Premenstrual Dysphoric Disorder

Definition

Premenstrual dysphoric disorder (PMDD) is a collection of physical and emotional symptoms that occurs 5 to 11 days before a woman's period begins, and goes away once menstruation starts. The most severe form of premenstrual syndrome (PMS) is PMDD.

Description

PMS is estimated to affect 70–90% of women of childbearing age. The more severe form of the disorder, PMDD, affects 3–5% of women of childbearing age. Up to 40% of women have PMDD symptoms that are so severe they interfere with their daily activities. It is more common in women in their late 20s and early 40s, who have at least one child and a history of depression, anxiety/tension, affective lability, or irritability/anger.

Causes and symptoms

Although the actual cause of PMDD is not known, it is believed to be related to hormonal changes that occur before menstruation. There are more than 150 signs and symptoms attributed to PMDD, and every woman experiences different ones at different times. There seem to be socioeconomic and genetic factors that precipitate PMDD. Twin studies have demonstrated a positive correlation with heritability and PMDD symptoms. Anti-anxiety medications have been shown to help improve symptoms associated with PMDD. The most common symptoms include headache, swelling of ankles, feet, and hands, backache, abdominal cramps, heaviness or pain, bloating and/or gas, muscle spasms, breast tenderness, weight gain, recurrent cold sores, acne, nausea, constipation or diarrhea, food cravings, anxiety or panic, confusion, difficulty concentrating and forgetfulness, poor judgment, and depression.

Diagnosis

PMDD is diagnosed when symptoms occur during the second half of the menstrual cycle (14 days or more after the first day of a woman's period), are absent for about seven days after the period ends, increase in severity as the cycle progresses, go away when the menstrual flow begins or shortly thereafter, and occur for at least three consecutive menstrual cycles. There are no tests to diagnose it. The diagnosis of PMDD emphasizes and requires psychologically important mood symptoms.

Treatment

Recently, the Food and Drug Administration approved the first prescription drug for the treatment of PMDD, Serafem (fluoxetine). Additionally, nonsteroidal anti-inflammatory drugs, such as ibuprofen and aspirin, may help with bloating and pain; beta-blockers may help with migraines; anti-anxiety medications, such as buspirone or alpraxolam, may help with anxiety; and certain other antidepressants in addition to Serafem may help with depression.

Alternative treatment

Non-pharmaceutical treatments include a variety of lifestyle changes, such as following a healthy diet, exercise, stress relief therapies, and even such alternative therapies as aromatherapy. Certain vitamins and supplements may also help, such as vitamin B₆, calcium, magnesium, and vitamin E. Certain herbs may also help with symptom relief, including vitex, black cohosh, valerian, kava kava, and St. John's wort.

Prognosis

The prognosis varies for each woman, and is largely dependent on how much work she is willing to do in terms of lifestyle changes. Additionally, planning for PMDD symptoms, joining a support group, and communicating with her spouse and family can help minimize the negative effects of PMDD and its impact on a woman's home and work environments.

Prevention

Some women may find their PMDD disappears periodically. Diet and nutritional supplements can have the greatest impact in preventing PMDD.

BOOKS

Michelle Harrison, M.D. Self-Help for Premenstrual Syndrome. New York: Random House, 1998

Judy E. Marshel, and Anne Egan. PMDD Relief: Natural Approaches to Treating Symptoms. Berkley Books, 1998

ORGANIZATIONS

National Association for Premenstrual Syndrome. 7 Swift's Court, High Street, Seal, Kent TN15 0EG UK. +44 (0) 1732 760011 <www.PMDD.org.uk>.

Advancement of Women's Health Research, 1828 L Street, N.W., Suite 625 Washington, D.C. 20036. (202) 223-8224. <www.womens-health.org>.

KEY TERMS

Antidepressant—A medication used to relieve the symptoms of clinical depression.

Beta blockers—Class of drug, including Corgard (nadolol), and Lanoxin (digoxin), that primarily work by blunting the action of adrenaline, the body's natural fight-or-flight chemical.

Nonsteroidal anti-inflammatory drugs—This class of drugs includes aspirin and ibuprofen, and primarily works by interfering with the formation of prostaglandins, enzymes implicated in pain and inflammation.