Premenstrual dysphoric disorder (PMDD) is very similar to premenstrual syndrome (PMS) however, it is not as common. Recent studies have shown that roughly 80 to 90% of women experience PMS symptoms with only 2.5 to 3% of them showing signs of PMDD. 

Despite its low rate of occurrence, PMDD takes a massive toll on the health of anyone affected by it.

Many symptoms of PMDD overlap with other mental health disorders. For this reason, understanding the entirety of PMDD helps to narrow down the proposed diagnoses and leads to a definitive diagnosis.

 

What is Premenstrual Dysphoric Disorder? 

In general, PMDD has been classified as a more severe form of PMS. The most recent publication of the diagnostic and statistical manual for mental disorders (DSM-5) lists PMDD as its own disorder- outside of PMS or other depressive disorders.

Similar to PMS, PMDD causes emotional imbalances, commonly known as mood swings. These mood swings are more intense and are typically referred to as more draining in comparison to PMS symptoms.

In some cases, symptoms of PMDD go as far as impacting the quality of life of the person experiencing them. Work, personal relationships and leisure activities are impacted areas that have been reported by those with PMDD.

Causes

There is no definitive cause of PMDD as of yet however, there are many proven links to the disorder. It is proposed that this disorder is heritable and consists of hormone sensitivity in the brain. 

Other studies have found that the brain circuits of those with PMDD react differently in response to emotional triggers compared to those without the diagnosis. This may be caused by atypical reactions to luteal phase changes in the progesterone metabolite known as allopregnanolone.

Typically, those with PMDD experience feelings of anxiety, agitation and negative thoughts when allopregnanolone is increased. Normally, as a result of this elevated metabolite, people become calmer.

Another link to PMDD is low levels of serotonin. This brain chemical, when impacted by hormonal changes, provokes symptoms of PMDD. 

To add, women and assigned females at birth (AFAB) have been found to be more sensitive to sex hormones due to a molecular mechanism in their genes. Finally, some proven risk factors for PMDD include obesity, past traumatic events and cigarette smoking.

Signs and Symptoms

Premenstrual dysphoric disorder symptoms can be broken down into 3 distinct categories. These include mood, behavioral and somatic symptoms.

Mood

  • Heightened anxiety
  • Feelings of hopelessness, depression, worthlessness
  • Increased irritability or anger
  • Frequent marked mood swings

Behavioral

  • Trouble concentrating
  • Feeling overwhelmed or out of control
  • Changes to appetite (overeating or craving specific foods)
  • Disrupted sleep patterns (insomnia or hypersomnia)
  • Lack of energy
  • Decreased interest in preferred activities

Somatic

  • Headaches
  • Muscle or joint pain
  • Bloating or weight gain
  • Breast swelling and tenderness

Other symptoms of PMDD include fluid retention, respiratory issues, gastrointestinal problems, changes to skin complexion and decreased sex drive. 

Diagnosis

Receiving a formal diagnosis may be a lengthy process due to the nature of PMDD. Typically, a doctor will assess your physical and mental symptoms through a thorough exam.

This process helps rule out any other associated diagnoses such as panic disorder, depression or other gynecological conditions.

According to the guidelines set in the DSM-5, a person must exhibit 5 of the above-mentioned symptoms. Of these symptoms, the person must have at least 1 of the following 4 symptoms:

  • Depressed mood or feelings of hopelessness
  • Persistent anger or irritability
  • Marked anxiety or feelings of being on edge
  • Affective lability

Other factors that influence the diagnosis of PMDD include:

  • Symptoms that interfere with social, sexual or occupational functioning
  • Symptoms that are directly related to the menstrual cycle

The presence of any of these guidelines over the course of 2 consecutive menstrual cycles will ultimately result in a diagnosis. Physicians will normally indicate that PMDD is the cause of these symptoms, however, cannot confirm the diagnosis until after these 2 cycles.

 

Treatment 

The process of premenstrual dysphoric disorder treatment can consist of pharmacological treatment, non-pharmacological methods or a combination of the two. Since PMDD is a chronic condition, the treatment will vary depending on the severity of symptoms.

Some most common pharmacological forms of treatment for people diagnosed with PMDD include hormone therapy through the use of birth control pills as well as antidepressants- specifically SSRIs. 

To add, non-pharmacological methods include frequent exercise, vitamin supplements and changes to diet. This may include increasing intake of carbohydrates and protein and decreasing caffeine, alcohol and salt.

In some instances, stress management is also used to treat PMDD. This form of treatment may include yoga or breathing exercises.  

Symptoms may become more or less intense as you age. For this reason, treatment may vary from person to person, so it is important to regularly keep in touch with your primary physician.

 

Related Disorders

Some symptoms of PMDD overlap with many other types of psychiatric disorders. These symptoms typically refer to changes in depressive mood, anxiety or physiological states. Some differential diagnoses include:

 

Generalized Anxiety Disorder

Symptoms of generalized anxiety disorder consist of feelings of fear and heart palpitations. Chronic anxiety does not change during the menstrual cycle however it may coexist with PMDD.  

Thyroid Disease

Symptoms of hyperthyroidism include weight loss, disruption of sleep, heat intolerance and change in heart rhythm. Alternatively, hypothyroidism symptoms include gastrointestinal issues, weight gain, depression and dry skin.

Major Depressive Disorder 

Low mood and energy, changes in appetite, sleep disturbance and difficulty concentrating are all common overlapping symptoms of PMDD and major depressive disorder. It is estimated that a diagnosis of depression coexists with roughly half of PMS/PMDD diagnoses.

Mastalgia

The symptoms of mastalgia that overlap with PMDD consist of breast tenderness and swelling. Mastalgia can present itself outside of the luteal phase but is commonly worsened during this phase.

Each of these conditions must be ruled out prior to the diagnosis of PMDD. 

 

Knowing When to Seek Help

Treatment of your physical and mental well-being is of the utmost importance regardless of your diagnosis. If you are concerned about any of the previously stated symptoms of premenstrual dysphoric disorder, do not hesitate to contact a trusted medical professional.

Take the first step today by seeking help and discover how you can improve your overall quality of life with the right treatment.