Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects a woman's physical, emotional, and behavioral health. It is estimated that 3-8% of women of reproductive age experience PMDD. PMDD is characterized by a range of physical and psychological symptoms that occur in the luteal phase of the menstrual cycle, which is the two weeks before a woman's period begins.

Causes of PMDD

The exact cause of PMDD is unknown, but it is believed to be related to the hormonal changes that occur during the menstrual cycle. It is also thought that certain neurotransmitters, such as serotonin, may play a role in the development of PMDD. Other factors, such as stress, may also contribute to the development of PMDD.

Diagnosis of PMDD

PMDD is diagnosed based on a woman's symptoms and the timing of her menstrual cycle. A doctor may ask a woman to keep a diary of her symptoms for several months to help diagnose PMDD. A physical exam and laboratory tests may also be done to rule out other conditions.

Complications of PMDD

PMDD can have a significant impact on a woman's quality of life. It can lead to depression, anxiety, and difficulty functioning in daily life. Women with PMDD may also have difficulty maintaining relationships and may experience social isolation.

Prevention of PMDD

There is no known way to prevent PMDD, but there are lifestyle changes that may help reduce the severity of symptoms. These include getting regular exercise, eating a healthy diet, and managing stress. Women should also talk to their doctor about any medications they are taking that may be contributing to their symptoms.

Physical Symptoms of PMDD

Physical symptoms of PMDD can include:

• Abdominal bloating
• Breast tenderness
• Headaches
• Joint or muscle pain
• Weight gain

Psychological Symptoms of PMDD

Psychological symptoms of PMDD can include:

• Anxiety
• Depression
• Irritability
• Mood swings
• Trouble concentrating

Diagnosing PMDD

If you think you may have PMDD, it is important to talk to your doctor. Your doctor will ask you questions about your symptoms and may recommend that you keep a diary of your symptoms for several months to help make a diagnosis. Your doctor may also order tests to rule out other conditions that could be causing your symptoms.

Treating PMDD

Treatment for PMDD may include lifestyle changes, such as getting regular exercise and eating a healthy diet, as well as medications, such as birth control pills or antidepressants. It is important to talk to your doctor about the best treatment plan for you.

Hormonal Changes

Hormonal changes during the menstrual cycle may play a role in the development of PMDD. During the luteal phase, levels of the hormones estrogen and progesterone rise and then drop sharply just before a woman’s period. This fluctuation in hormones may trigger the physical and emotional symptoms of PMDD. Additionally, some research suggests that women with PMDD may have an abnormal sensitivity to these hormonal changes.

Genetics

Genetics may also be a factor in the development of PMDD. Studies have found that women with PMDD are more likely to have a family history of depression, anxiety, or other mood disorders. Additionally, some research suggests that women with PMDD may have a genetic predisposition to be more sensitive to hormonal changes.

Stress

Stress can also be a contributing factor to PMDD. Stressful life events, such as the death of a loved one, a divorce, or a job loss, can trigger the physical and emotional symptoms of PMDD. Additionally, chronic stress can worsen the symptoms of PMDD.

Diet and Exercise

Diet and exercise can also play a role in the development of PMDD. Eating a healthy diet and getting regular exercise can help reduce the symptoms of PMDD. Additionally, avoiding certain foods, such as caffeine, alcohol, and sugar, can help reduce the severity of PMDD symptoms.

Conclusion

While the exact cause of PMDD is unknown, there are several factors that may contribute to its development. These include hormonal changes, genetics, stress, and diet and exercise. If you think you may be suffering from PMDD, it is important to talk to your doctor to discuss treatment options.

Diagnostic Criteria for PMDD

The diagnosis of PMDD is based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed with PMDD, a woman must experience at least five of the following symptoms during the luteal phase of her menstrual cycle:

• Depressed mood
• Anxiety, tension, or feelings of being "on edge"
• Mood swings
• Decreased interest in usual activities
• Difficulty concentrating
• Fatigue or lack of energy
• Change in appetite or food cravings
• Feeling out of control or overwhelmed
• Sleep disturbances
• Physical symptoms such as bloating, breast tenderness, or joint or muscle pain

These symptoms must be severe enough to interfere with daily activities and relationships, and must occur consistently during the luteal phase of the menstrual cycle for at least two consecutive menstrual cycles.

