Most women of childbearing age experience some minor physical and emotional symptoms as their menstrual period approaches.
Perhaps 20% of those women (and sometimes those around them) suffer from a more severe set of symptoms, commonly known as premenstrual syndrome, or PMS.
PMS can emerge about a week before a period commences and persist for up to a week after menstruation begins. As hormone levels fluctuate during the menstrual cycle, PMS can cause physical discomfort, coupled with some relatively minor mood alterations. PMS can be troublesome, but most women can usually find ways to cope with it.
What is PMDD (premenstrual dysphoria disorder)?
About 5% of menstruating women have a much more severe subset of PMS known as premenstrual dysphoria disorder or PMDD. PMDD can be debilitating. It may disrupt or even destroy a woman’s home life, her job performance, and her relationships.
What are the symptoms of PMDD?
Women with PMDD deal with lengthy bouts of severe depression, alternating with irritability which can rapidly escalate into rage. Other symptoms of PMDD include:
- Sadness, despair, and a sense of hopelessness. These feelings can merge into suicidal thoughts.
- Panic attacks, severe anxiety.
- Rapid swings from one extreme emotion to another.
- Loss of interest in ordinary daily activities.
- An overwhelming sense that everything is out of control.
- Inability to concentrate.
- Habitual initiation of conflict with friends and relatives.
Not only are there emotional symptoms of PMDD but physical symptoms as well such as:
- Fatigue, low energy.
- Sleep difficulties, both in falling asleep and staying asleep.
- Breast tenderness.
- Severe cramps and bloating.
- Joint/muscle pain.
- Hot flashes.
- Increased appetite and consequent weight gain.
What are the causes of PMDD?
This is a very good question, without any very good answers.
PMDD can afflict any woman, but the following factors seem to increase the risk:
- A family history of severe PMS or PMDD.
- A personal or family history of depression, whether general or postpartum.
- Smoking tobacco also appears to increase the chances that a woman can incur PMDD.
Fluctuations in hormonal steroids play a role in Premenstrual Dysphoria Disorder
A 2017 study indicates that the genetic makeup of women with PMDD makes them more susceptible to the ebbs and flows of hormone levels that occur during a menstrual cycle.
Researchers at the National Institutes of Health and the University of North Carolina studied 67 women. 34 had PMDD, the other 33 did not.
Estrogen and progesterone are hormone steroids
The scientists first blocked, then restored, the woman’s production of estrogen and progesterone. These are the hormonal steroids activated during a woman’s period.
The results showed that cells of women with PMDD respond differently to estrogen and progesterone than do cells from women without PMDD.
This research suggests that PMDD might have an inherited basis
A lot of caveats surround this study. It was not randomized. And the only conclusions that can be drawn are somewhat speculative. The researchers themselves emphasized that much more study is needed before any concrete conclusions can be reached.
But the study does establish a promising pathway for further productive research into the causes of PMDD. Once the cause(s) are found, effective solutions to this destructive condition may soon follow.
How Premenstrual Dysphoria Disorder is diagnosed
Diagnosis of PMDD is currently more a matter of elimination than discovery. After a complete medical history is taken, and physical and pelvic exams are administered, there are very few diagnostic tests.
Because so many of the symptoms are emotional and related to mood, mental health concerns should be evaluated. As a general rule of thumb, PMDD is present when 5 or more of the standard symptoms, including one related to mood fluctuation, are found.
How to treat PMDD
There is nothing approaching a cure for PMDD in the current arsenal of healthcare providers. But some treatment protocols may alleviate the severity of PMDD symptoms.
- Serotonin is a chemical found in the brain that plays a complex role in controlling mood. As estrogen and progesterone levels drop during the menstrual cycles of women with PMDD, their serotonin levels correspondingly decrease. So it’s not surprising that women with PMDD often respond well to medications known as selective serotonin reuptake inhibitors, or SSRI, which stabilize serotonin levels.
- Birth control pills can also reduce PMDD symptoms because they control hormonal steroid levels.
- Over-the-counter pain medications can reduce the physical symptoms of PMDD.
- Non-medication treatment protocols for PMDD include stress management programs, changes in diet (increase protein and carbohydrates, decrease sugar, salt, caffeine, and alcohol), regular exercise, and vitamin supplements. Diuretics can help with fluid retention and consequent bloating.
It’s good to know that researchers are making advances in their understanding of how PMDD is caused. While we’re waiting for a cure, the above treatment modalities can be helpful. Thaïs
About Dr. Thaïs Aliabadi
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