• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

PMDD (PREMENSTRUAL DYSPHORIC DISORDER) EPIDEMIOLOGY AND TREATMENT

Premenstrual dysphoric disorder – PMDD, is a severe form of premenstrual syndrome that causes mood disorders due to hormonal changes, leading to multiple psychological symptoms around the time of the monthly menstruation cycle. This is a more severe and disabling form of PMS – Premenstrual syndrome and can occur anytime during the reproductive age of a woman, though it is expected to occur at the age of 26 years. PMDD causes heightened irritability, depression or anxiety in a week or more before the start of the period when the hormone levels start to fall post ovulation and continue even after two days of the start of the period. PMDD can cause such serious symptoms that could disrupt normal life and strain relationships. 

Symptoms of PMDD

PMDD can be categorised based on emotional and physical symptoms such as below:

Emotional symptoms include

  • Extreme anxiety
  • Severe agitation and nervousness
  • Crying outbursts
  • Losing control
  • Memory problems
  • Loss of interest in life and relationships
  • Irritability
  • Mood swings
  • Panic attacks
  • Paranoia
  • Sadness
  • Hopelessness
  • Depression
  • Suicidal thoughts

Physical symptoms include

  • Acne
  • Chronic backache
  • Bloating
  • Swollen and tender breasts
  • Gastrointestinal issues
  • Abdominal cramps
  • Light-headedness
  • Nausea
  • Headache
  • Heart palpitations
  • Fluctuations of appetite
  • Extreme joint or muscle pain
  • Muscle spasms
  • Pain during periods
  • Reduced desire to have sex
  • Lack of energy
  • Trouble in focusing
  • Trouble in sleeping
  • Paranoia and issues with self-image
  • Backache
  • Vision problems
  • Reduced libido
  • Easy bruising
  • Increased sensitivity

These symptoms, especially emotional factors, cause a huge problem in everyday life, work, relationships, health, etc. Moreover, these symptoms tend to fade on their own at the start of the period and begin upon the next ovulation cycle.

Causes of PMDD

Though the exact cause PMDD is not known yet, it is attributed to the shifting hormone levels during the menstrual cycle and before. Some women are more sensitive to the changing levels of estrogen and progesterone and tend to experience symptoms of PMDD.

Risk Factors of PMDD

Certain factors increase the risk of women experiencing PMDD, such as:

  • Environmental: Environmental factors such as stress, surroundings, personal trauma, as well as seasonal fluctuations, tend to affect premenstrual dysphoric disorder.
  • Genetics: Family history or genes play an important role in the premenstrual dysphoric disorder.
  • Oral contraceptives: Women who take oral contraceptives are known to have lesser premenstrual dysphoric disorders.

Diagnosis of PMDD

Apart from understanding the symptoms of PMDD, the doctor will conduct a physical exam, understand medical history, and also analyse risk factors, including family history. That said, the symptoms must correlate with the menstrual cycle for a minimum of two consecutive cycles to consider it as a case of PMDD. Moreover, the symptoms of PMDD:

  • Must last till the beginning of menses
  • Fade out on their own within the first few days of the period
  • Interfere with the normal functioning of life

Treatment of PMDD

Though there is no set treatment to cure PMDD completely, efforts are made to prevent or manage symptoms. Some of the treatment options include:

  • Antidepressants: Antidepressants, as suggested by the doctor, can reduce emotional symptoms, including fatigue, excessive hunger, and sleep problems.
  • Birth control pills: Regular birth control pills without any break or a short break, can greatly impact PMS and PMDD symptoms for women.
  • Nutritional supplements: Nutritional supplements for calcium, vitamin B, etc. can help with PMDD symptoms.
  • Diet and Lifestyle changes: Regular physical exercise, less caffeine, limited alcohol, no smoking, enough sleep, less stress, balanced relaxation, and other techniques such as meditation, yoga, warm bath, etc. can greatly impact PMDD symptoms. Moreover, keeping yourself hydrated, eating clean food, maintaining sugar levels, etc. also helps to treat PMDD.

A combination of two or more factors can be used to treat symptoms. Moreover, the effectiveness of the treatment also depends on the internal motivation of the person suffering from PMDD. Further, if non-invasive methods fail to manage symptoms of PMDD, the doctors might suggest surgery as an option to cure PMDD. The surgery will involve removing the ovaries to relieve the symptoms; though it will cause women to stop ovulating and also experience menopause that might bring along different symptoms. However, surgery is a very critical and complex decision, one which must be made after careful consideration and only if all other methods of treatment have failed and the situation is worsening with time.

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