Diagnostic Process

The diagnosis of PMDD is made through a process of exclusion. This means that other possible causes of the symptoms must be ruled out before a diagnosis of PMDD can be made. This includes ruling out other medical conditions, such as thyroid disorders, and psychological conditions, such as depression or anxiety. The doctor may also ask about lifestyle factors, such as stress, diet, and exercise, that could be contributing to the symptoms.

Once other causes have been ruled out, the doctor may recommend keeping a symptom diary to track the symptoms over several menstrual cycles. This can help to identify patterns in the symptoms and confirm that they are related to the menstrual cycle.

Conclusion

PMDD is a severe form of premenstrual syndrome that can have a significant impact on a woman's life. The diagnosis of PMDD is based on the criteria outlined in the DSM-5 and is made through a process of exclusion. Keeping a symptom diary can help to identify patterns in the symptoms and confirm that they are related to the menstrual cycle. If you think you may have PMDD, it is important to talk to your doctor to get an accurate diagnosis and find the best treatment for your symptoms.

If you think you may have PMDD, it is important to talk to your doctor. Here are some things to discuss with your doctor:

Your Symptoms

Be sure to tell your doctor about all of your symptoms, including physical and emotional symptoms. It is also important to tell your doctor how long your symptoms have been occurring and how severe they are. This will help your doctor determine if you have PMDD or another condition.

Your Medical History

Your doctor will also want to know about your medical history, including any other medical conditions you have, any medications you are taking, and any family history of mental health conditions. This information can help your doctor determine the best treatment for you.

Your Lifestyle

Your doctor may also ask about your lifestyle, including your diet, exercise habits, and stress levels. This information can help your doctor determine if any lifestyle changes may help reduce your symptoms.

Your Treatment Options

Your doctor can discuss treatment options with you, including medications, lifestyle changes, and counseling. Your doctor can help you decide which treatment is best for you.

Medications

Medications are the most common treatment for PMDD. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications for PMDD. SSRIs work by increasing the amount of serotonin, a neurotransmitter, in the brain. Common SSRIs used to treat PMDD include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). Other medications that may be used to treat PMDD include nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, and gonadotropin-releasing hormone (GnRH) agonists.

Lifestyle Changes

In addition to medications, lifestyle changes can also help to reduce the symptoms of PMDD. Regular exercise can help to reduce stress and improve mood. Eating a healthy diet that is low in sugar and processed foods can also help to reduce symptoms. Avoiding caffeine and alcohol can also help to reduce symptoms. Stress management techniques such as yoga, meditation, and deep breathing can also help to reduce symptoms.

Alternative Therapies

Alternative therapies such as acupuncture, massage, and herbal remedies may also be helpful in reducing the symptoms of PMDD. Acupuncture can help to reduce stress and improve mood. Massage can help to reduce muscle tension and improve circulation. Herbal remedies such as chasteberry, evening primrose oil, and St. John’s wort may also be helpful in reducing symptoms.

Conclusion

Premenstrual dysphoric disorder is a severe form of premenstrual syndrome that affects up to 8% of women of reproductive age. Treatment for PMDD typically includes medications, lifestyle changes, and alternative therapies. Medications such as SSRIs, NSAIDs, oral contraceptives, and GnRH agonists may be used to treat PMDD. Lifestyle changes such as regular exercise, a healthy diet, and stress management techniques can also help to reduce symptoms. Alternative therapies such as acupuncture, massage, and herbal remedies may also be helpful in reducing symptoms.

Selective Serotonin Reuptake Inhibitors (SSRIs)

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications for PMDD. SSRIs work by increasing the amount of serotonin, a neurotransmitter that helps regulate mood, in the brain. Commonly prescribed SSRIs for PMDD include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). SSRIs are generally well-tolerated, but they can cause side effects such as nausea, headache, and insomnia.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that reduce inflammation and pain. NSAIDs are sometimes used to treat PMDD symptoms such as cramps and headaches. Commonly prescribed NSAIDs for PMDD include ibuprofen (Advil) and naproxen (Aleve). NSAIDs can cause side effects such as stomach upset, nausea, and dizziness.

