Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Premenstrual dysphoric disorder (PMDD) can be considered a severe form of premenstrual syndrome (PMS).
What is premenstrual dysphoric disorder (PMDD)?
Premenstrual dysphoric disorder (PMDD) can be considered a severe form of 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.
What are the symptoms?
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. Having suicidal thoughts are not uncommon with PMDD. Other symptoms such as anxiety and insomnia have also been reported. PMDD can 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.
What causes PMDD?
Although the precise cause of PMS and PMDD is unknown, it is believed that these conditions result from the interaction of 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. PMDD often exacerbates existing medical or psychological issues.
Treatment of PMDD
A number of medical therapies have been shown to be effective in managing PMDD symptoms. These include antidepressants (SSRI’s). 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). Continuous treatment is probably the most effective treatment.
Oral contraceptives: Medication 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. Gonadotrophin releasing hormone (GnRH) analogues have also been used to treat PMDD. These drugs suppress oestrogen production by the ovaries by inhibiting the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop mimicking menopause. Significant side effects can occur.
Natural remedies: Some natural remedies including evening primrose oil and vitamin B6 have been shown in limited studies to reduce PMS/PMDD symptoms, but are especially used for those with mild symptoms and not PMDD
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 symptoms that interfere with your daily activities and functioning abilities.
Dr Kliman will work together with your General Practitioner and has access to Psychiatrists and Psychologists with a special interest in women’s health.
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