Premenstrual Dysphoric Disorder (PMDD): Causes, Symptoms and Treatment.

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome experienced by approximately 3-8% of women in their reproductive years.

The symptoms differ from premenstrual syndrome (PMS) in that PMDD causes severe and debilitating symptoms which affect daily living.

PMDD is a chronic condition that necessitates treatment when it occurs. Available treatments include lifestyle modifications and medication.

This Knowledge Center article examines the causes, symptoms and diagnosis of this debilitating condition, along with the treatment options that are available for people who are affected by it.

Fast facts on PMDD

Here are some key points about premenstrual dysphoric disorder. More detail and supporting information can be found in the main article.

  • PMDD is more severe than the symptoms experienced in PMS and requires medical treatment
  • PMDD is not as common as PMS
  • Symptoms are most commonly experienced during the second half of a woman’s menstrual cycle
  • For some women, the symptoms of PMDD can last until menopause
  • The symptoms of PMDD are so severe that they often disrupt a woman’s ability to function normally in her daily life.

Symptoms of PMDD

Despite their similarities, the symptoms of PMDD are more severe that those experienced in PMS.

Symptoms are typically present during the week before menses and resolve within the first few days after menstrual onset.

Women who suffer from PMDD are often unable to function at their normal capacity during the symptomatic phase of the condition. The condition can affect relationships and disrupt their routines at home and work.

Symptoms of PMDD include:

Premenstrual dysphoric disorder is a debilitating condition that causes symptoms such as gastrointestinal discomfort and dizziness.

Severe fatigue

Mood changes including irritability, depression and anxiety

  • Difficulty concentrating
  • Heart palpitations
  • Paranoia and issues with self-image
  • Coordination abnormalities
  • Forgetfulness
  • Abdominal bloating, increased appetite and gastrointestinal upset
  • Headaches
  • Muscle spasms, numbness or tingling in the extremities
  • Skin conditions such as acne, eczema and the worsening of other skin conditions
    • Hot flashes
    • Dizziness
    • Fainting
    • Sleeplessness
    • Fluid retention, breast tenderness, decreased urine production
    • Vision changes and eye complaints
    • Respiratory complaints such as allergies and infections
    • Painful menses, decreased libido.
  • Causes of PMDD

    Experts have yet to identify a cause for PMDD and its counterpart, PMS.

    It is suggested that PMDD is caused by the brain’s abnormal response to a woman’s fluctuation of normal hormones during the menstrual cycle, leading in turn to a deficiency in the neurotransmitter serotonin.

    Some women are more likely than others to experience PMDD and include those who have had a personal or family history of postpartum depression, mood disorders or depression.

    Diagnosis of PMDD

  • Because PMDD can cause symptoms consistent with other conditions, it is likely that health care providers will perform a physical exam, obtain a medical history and order certain tests to rule out other conditions when making a diagnosis.

    A symptom chart is also used in the diagnostic process to determine any correlation between the patient’s symptoms and their menstrual cycle.

    Guidelines from the American Psychiatric Association require that the symptoms of PMDD be present for a minimum of two consecutive menstrual cycles before a diagnosis of PMDD can be made.

    According to the guidelines, symptoms must be present a week before the onset of menses with resolution after the start (within the first few days) of flow while also interfering with normal daily living.

  • For a PMDD diagnosis to be made, a patient must experience at least one of the following symptoms:
    • Feelings of sadness or hopelessness
    • Feelings of anxiety or tension
    • Mood changes
    • Feelings of anger or irritability.

    Other symptoms of PMDD can include:

    • Apathy to routine activities, which may be associated with social withdrawal
    • Difficulty concentrating
    • Fatigue
    • Changes in appetite
    • Sleeping problems – excessive sleeping (hypersomnia) or insomnia

Feeling overwhelmed or a lack of control.

Other physical symptoms of PMDD can include breast tenderness or swelling, headaches, joint or muscle pain, bloating and weight gain.

For a PMDD diagnosis to be made, a patient must exhibit a total of five or more of the symptoms mentioned above.

Treatment for PMDD

Some people may require medication such as anti-inflammatories to treat PMDD.

Treatment for PMDD can include the use of:

Treatment for PMDD can include the use of:

  • SSRI antidepressants such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa)
  • Oral contraceptives
  • Gonadotropin-releasing hormone analogs such as leuprolide (Lupron), nafarelin (Synarel) and goserelin (Zoladex)
  • Danazol (Danocrine)
  • Anti-inflammatory medications
  • Chasteberry extract
  • Dietary supplementation with calcium, vitamin B6, magnesium and vitamin E
  • Dietary changes: decreasing intake of sugar, salt, caffeine and alcohol and increasing protein and carbohydrate intake
  • Exercise and stress management techniques.

Speak with your health care provider right away if you think you may be experiencing symptoms of PMDD. As the symptoms of PMDD can be long-lasting, it is advisable to seek treatment as soon as possible.