What is PMDD and do I have it?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome.
For many women the week or two before their period can be difficult, and for some quite crippling. The good news is that there is effective treatment available to relieve symptoms and improve your quality of life.
PMS affects around 30% of women. They can experience both physical & psychological symptoms in the days leading up to a period.The symptoms are usually manageable. In contrast, PMDD affects around 5% of all women, with more severe psychological symptoms and to a lesser extent physical symptoms, that can greatly affect quality of life, employment, relationships etc.
What are the symptoms of PMDD?
Symptoms are experienced 7-10 days prior to your period, and are severe enough to affect your day to day activities and your ability to function normally:
- Depression, anxiety, mood swings, reduced libido, loss of enjoyment in usual activities, tearfulness, sadness, feelings of worthlessness, anger and aggression
- Loss of concentration, focus and a feeling of “brain fog”
- Fluid retention (swollen ankles, feet, hands)
- Abdominal bloating
- Breast tenderness and/or swelling
- Acne flare ups
- Food cravings
- Weight gain
- Constipation or diarrhoea
The psychological symptoms of PMDD are very similar to clinical depression and anxiety. The difference is in PMDD these symptoms are experienced only in the premenstrual phase (around 7-10 days before the onset of your period), and usually resolve within 4 days of the onset of your period(1)
What causes PMDD and PMS
The causes are complex, and it is not known why some women experience PMDD or PMS and others don’t. It may be due to body and brain sensitivity to progesterone, a hormone that is found in higher levels during the premenstrual phase of your menstrual cycle. Genetics also play a significant role. Often women with PMDD have other family members with the condition(1)
There are no blood tests that can diagnose PMDD. The diagnosis is based on the symptoms you experience. Your GP may recommend blood tests to rule out other causes of your symptoms such as a thyroid disorder or low iron levels.
What can be done to manage PMDD
Firstly, keeping a diary of symptoms and how they relate to your menstrual cycle for at least 3 months is crucial. This can help you and your doctor ascertain if there is a monthly pattern. A notebook or online tool can be used for tracking symptoms. There are also several lifestyle changes that may help the management of PMDD included
- Exercise such as yoga, walking, stretching or more vigorous activity can help relieve symptoms.(3)
- Meditation, mindfulness and other methods of stress reduction
- Good sleep hygiene
- Avoidance of alcohol, smoking and illicit drugs (3)
- Keep caffeine & high salt foods to a minimum
- Managing your life around your menstrual cycle if possible, so as to avoid stressful situations during the premenstrual phase
- Cognitive behaviour therapy with an experienced psychologist/GP (3)
Vitamins, Minerals & Herbal supplements
There is some low level evidence the following supplements may help, though more studies are needed in this area. Check with your GP before taking these:
- Vitex Agnus-Castus (Chasteberry). Note this supplement may interact with the oral contraceptive pill & is best prescribed by a medical practitioner with experience in herbal medicine (2)
- Vitamin B6 50-200 mg daily (note doses greater than 200 mg can cause nerve damage) (1)
- Magnesium 900 mg daily amy assist specifically with premenstrual headache(1)
- Calcium 600 mg twice per day (1)
- SSRIs (serotonin reuptake inhibitors) traditionally used to treat depression and anxiety have been shown to be up to 70% effective in the management of PMDD. The most commonly used SSRI for this condition is Fluoxetine (Prozac) tablet, and it can be taken every day (which is the best option), or on days 14-28 of your cycle (day 1 being the first day of your period). Your GP will usually start this at a low dose, and it may take up to 6 weeks to notice an effect (3).
- Suppressing Ovulation keeps the level of progesterone low and therefore relieves many of the symptoms of PMDD. Medications used for this purpose include the oral contraceptive pill, a hormone releasing IUD (Mirena) in combination with an oestrogen patch or other hormone formulations. A 3 month trial is needed before deciding if one of these hormone formulations is right for you. This method can be used in combination with an SSRI, and has the added benefit of providing contraception (3)
- Medically induced menopause which essentially switches off the ovaries and therefore the hormone fluctuations that occur during your menstrual cycle.This is usually the treatment of last resort. This is achieved via medication prescribed under the guidance of a medical specialist (3)