Premenstrual Dysphoric Disorder (PMDD) Symptoms, Diagnosis, and Treatment

PMDD in women

PMDD is not a reflection of personal weakness or a psychological flaw; it is a recognised medical condition influenced by environmental, social, psychological, and biological factors. Importantly, it can be effectively managed through professional treatment, including medications and lifestyle changes. Previously, PMDD was referred to as late luteal phase dysphoric disorder.

The Royal College of Obstetricians and Gynaecologists (RCOG) notes that up to 85% of women menstruating experience at least one symptom of Premenstrual Syndrome during their cycle. However, PMDD is less common, affecting only 3%-8% of females. Diagnosing PMDD requires at least five of the aforementioned symptoms, with at least one being a prominent emotional symptom.

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Diagnosing PMDD

Diagnosing PMDD involves differentiating it from other conditions with similar symptoms, such as mood disorders or anxiety and thyroid disorders. A comprehensive medical history, blood tests, and physical examination may be conducted to cross out other causes.

To establish a pattern, women may be asked to track their symptoms daily over several menstrual cycles. This helps demonstrate the link between the menstrual cycle and the symptoms.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides formal criteria for diagnosing premenstrual dysphoric disorder. To meet these criteria:

• Some symptoms must be present, including one of the following: persistent irritability, mood disorder, sadness, or anxiety
• Symptoms must be present in most menstrual cycles during the week before menstruation and subside within a few days of the period starting

Premenstrual Dysphoric Disorder Symptoms

PMDD shares similarities with PMS, but the intensity and unbearable nature of the symptoms set them apart. Symptoms differ between individuals but commonly include:

• Trouble concentrating and forgetfulness
• Sadness and depression
• Lethargy and fatigue
• Hot flushes
• Palpitations
• Headaches
• Increased appetite and food cravings
• Anger and Irritability
• Sleep disturbances (insomnia or excessive sleepiness)
• Digestive discomfort
• Tenderness in the breasts
• Acne
• Tearfulness
• Abdominal bloating
• Sensitivity to sound, touch, or light

These symptoms occur in the latter half of the menstrual cycle and typically subside within a few days of menstruation beginning.

Causes of Premenstrual Dysphoric Disorder

The exact cause of Premenstrual Dysphoric Disorder remains unclear, but it is believed to result from interactions between ovarian hormones (progesterone and oestrogen) and neurotransmitters in the brain, particularly serotonin. Although the levels of hormones are normal in women who have Premenstrual Dysphoric Disorder, the brain's response to these fluctuations may be atypical.

Stress and nutritional deficiencies are not considered direct causes of PMDD, although stress may exacerbate symptoms. PMDD is unrelated to personality traits and does not stem from psychological instability.

Risk factors for Premenstrual Dysphoric Disorder

You may be at higher risk of developing PMDD if you have:

• Anxiety or depression
• Premenstrual syndrome (PMS)
• A family history of PMS, PMDD, or mood disorders
• A personal history of trauma, abuse, or significant stress

When should you seek medical advice?

If menstrual-related physical or emotional symptoms are interfering with your daily life, it is advisable to consult a healthcare professional.

PMDD-related depressive symptoms, especially if accompanied by thoughts of self-harm or suicide, require urgent medical attention. Such situations are considered medical emergencies and must be addressed as soon as possible.

Natural remedies and supplements for PMDD relief

Certain natural remedies and dietary supplements have shown promise in alleviating symptoms of PMDD:

Vitamin E, calcium, and vitamin B6 have shown potential benefits in limited studies. Agnus Castus (Chasteberry extract) demonstrated effectiveness in reducing symptoms of PMDD and PMS.

Treatment options for PMDD

Lifestyle and nutritional adjustments:

A healthy diet, regular exercise, stress management, and adequate sleep may help improve symptoms.

Hormonal therapies:

• Gonadotropin-releasing hormone (GnRH) agonists: They suppress oestrogen production, effectively halting ovulation and menstruation. However, side effects such as bone loss, hot flashes, and mood swings may occur. Small doses of progesterone and oestrogen are often added back to mitigate these effects.
• Oral contraceptives (OCPs): Used to regulate the menstrual cycle and suppress ovulation.

SSRIs (Antidepressants):

Selective serotonin reuptake inhibitors (SSRIs) are highly effective for treating PMDD. Commonly prescribed SSRIs include:

• Paroxetine
• Fluoxetine
• Citalopram
• Sertraline

These medications regulate serotonin levels in the brain, providing symptom relief for up to 75% of women. SSRIs may be taken continuously or during the luteal phase of the cycle.

PMDD complications

PMDD symptoms can severely disrupt relationships, education, work, and overall quality of life. Untreated emotional symptoms, particularly depression, can increase the risk of suicidal behaviour or thinking.

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Prognosis and prevention of PMDD

Even though PMDD can significantly impact a woman's life, effective treatments are available to manage symptoms. As PMDD is linked to hormonal and neurotransmitter interactions, there is no known method to prevent its onset.