Premenstrual Dysphoric Disorder (PMDD): What is it? Symptoms & Treatment (A Helpful Guide)
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome characterized by significant emotional, behavioural, and physical symptoms that disrupt daily life, particularly among young women. PMDD is different to the entity known as PMS.
PMDD occurs in the luteal phase, which is the part of the cycle occurring after ovulation and before menstruation. During this phase there are marked changes in hormones aimed at facilitating conception. The impacts of the change in hormonal levels may result in emotional disturbances manifesting as mood swings which can be extreme at times, irritability and depression, alongside physical symptoms including fatigue, headaches, and breast tenderness.
These PMDD symptoms can affect relationships, academic performance, work and overall quality of life, making PMDD a significant health concern. The disorder is notably distinguished from other mood-related conditions due to its cyclical nature. There are multiple challenges with diagnosis due to the overlap of PMDD symptoms with various other conditions.
What are the symptoms of PMDD?
The symptoms of PMDD manifest in both physical and cognitive realms.
Physical symptoms of PMDD include fatigue, headaches, joint or muscle pain, and significant bloating or weight changes (mostly gain) associated with breast tenderness and swelling. These physical symptoms can often lead to and exacerbate emotional distress, creating a cycle of discomfort that can further impede daily functioning.
Cognitive symptoms of PMDD include difficulties in concentrating or experiencing "brain fog" often leading to executive dysfunction associated with a reduction in the repertoire of previously enjoyable activities. Sleep disturbances are common and contribute to overall fatigue and energy levels.
Combination of these symptoms can negatively impact social interactions, occupational performance, and psychological well-being.
Women with PMDD report an increased risk of suicidal ideation and attempts compared to those with less severe premenstrual symptoms making access to recognition and intervention of PMDD specialists important.
How is PMDD diagnosed?
Premenstrual Dysphoric Disorder (PMDD) can be a complex diagnostic entity due to the overlap of its symptoms with multiple other mental health conditions such as depression and anxiety disorders. Accurate diagnosis relies on a combination of symptom tracking and a thorough examination of a patient's medical history including review of the cyclical nature of PMDD symptoms.
How do I know if I have PMDD?
If you have ever asked yourself “do I have PMDD?”, the most effective way to assess your case is to track your symptoms over several menstrual cycles, noting the timing of their onset in relation to your menstrual cycle, which can assist in differentiating PMDD from other conditions.
The diagnosis of PMDD requires the presence of at least five symptoms, with at least one being a core mood symptom such as irritability, depression, or anxiety. These symptoms must manifest in the week prior to menstruation and resolve shortly after its onset.
Core PMDD symptoms include:
Mood swings, heightened interpersonal sensitivity or sadness
Increased irritability or anger
Significant depressed mood or feelings of hopelessness
Increased anxiety or tension
In addition to these core symptoms, atleast one of the following additional symptoms must also be present to confirm the diagnosis.
A reduction in interest in usual activities
Impairment in concentration
Changes in appetite
Sleep disturbances
Physical symptoms such as joint pain and or bloating
To aid in the diagnosis, tools such as period trackers with ‘daily record of severity of problems’ can be of great assistance allowing patients to record their symptoms over at least two cycles. These help in establishing the cyclical nature of symptoms, which is crucial for a PMDD diagnosis.
It is important to note that PMDD is not merely an exacerbation of any other underlying disorders and that the symptoms are not attributable to the effects of substances or other medical conditions.
Treatment for PMDD
PMDD often impacts the quality of life of women, necessitating a range of treatment options tailored to individual needs. Best practice management of PMDD requires a multimodal and multidisciplinary approach which include potential pharmacologic interventions, lifestyle modifications, and psychological supports with PMDD specialists.
Pharmacological Treatments
Selective Serotonin Reuptake Inhibitors (SSRIs) are considered the first-line treatment for PMDD, demonstrating efficacy at low doses and acting quickly to alleviate mood-related symptoms.
In some cases, the use of hormonal therapies, such as oral contraceptives, help with interruption of the hormonal cycles triggering PMDD symptoms. It is however important to remember not all contraceptives are created equal.
Lifestyle Modification Approaches
Lifestyle changes are vital for managing PMDD symptoms. Some natural remedies for PMDD include regular physical activity, a balanced diet rich in complex carbohydrates, and omega-3 fatty acids, and effective stress-reduction techniques such as mindfulness and yoga which have been proven to show improvement in the severity and symptom profile. Besides, aerobic activity and maintenance of routine significantly improve both physical and psychological well-being.
Psychological Therapy
Cognitive-behavioural therapy (CBT) is an effective psychological intervention that helps individuals develop coping strategies and address negative thought patterns associated with PMDD. Supportive therapies, including stress management and relaxation techniques, are essential components of comprehensive care, as they can help individuals better cope with their symptoms.
In Conclusion
Premenstrual Dysphoric Disorder (PMDD) is a complex and often debilitating condition that significantly impacts daily life, relationships, and mental well-being. Its cyclical nature distinguishes it from other mood disorders, making accurate diagnosis through symptom tracking essential. While PMDD presents a range of emotional, cognitive, and physical symptoms, effective management is possible through a multidisciplinary approach, including pharmacological treatments, lifestyle modifications, and psychological therapy.
If you suspect you have PMDD, tracking your symptoms over multiple cycles is a crucial first step. While there are many natural remedies for PMDD, seeking professional guidance from PMDD specialists can help confirm a diagnosis and develop a tailored treatment plan. You don’t have to navigate this alone—early recognition and proactive management can make a significant difference in improving your quality of life.
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