PREMENSTRUAL DYSPHORIC DISORDER (PMDD)
Premenstrual dysphoric disorder (PMDD) can be considered a severe form or premenstrual syndrome (PMS). Both PMS and PMDD are characterised by unpleasant physical and psychological symptoms that occur in the second half of a woman’s menstrual cycle, most commonly in the days preceding menstruation. Physical symptoms such as bloating, breast tenderness, headaches, joint pain, food cravings, mood swings or frequent crying, panic attacks, fatigue, mood changes, irritability and trouble focusing are among the most common symptoms. Other symptoms like anxiety and insomnia have also been reported. PMS symptoms may be troubling and unpleasant. PMDD may cause severe debilitating symptoms that interfere with a woman’s ability to function. It is estimated that at least 85% of menstruating women have at least one PMS symptom as part of their monthly cycle. PMS is much more common than PMDD. You must have five or more of the symptoms listed above to be diagnosed with PMDD.
What Causes PMDD?
Although the precise cause of PMS and PMDD is unknown it is believed that these conditions result from the interaction or hormones produced by the ovaries at different stages of their menstrual cycle with neurotransmitters in the brain. While the ovarian hormone levels are normal in women with PMDD it is likely that the brain’s response to these normally fluctuating hormone levels is abnormal.
How Is PMDD Diagnosed?
PMDD must be distinguished from other physical and psychological conditions that can produce the same symptoms. The differential diagnosis includes both mood and anxiety disorders as well as medical conditions such as thyroid disease. In addition to a thorough medical history and physical examination blood tests may be performed to rule out whether medical conditions may be present that may account for the PMDD symptoms.
Treatment of PMDD
A number of medical therapies have been shown to be effective in managing PMDD symptoms. These include antidepressants (SSRIs). Up to 75% of women report relief of symptoms when treated with SSRI medications. Side effects can occur in up to 15% of women and can include nausea, anxiety and headaches. SSRI medication to treat PMDD may be prescribed to be taken continuously or only during the 14 day luteal phase (the second half of the menstrual cycle).
Oral Contraceptives: Medications that interfere with ovulation and the production of ovarian hormones have also been used to treat PMDD. Oral contraceptive pills can be prescribed to suppress ovulation and regulate the menstrual cycle. Gonadotropin releasing hormone (GnRH) analogues have also been used to treat PMDD. These drugs suppress oestrogen production by the ovaries but inhibiting the secretion or regulatory hormones from the pituitary gland. As a result menstrual periods stop mimicking menopause. Nasal and injection forms of gonadotropin releasing hormones are available. The side effects of (GnRH) analogous drugs are a result of the lack of oestrogen and can include mood changes, fatigue and osteoporosis. This can be rectified by adding small amounts of oestrogen and progesterone.
Natural Remedies: Some natural remedies, include evening primrose oil and vitamin B6, have been shown in limited studies to reduce PMS/PMDD symptoms.
The Complications of PMDD
PMDD by definition is characterised by symptoms severe enough to interfere with daily functioning activities. If untreated, these symptoms can significantly impact quality of life and a woman’s ability to function at work, school or at home. Further, mood changes and depression that may accompany PMDD can be associated with suicidal thoughts and behaviour. It is important to seek medical advice from your GP or gynaecologist if you are experiencing conditions that interfere with your daily activities and functioning.
Dr Len Kliman is one of Melbourne’s most experienced and respected obstetrician and gynaecologists.
With over three decades of experience, Dr Kliman has treated tens of thousands of gynaecological patients and delivered over 20,000 babies and still counting!
In 2017, Dr Kliman was awarded an Order of Australia for his services to obstetrics and gynaecology.