What are the Symptoms of Premenstrual Dysphoric Disorder

The Premenstrual dysphoric disorder is a condition similar to premenstrual syndrome (PMS) but with more severe symptoms. The symptoms of PMDD can be physical, emotional, or behavioral and are cyclic starting about 2 weeks before the start of your period and lasting up till the second or third day of your period. This condition can impact your daily life in several ways by interfering with work, school, relationships, and social life.

About 5 % of women of reproductive age group suffer from PMDD. The symptoms usually occur around the age of twenty and may worsen as it progresses. Although adult women suffer from this condition, you need to know that teenagers can also have PMDD. Symptoms are linked with the menstrual cycle, and they disappear if you get pregnant- come back when ovulation begins- and also resolve after menopause.

The Emotional Disturbances of PMDD in Women

• Extreme sadness.
• Mood swings.
• Intense anger.
• Irritability.
• Disagreements with friends and family.
• Anxiety, tearfulness, hopelessness, and suicidal thoughts may be involved too.

The Physical Symptoms of PMDD

• Joint pain.
• Breast tenderness.
• Muscle ache.
• Bloating.
• Nausea.
• Headaches.
• Backache.
• Skin issues such as acne.

The Behavioral Symptoms of PMDD

• Problems with concentration.
• Low energy.
• Decreased interest in activities that used to interest you.
• Sleep disturbances.
• Appetite change.

What is the cause of Premenstrual Dysphoric Disorder?

The menstrual cycle is divided into three phases based on the physiological changes that occur in the body. These phases are the follicular, ovulation, and luteal phase. PMDD coincides with the luteal phase which typically takes about 2 weeks.

Although the exact cause of PMMD is not fully understood, however, it is thought to be a result of increased sensitivity to the hormonal changes that occur during the menstrual cycle [¹]. In most women, the level of serotonin (one of the most crucial brain chemicals in emotional regulation) doesn’t change in the cycle; in others, its level shows a drop following the drop in estrogen during the luteal phase. This is also believed to play a role in the development of PMDD. 

Research has also shown that smoking can increase susceptibility to PMS [²]. Other factors associated with an increased risk of PMDD include:

• Stress.
• Emotional or physical abuse.
• History of childhood trauma.
• Family history of PMS or PMDD.

Women with PMDD often have concomitant anxiety and depression. Also, genetic differences that might increase sensitivity to hormonal changes may play a role.

How is PMDD diagnosed?

No test that can diagnose PMDD. Usually, a thorough history and physical examination are necessary to differentiate PMDD from other possible causes of the symptoms. Furthermore, the cyclic nature of the symptoms is a crucial clue for a diagnosis of PMDD. However, if you some of the above symptoms, you can keep a calendar and observe the time they occur. The benefit of keeping this information is to assist health professionals to rule out conditions such as depression, anxiety and other reproductive health issues.

PMDD may be considered an endocrine disorder due to the supposed underlying endocrine abnormalities that are responsible for it. Still, due to the different mental health challenges associated with it, DSM 5 (a diagnostic manual broadly used by health experts to diagnose mental health problems) has categorized it as a mental health problem.

How to Treat PMDD

PMDD is a serious health problem, while there is no cure yet, there are different ways to relieve or decrease the severity of the condition.

1. Dietary changes: Incorporating more protein and carbohydrates into your meals and lowering sodium intake, caffeine, alcohol, and sugar may ameliorate the symptoms.
2. Manage stress: Practicing stress control through medication and exercising regularly.
3. Medications: An over-the-counter analgesic can help with symptoms such as headaches and breast tenderness. Your healthcare provider may prescribe certain birth control medications, antidepressants, and anti-inflammatory drugs.

In conclusion, with proper treatment and follow-up, women suffering from premenstrual dysphoric disorder can get relief from the symptoms and enjoy life fully.

Written by: Selam Temesgen. M.D.