Premenstrual Dysphoric Disorder (PMDD)

By:  Aaliyah Ellison-McPeters

Photo Credit: www.depositphotos.com

What is PMDD?

Premenstrual dysphoric disorder, or PMDD, is a condition that typically presents as hormone levels decrease after ovulation, 1-2 weeks before the start of menstruation, accompanied by symptoms of depression, emotional instability, mood swings, and tension. Premenstrual dysphoric disorder affects up to 5-8% of menstruating women, and many women with this disorder also suffer from anxiety or depression. For many people, PMDD symptoms can drastically affect one’s daily life, making it difficult to work, interact with others, and maintain healthy relationships. In severe cases, premenstrual dysphoric disorder can cause severe depression and suicidal thoughts.

PMDD versus PMS

PMS, or premenstrual syndrome, presents as emotional and physical symptoms of mild mood swings, breast swelling and tenderness, bloating, irritability, food cravings, and more. These symptoms usually begin about 1-2 weeks before the period starts. PMDD is a severe form of PMS and is less common. PMS typically does not affect one’s daily life or cause extreme emotional shifts, is not considered a mental health disorder, and does not require intervention as PMDD does.

Causes of PMDD

While the exact cause of premenstrual dysphoric disorder is unclear, studies have shown that it is likely caused by sensitivity to the normal fluctuations in hormones, such as progesterone, estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), every month. The dip in estrogen and progesterone, in particular, after ovulation may potentially trigger the onset of symptoms. A deficiency in serotonin, a chemical substance found in the brain that affects mood, can be caused by hormone changes leading to mood changes and physical symptoms. Additional potential causes and risk factors for PMDD are genetic variation, smoking, stress, and trauma.

Diagnosis and Treatment

To diagnose someone with premenstrual dysphoric disorder, a healthcare provider will determine if the patient presents with at least five of the common PMDD symptoms, one of those being a symptom that is associated with mood changes. The patient may be asked to track their symptoms throughout a few menstrual cycles. Physical exams such as pelvic and thyroid exams, along with a complete history, are performed to rule out any other conditions or reproductive disorders. When managing PMDD, maintaining a healthy lifestyle is the most crucial step. Limiting sugar and caffeine while incorporating daily exercise and proper sleep is recommended. Selective serotonin reuptake inhibitors, or SSRIs, are a type of antidepressant that changes the levels of serotonin in the brain and are a common treatment for PMDD. Suppression of ovulation through birth control pills is another form of treatment for PMDD. Drospirenone was found to be a good form of treatment for reducing symptoms due to its anti-aldosterone and anti-androgenic properties.

Resources

Clay, R.A. (2023). PMS vs. PMDD: What’s the difference. American Psychological Association. Retrieved from: https://www.apa.org/topics/women-girls/pms-vs-pmdd

Cleveland Clinic (2023). Premenstrual Dysphoric Disorder (PMDD). Cleveland Clinic. Retrieved from: https://my.clevelandclinic.org/health/diseases/9132-premenstrual-dysphoric-disorder-pmdd

Gudipally PR, Sharma GK. Premenstrual Syndrome. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560698/

Mayo Clinic (2022). Premenstrual syndrome: Symptoms and Causes. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780

MedLine Plus (2022). Premenstrual dysphoric disorder. National Library of Medicine. Retrieved from: https://medlineplus.gov/ency/article/007193.htm

MedLine Plus (n.d). Premenstrual Syndrome. National Library of Medicine. Retrieved from: https://medlineplus.gov/premenstrualsyndrome.html

Mind.org (2021). What is PMDD? Mind.org. Retrieved from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/

Mishra S, Elliott H, Marwaha R. Premenstrual Dysphoric Disorder. [Updated 2023 Feb 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532307/

Office on Women’s Health (2021). Premenstrual Dysphoric Disorder (PMDD). U.S. Dept. of Health and Human Services. Retrieved from: https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome/premenstrual-dysphoric-disorder-pmdd

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