Having premenstrual dysphoria disorder can be quite painful and embarrassing, but with the right treatment and knowledge, you can learn to control the symptoms and have a better quality of life. In this article, we’ll explore some of the most common symptoms of PMDD, as well as some of the treatment options available.
Symptoms
Symptoms of premenstrual dysphoria disorder (PMDD) are a cluster of psychological and somatic symptoms. They generally occur within a few days before menstruation and may interfere with your daily activities. They should disappear shortly after menses begin.
In addition to physical symptoms, women with PMDD can have suicidal thoughts. Treatment for these thoughts can be effective. If you think you have the disorder, it is important to consult with your physician.
Depending on your symptoms, you may be treated with medications such as antidepressants or hormone therapies. Lifestyle changes such as exercise and relaxation strategies can also help. You may need to change your diet to accommodate hormonal fluctuations.
A complete medical history is necessary to make a diagnosis. Your doctor may perform blood tests to rule out other conditions that can cause symptoms. He or she will also be able to diagnose PMDD by performing a physical exam.
Symptoms of PMDD usually peak two days before menses. They will be absent for the week following menses. This is called the symptom-free week and can be a crucial determinant of a correct diagnosis.
A complete medical history is also required to identify any underlying medical disorders that could be causing the symptoms. Your doctor may recommend a temporary menopause or hysterectomy, which will prevent you from becoming pregnant. You may not want to undergo this surgery if you are planning to have children. However, it is often helpful to do so while you are undergoing treatment.
The best way to make a diagnosis of the premenstrual dysphoric disorder is to have a full physical exam and a symptom-free interval. In addition, you will need to document your symptoms on a daily basis. This will help your physician to distinguish between moderate and severe PMS.
The International Association for Premenstrual Disorders (IAPMD) and the Royal College of Obstetricians and Gynecologists have developed diagnostic criteria for PMDs. These include five specific symptoms. They must be present most of the time during the week before menses and are not caused by substance use.
Although PMD is a serious condition, it can be effectively treated. Whether or not you have the disorder, you can find information on its symptoms, causes, and treatments on Medscape, UpToDate, Endotext, and Informed Health Online.
Diagnosis
Psychiatric symptoms during the perimenstrual period can cause problems for a woman and her friends and family. The most common symptoms are marked irritability, sadness, and diminished interest. These symptoms may be mistaken for depression, infertility, or other conditions. It is important to have a doctor diagnose premenstrual dysphoria disorder.
Women who have premenstrual dysphoria disorder have a very predictable pattern of symptom onset and remission. The symptoms typically develop five to fourteen days before menstruation and are expected to resolve within a few days of menstruation.
However, some months are more intense than others. These symptoms can disrupt a woman’s daily life, increase interpersonal conflict, and lead to suicide attempts. It is important to evaluate a woman’s symptoms for other conditions, such as major depression, and rule out any other underlying conditions.
Studies have shown that some women with premenstrual dysphoria have other psychiatric disorders. These women are likely to have high rates of comorbidity, but it is not yet clear why this is the case.
One study found that premenstrual dysphoric disorder is associated with an increased risk of avoidant personality disorder. This disorder is defined as a pattern of behavior that prevents a person from engaging in normal social and personal relationships.
During the luteal phase of the menstrual cycle, estrogen and progesterone levels are fluctuating, producing debilitating emotional and physical symptoms. The symptoms usually remit shortly after menstruation and can interfere with a woman’s daily life.
In addition to the symptoms of mood lability, a woman with PMDD is also more likely to experience decreased pleasure, irritability, and anxiety. This type of mood disorder is different than other mood disorders.
Researchers have determined that women with PMDD are more likely to have altered genes that affect how their bodies process hormones. These changes may account for the increased risk of this comorbidity.
It is important to use prospective daily ratings to confirm a diagnosis of the premenstrual dysphoric disorder. This allows for a more accurate assessment of the symptoms’ timing with respect to the menstrual cycle and helps to limit the inappropriate inclusion of women with ongoing affective disorders.
Treatment
SSRIs are a class of antidepressants that have shown efficacy in the treatment of PMDD. They inhibit the reuptake of serotonin, a neurotransmitter that plays a critical role in emotional regulation. Some women with PMDD can take antidepressants around their menstrual cycle to alleviate their symptoms.
Selective serotonin reuptake inhibitors (SSRIs) include fluoxetine, sertraline, and paroxetine. These drugs have been shown to improve social and occupational functioning in those with depression. They can also be used to treat premenstrual dysphoria.
