A guide to premenstrual dysphoric disorder

Premenstrual dysphoric disorder, also known as PMDD, is a condition that manifests before the menstrual period and is characterised by its symptoms of severe psychological and physical distress. It can occur anywhere between two weeks up to a few days before the period, and during the period it is much milder. It is related to premenstrual syndrome (PMS) and premenstrual tension (PMT), but is notably quite extreme in comparison to those two. In this article, consultant gynaecologist Mr Narendra Pisal explains clearly what PMDD is and how to handle it.

It is believed that PMDD is caused by hormonal changes due to ovarian function affecting neurotransmitters, such as serotonin, which is often referred to as the “happy” chemical due to its influence on mood, memory, and appetite. During ovulation, the ovaries produce higher levels of progesterone whilst oestrogen levels decrease, and this affects how serotonin is received by the brain.

PMDD was only added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013. People can spend years believing their PMDD symptoms to be typical of the menstrual cycle experience due to a lack of awareness of this disorder, which results in many people worldwide remaining mis- or undiagnosed and without treatment or management tools that can alleviate their discomfort and psychological burden wrought by PMDD.

It can be quite severe and impact a person’s quality of life and their relationships. During PMDD, their state of mind is altered and so they are susceptible to doing or saying things they may come to regret. Around 20-30% of menstruating people experience significant PMS symptoms, but it is estimated that 4-5% experience PMDD.

What are the symptoms of PMDD?

The symptoms of PMDD exist in a spectrum and no two experiences of PMDD will be the same. Common symptoms include:

• Intense mood swings, with feelings of anxiety, sadness, and irritability
• Depression and hopelessness, sometimes to the point of suicidal thoughts
• Aggression
• Lack of energy to partake in school, work, activities, and socialising
• Lack of concentration
• Poor sleep

These are likely to be accompanied by additional, regular menstrual symptoms like cramps, breast tenderness, headaches, and hot flashes.

How is PMDD diagnosed?

There are several ways to diagnose PMDD, however, there is no consensus or standard on how it can be best diagnosed. Some validated methods include scales for recording premenstrual symptoms, or patients can try keeping a record of the premenstrual symptoms in a journal or diary to collate the information for the doctor to assess.

How is PMDD treated or managed?

In order to treat PMDD, a doctor may recommend the contraceptive pill as it restricts hormone production by suppressing ovary function, which can effectively reduce symptoms. Other contraceptive methods, like the IUD, will not be applicable for treating PMDD. Depressive symptoms can also be alleviated by anti-depressants such as selective serotonin reuptake inhibitors (SSRIs), which can be prescribed only for certain cases.

While PMDD can be addressed with medication, it also useful to consider risk factors that can contribute to the degree and onset of PMDD, such as:

• High-stress lifestyles
• Preexisting or family history of depression and anxiety
• Obesity
• Smoking and substance abuse
• Age, as those in their prime ovulation years between 20 to 35 years old will have stronger ovulation and hormone production

Learning coping skills and management techniques for stress and negative feelings, like repeating affirmations and meditation, can help mitigate the intensity of the symptoms. Some people may benefit from counselling and talking therapies like cognitive behavioural therapy. Taking action to address factors that cause stress, and avoiding caffeine, unhealthy foods, and substances can also help. Even just sleeping better for eight hours a night can lead to an improvement.

If you believe you have PMDD would like to consult with Mr Pisal, you can do so via his profile.