieve their symptoms. However, more research is necessary to determine the efficacy of these approaches.

Summary

PMDD affects between 1.3% and 5.3% of people with periods and causes significant physical and emotional disturbances, impacting their quality of life. There are different treatment options for managing PMDD, but the most common therapy is medication management with SSRIs. If you struggle with PMDD, work closely with a healthcare provider or specialist, such as a gynecologist, to determine the best treatment for managing your symptoms.