All You Need to Know About PMDD

Premenstrual dysphoric disorder (PMDD) is a health problem similar to premenstrual syndrome (PMS), but it’s more serious.

Chances are good that you’ve had some type of PMS since you started your period. Doctors think as many as three-quarters of women who get periods have some signs of PMS, whether it’s food cravings, cramps, tender breasts, moodiness, or fatigue.

But PMDD is different. It causes emotional and physical symptoms like PMS, but women with PMDD find their symptoms draining. Your PMDD symptoms could interfere with your daily life, including work, school, social life, and relationships.

PMDD Symptoms

The symptoms of PMDD usually show up the week before you start your period and last until a few days after it begins. Most of the time they’re severe and exhausting, and they can keep you from daily activities.

Symptoms of PMDD include:

  • Mood swings
  • Depression or feelings of hopelessness
  • Intense anger and conflict with other people
  • Tension, anxiety, and irritability
  • No interest in your usual activities
  • Trouble concentrating
  • Fatigue
  • Appetite changes
  • Feeling out of control
  • Sleep problems
  • Cramps and bloating
  • Breast tenderness
  • Headaches
  • Joint or muscle pain
  • Hot flashes

PMDD Causes and Risk Factors

Researchers don’t know the exact cause of premenstrual dysphoric disorder. Most think it may be an abnormal reaction to hormone changes related to your menstrual cycle.

PMDD affects up to 5% of women of childbearing age. Many women with PMDD may also have anxiety or depression.

Studies have shown a link between PMDD and low levels of serotonin, a chemical in your brain that helps transmit nerve signals. Certain brain cells that use serotonin also control mood, attention, sleep, and pain. Hormonal changes may cause a decrease in serotonin, leading to PMDD symptoms.

PMDD Diagnosis

If you have any of the classic PMDD symptoms, see your doctor. They’ll go over your medical history with you and give you a thorough exam. The doctor will do some tests to find out how you’re feeling emotionally and mentally.

Before they diagnose you with premenstrual dysphoric disorder, the doctor will make certain that emotional problems, such as depression or panic disorder, aren’t causing your symptoms. They’ll also rule out other medical or gynecological conditions, like endometriosis, fibroids, menopause, and hormone problems.

Your doctor can diagnose you with PMDD if:

You have at least five of the symptoms listed above.
They start 7-10 days before you get your period.
They go away shortly after you start bleeding.

If you’re dealing with these issues daily and they don’t get better when your period starts, it’s unlikely that PMDD is to blame.

PMDD Treatment

Many of the same things you do to manage PMS can ease your PMDD symptoms.

Common treatments include:

  • Antidepressants
  • Hormone therapy (like birth control pills)
  • Changes in what you eat
  • Regular exercise
  • Stress management
  • Vitamin supplements
  • Anti-inflammatory medicines

Some over-the-counter pain relievers such as aspirin, ibuprofen, and nonsteroidal anti-inflammatory drugs (NSAIDs) may ease symptoms like headache, breast tenderness, backache, and cramping. Diuretics, also called “water pills,” can help with fluid retention and bloating.

For some women, 1,200 milligrams a day of dietary and supplemental calcium may help with symptoms. Vitamin B6, magnesium and L-tryptophan also may work, but ask your doctor for advice before taking any supplements.

Some studies suggest that chasteberry (Vitex agnus-castus) is good for PMDD, but there isn’t enough research to be sure. The FDA doesn’t control herbal supplements, so talk with your doctor before trying one.

Talking to a therapist may also help you find new ways to manage PMDD. Relaxation therapy, meditation, reflexology, and yoga might also provide you relief, but they haven’t been widely studied, either.


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