Premenstrual dysphoric disorder

Premenstrual dysphoric disorder (PMDD) occurs when a woman experiences severe psychological and physical symptoms before her monthly period (menstruation). The symptoms of PMDD are more severe than those of premenstrual syndrome.

Causes and risk factors

The exact causes of PMDD are not known. Changes in hormones during the menstrual cycle might have an influence.

Factors associated with the condition include:

• Anxiety and depression;
• Seasonal affective disorder;
• Being overweight and not exercising enough;
• Drinking too much caffeine or alcohol, and;
• Having a family history of PMDD.

Signs and symptoms

The symptoms of PMDD are more severe than those of premenstrual syndrome (PMS) and include:

• Depression;
• Anxiety and panic attacks;
• Headaches, bloating and breast tenderness;
• Joint or muscle pain;
• Fatigue;
• Trouble sleeping;
• Difficulty concentrating;
• Irritability, and;
• Feeling sad, hopeless, lonely, or sometimes suicidal.

Five or more of the above symptoms, of which at least one is a symptom related to mood, have to be present for a diagnosis of PMDD to be made.

Premenstrual dystrophic disorder can cause changes to your mood. 

Methods for diagnosis

Your doctor will likely perform a physical examination to rule out other conditions. Evaluation may also help rule out mental health conditions such as depression. Often, keeping a diary of when you experience symptoms could help your doctor make a diagnosis.

Types of treatment

The main line of treatment for PMDD is maintaining a healthy lifestyle by eating a healthy diet and getting enough sleep and exercise.

Additional treatments that may be used include:

• Diuretics, for women who retain a lot of water;
• Medications that suppress ovulation, such as the oral contraceptive pill ('The Pill');
• Nutritional supplements;
• Pain-relief medications for headache, menstrual cramping and breast tenderness, and;
• Cognitive behaviour therapy alongside or instead of antidepressant medication for depression, if you have it.

Potential complications

Symptoms of PMDD can have an impact on daily life. If you have depression, then your symptoms may be worse in the second half of your cycle and your medication may need to be changed.

Prognosis

With treatment, symptoms usually resolve for most women.

Prevention

You can reduce your risk of PMDD by getting enough rest and exercise, maintaining a healthy diet and managing your stress levels.