Oral Contraceptives

Oral contraceptives are birth control pills that contain hormones that can help regulate the menstrual cycle. Oral contraceptives can help reduce PMDD symptoms such as mood swings and irritability. Commonly prescribed oral contraceptives for PMDD include ethinyl estradiol and drospirenone (Yaz) and ethinyl estradiol and norethindrone (Ortho Tri-Cyclen). Oral contraceptives can cause side effects such as nausea, breast tenderness, and headaches.

Gonadotropin-Releasing Hormone (GnRH) Agonists

Gonadotropin-releasing hormone (GnRH) agonists are medications that can help reduce PMDD symptoms by suppressing the production of hormones that regulate the menstrual cycle. Commonly prescribed GnRH agonists for PMDD include leuprolide (Lupron) and goserelin (Zoladex). GnRH agonists can cause side effects such as hot flashes, headaches, and nausea.

Conclusion

PMDD is a severe form of PMS that affects up to 8% of women of reproductive age. Treatment for PMDD typically involves a combination of lifestyle changes and medications. Commonly prescribed medications for PMDD include SSRIs, NSAIDs, oral contraceptives, and GnRH agonists. These medications can help reduce PMDD symptoms, but they can also cause side effects such as nausea, headache, and insomnia.

Foods to Eat

Eating a balanced diet that includes plenty of fruits, vegetables, whole grains, and lean proteins can help reduce PMDD symptoms. Foods that are high in fiber, such as beans, legumes, and whole grains, can help regulate hormones and reduce bloating. Eating foods that are rich in calcium, such as dairy products, can also help reduce PMDD symptoms. Additionally, foods that are high in omega-3 fatty acids, such as salmon, walnuts, and flaxseed, can help reduce inflammation and improve mood.

Foods to Avoid

Certain foods can worsen PMDD symptoms, so it is important to limit or avoid them. Foods that are high in sugar, such as candy, cookies, and cakes, can cause blood sugar spikes and worsen mood swings. Caffeine and alcohol can also worsen PMDD symptoms, so it is best to limit or avoid them. Additionally, processed foods, such as chips, crackers, and frozen meals, can worsen PMDD symptoms, so it is best to limit them.

Conclusion

Making dietary changes can help reduce PMDD symptoms. Eating a balanced diet that includes plenty of fruits, vegetables, whole grains, and lean proteins can help regulate hormones and reduce inflammation. Additionally, it is important to limit or avoid foods that are high in sugar, caffeine, and alcohol, as well as processed foods.

Exercise

Regular exercise can help reduce the physical and emotional symptoms of PMDD. Exercise releases endorphins, which are hormones that can help reduce stress and improve mood. Aim for at least 30 minutes of moderate-intensity exercise, such as walking, jogging, or swimming, three to five times a week.

Diet

Eating a healthy, balanced diet can help reduce the symptoms of PMDD. Avoid processed foods and refined sugars, which can cause blood sugar spikes and crashes. Instead, focus on eating whole grains, lean proteins, fruits, and vegetables. Eating small, frequent meals can also help keep blood sugar levels stable.

Stress Management

Stress can worsen the symptoms of PMDD, so it’s important to find ways to manage stress. Try relaxation techniques such as yoga, meditation, or deep breathing. Make time for activities that you enjoy, such as reading, listening to music, or spending time with friends. Avoid caffeine and alcohol, which can increase anxiety and irritability.

Sleep

Getting enough sleep is essential for managing PMDD symptoms. Aim for seven to nine hours of sleep each night. Avoid screens before bed, as the blue light can interfere with sleep. Establish a regular sleep schedule and stick to it, even on weekends.

Talk to Your Doctor

If lifestyle changes don’t help manage your symptoms, talk to your doctor. They may recommend medications or other treatments to help manage your PMDD.