Premenstrual Dysphoric Disorder (PMDD) – Symptoms, Causes & Treatment

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Premenstrual Dysphoric Disorder (PMDD) – Symptoms, Causes & TreatmentWhile everybody knows about the almighty premenstrual syndrome (PMS) and its nefarious effects on women, few are aware about the premenstrual dysphoric disorder (PMDD), which is a severe form of PMS.

Premenstrual dysphoric disorder affects roughly three to eight percent of all women, which is why it is not as infamous as PMS. PMDD is a diagnostic primarily associate with the luteal phase of the menstrual cycle. However, up to one-third of all women suffering from PMDD experience residual symptoms in the first two or three days of the follicular phase. Premenstrual Dysphoric Disorder Symptoms

Just like the simpler PMS, premenstrual dysphoric disorder follows a similar pattern which is cyclic and predictable. Symptoms start in the late luteal phase of the menstrual cycle, i.e. after ovulation, and end shortly after actual menstruation begins.

Women generally experience emotional symptoms while PMS-ing, but in PMDD its all accentuated and mood symptoms are dominant. Women with PMDD often face significant disruption to personal relationships due to this disorder, and may feel anxious, angry or depressed. The main symptoms of premenstrual dysphoric disorder can be disabling, and include:

  • Intense tension or anxiety;
    Deep sadness or despair;
    Increased sensitivity to rejection or criticism;
    Rapid and severe mood swings;
    Panic attacks;
    Bouts of uncontrollable crying;
    Persistent and long-lasting anger or irritability, more intense interpersonal conflicts – sufferers are usually unaware of the impact they may have on their friends, family or others close to them;
    Apathy or lack of interest in relationships or daily activities;
    Problems focusing;
    Food cravings;
    Binge eating;
    Chronic fatigue;
    Insomnia or excessive sleep;
    Increase or decrease in sexual drive;
    Increased need for emotional closeness;

Physical symptoms of premenstrual dysphoric disorder, meanwhile, include breast tenderness and/or swelling, headaches, joint or muscle pain, heart palpitations, swollen face and nose, a sensation of “bloating,” feeling fat or actually gaining weight. If a woman experiences five or more of these symptoms (both physical and emotional) she may be suffering from PMDD.

What Causes Premenstrual Dysphoric Disorder?

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The first major genetic finding in PMDD was reported back in 2007. PMDD is associated with variants in the estrogen receptor alpha gene. According to research, women with these genetic variants were more prone to PMDD. Researchers also found that this tie is only seen in women who carry a variant form of another gene, Catechol-O-methyl transferase (COMT), which plays a role in regulating the function of the prefrontal cortex, which is a critical mood regulator.

Previous research, meanwhile, discovered that women with premenstrual dysphoric disorder present an abnormal response to normal hormone levels, which in turn makes them differentially sensitive to their own natural hormone changes.

Objective correlational evidence suggests a neurological connection with PMDD distress, and the mood symptoms of PMDD patients is reportedly significantly connected to the concomitant worsening of their brain serotonin precursors.

Scientists have yet to determine an exact cause of PMDD, but a leading theory blames the disorder on the lack of serotonin, accentuated by the fluctuations in the levels of sex hormones – progesterone, estrogen and testosterone – in the luteal phase of the menstrual cycle.

Building on this serotonin theory, some clinical trials found a number of selective serotonin reuptake inhibitors (SSRIs) to effectively treat PMDD when taken during the dysphoric phase (see below).

Premenstrual Dysphoric Disorder and Depression Disorders

Premenstrual dysphoric disorder is widely considered a separate disease from major depressive disorder (MDD), because women with PMDD who have never suffered from MDD experience lower sensitivity and response to stress and pain compared to people with MDD. On the other hand, anxiety disorders, unipolar depression and other Axis I disorders are more common in women with PMDD than their non-PMDD counterparts.

Treating and Managing Premenstrual Dysphoric Disorder

The main goal of treatment for this disorder is to relieve the patient’s suffering and reduce the disruption to their personal and social relationships. As selective serotonin reuptake inhibitors (SSRIs) have proved effective in treating PMDD, they are currently the first-line therapy. Researchers have conducted several randomized, placebo-controlled trials to study the efficacy of SSRIs, and found they yield excellent results with minimal side effects.

The U.S. Food and Drug Administration (FDA) has so far approved four SSRIs for the treatment of premenstrual dysphoric disorder: Fluoxetine – available as generic or as Prozac or Serafem, sertraline – available as Zoloft, paroxetine – found as Paxil, and escitalopram oxalate – found as Lexapro.

In addition to medical treatment, women suffering from PMDD may experience ameliorated symptoms and more manageable effects of PMDD if they make some lifestyle changes such as regular physical exercise and a well-balanced diet. Two studies also found that a serotonin precursor called L-tryptophan can provide significant relief when supplemented daily in a large dose. Other evidence, meanwhile, suggests that vitamin B6 can relieve symptoms as well.

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