SSRIs can be given intermittently during the luteal phase of a woman’s menstrual cycle, which can lead to a rapid reduction of symptoms. However, the onset of action may be slower in PMDD than in major depression.
Studies have shown that PMDD may be triggered by cyclical changes in gonadal steroids. Therefore, a symptom-free interval is necessary before a diagnosis can be made.
Research on non-pharmacological treatments for PMDD has been conducted. Some of these include changing diets, getting regular exercise, and using supplements. These are not proven to be effective, but they may help.
The International Society for the Study of Premenstrual Disorders (ISPMD) has a consensus that PMDD and premenstrual syndrome falls under the ‘core PMD’ category. This category includes all disorders that involve a cluster of physical and psychological symptoms that occur during the ovulatory cycle.
The first line of treatment for PMDD is antidepressants. The most widely prescribed pharmacologic agents for depression are SSRIs. Many studies have shown that SSRIs can be effective in treating the symptoms of PMDD.
In addition to SSRIs, other pharmacologic agents are available. Clomipramine has been shown to reduce the severity of premenstrual syndrome symptoms. In a trial, clomipramine was administered during the luteal phase and it significantly reduced premenstrual irritability, depression, and tension.
Other medications include diuretics. These drugs can provide relief from the physical and psychological symptoms of dysmenorrhea. These drugs do not provide relief from the underlying cause of dysmenorrhea.
If you suspect that you have PMDD, the first step is to undergo screening. This can be done with a questionnaire that you fill out at home. In some cases, you may need to be interviewed by a doctor. The results of the questionnaire will be compared to your symptoms. If you meet the diagnostic criteria for PMDD, your symptoms can be assessed by an experienced psychiatrist.
Danazol
During the premenstrual phase, women suffer from emotional, behavioral, and physical symptoms. These symptoms may be mild or disabling, and they may interfere with daily functioning. Symptoms of PMS may vary based on the individual woman’s body and gender. Some of the most common symptoms of PMS include irritability, sleep disturbances, anxiety, and bloating.
Approximately 2% of women in their reproductive years have a premenstrual dysphoric disorder (PMDD). It is characterized by five or more of the following symptoms: marked mood change, depressed mood, affective lability, irritability, loss of interest in usual activities, and marked anxiety. Symptoms typically subside within a few days after the onset of menstruation.
Some studies suggest that serotonin plays an important role in the etiology and treatment of PMDD. It is believed that steroid fluctuations modulate the hypothalamic-pituitary-gonadal (HPG) axis and serotonergic transmission, which may play a significant role in the development of PMDD. Other studies have suggested that certain hormonal interventions, such as oral contraceptives (OCs), can induce premenstrual symptoms.
SSRIs are considered the first-line treatment for PMDD. These drugs are effective when given intermittently during the luteal phase of the menstrual cycle. They have also been shown to have an effect on cognitive-behavioral symptoms.
SSRIs are also useful for patients who have not responded to other treatments. They are available as either fluoxetine or sertraline. They are usually prescribed in low doses. When used with estrogen-progestin add-back therapy, they reliably suppress ovulation and decrease the risk of endometrial hyperplasia.
Danazol is a gonadotropin-releasing hormone agonist. It is used as a first-line treatment for moderate-to-severe premenstrual dysphoria. It is indicated for symptom relief in women who have not responded to other therapies.
Medical ovarian suppression is an option for patients who have not responded to first-line therapies. It can result in ongoing symptom relief and an improvement in the quality of life.
Aetna considers these procedures medically necessary for PMS and includes them in its coverage. They are also covered under pharmacy benefit plans. However, they are also considered investigational, because they are based on limited peer-reviewed literature.
Several other nonpharmacologic interventions can be helpful for women with mild to moderate symptoms of PMS. These interventions may include lifestyle changes, such as exercise and stress management. It may also be beneficial to use an oral contraceptive to reduce the incidence of ovulation-induced premenstrual syndrome.
Health Sources:
Health A to Z. (n.d.). HSE.ie. https://www2.hse.ie/az/
U.S. National Library of Medicine. (n.d.). https://www.ncbi.nlm.nih.gov/
Directory Health Topics. (n.d.). https://www.healthline.com/directory/topics
Health A-Z. (2022, April 26). Verywell Health. https://www.verywellhealth.com/health-a-z-4014770
Harvard Health. (2015, November 17). Health A to Z. https://www.health.harvard.edu/health-a-to-z
Health Conditions A-Z Sitemap. (n.d.). EverydayHealth.com. https://www.everydayhealth.com/conditions/
