PMDD, or premenstrual dysphoric disorder, is the most severe form of premenstrual syndrome a woman can experience. Approximately 75 percent of women of childbearing age (who continue to have their menstrual periods) have some degree of premenstrual syndrome. Of those approximately 2 to 10 percent also have premenstrual dysphoric disorder. Women with a personal or family history of mood disorders, including major depression or postpartum depression, are at even greater risk for developing premenstrual dysphoric disorder.
The symptoms of premenstrual syndrome are theorized to occur because of a woman’s sensitization to the hormonal fluctuations which occurred during the menstrual cycle. While researchers do not know the exact causes of premenstrual syndrome or premenstrual dysphoric disorder they can identify the symptoms.
Symptoms of premenstrual syndrome include bloating, breast tenderness, weight gain, trouble concentrating, skin problems, tearfulness, irritability, fatigue and anxiety. Symptoms of premenstrual dysphoric disorder include these plus feelings of nervousness, anxiety, anger, strong cravings for certain foods, sadness and crying and trouble sleeping.
The diagnostic criteria for premenstrual dysphoric disorder are included in the American Psychiatric Association DSM-IV published in 1994. In addition to the physical and emotional problems that are required for the diagnosis of premenstrual syndrome at least one of the following criteria must happen in the latter part of the menstrual cycle: severe feelings of stress, tension or anxiety, mood swings that include crying, constant your ability or anger, loss of interest in usual daily activities, inability to concentrate or focus, loss of normal energy level, feeling sad, hopeless or suicidal, or food binging.
Another cause of premenstrual dysphoric disorder has been discovered in recent studies which show a connection between the conditions and low levels of serotonin. Serotonin is a neurotransmitter that helps conduct nerve signals in the brain which may account for the improvement in conditions that women experience when they use selective serotonin reuptake inhibitors to treat their symptoms. Serotonin is used as a messenger that is involved in controlling mood, attention, sleep and pain.
Clinical evaluation for premenstrual dysphoric disorder should include a comprehensive review of symptoms and medical history. Your primary care physician will also perform a physical examination and a gynecological examination looking for other underlying medical conditions which may account for the symptomatology. A basic set of laboratory tests including what cell counts, electrolytes, liver and kidney profile and thyroid function tests may also be ordered.
Unfortunately, at this time there is no definitive test for premenstrual disorder or premenstrual dysphoric disorder. Therefore the diagnosis of these conditions is a diagnosis of exclusion. This means that the physician will rule out other potential underlying medical conditions which exhibit the same symptoms in order to diagnose either PMS or PMDD.
Many women will also choose to undergo a psychiatric evaluation to focus on the symptoms of depression or seasonal variation of depression as well as self treatment with alcohol or drug use. Women who have a history of early victimization or trauma or a family history of affects his disorder, alcoholism or current situational stressors may have an increased symptoms of PMDD.
Many women will gain relief from symptoms with changes in their lifestyle as well as education as to the reasons for the symptoms. Including exercise and vitamins in their every day routine and decreasing or eliminating caffeine in the diet often helps to decrease the symptoms of premenstrual dysphoric disorder. In other cases medications, including selective serotonin re-uptake inhibitors (antidepressants), may be used to treat the emotional symptoms.
The symptoms of premenstrual dysphoric disorder can affect your relationships and your ability to work and maintain employment. If you believe you have these symptoms and they appear to disappear when your period starts you may have either premenstrual syndrome or premenstrual dysphoric disorder. It’s if you believe this may be the case you must seek the advice of your primary care physician or gynecologist in order to receive an accurate diagnosis while not overlooking any other underlying medical conditions which could have dire results if left untreated.
PMDD Facts: What is Premenstrual Dysphoric Disorder?
Cleveland Clinic: PMS and PMDD