By definition premenstrual dysphoric disorder (PMDD) is a severe form of PMS (Premenstrual syndrome). Premenstrual syndrome (PMS) is characterized by significant mood, behavioural and physical changes that occur 1 to 2 weeks before menses and abate during the menstrual flow. The symptoms of PMDD are similar to those of PMS, but are severe enough to interfere with work, day to day activities and relationships.
Most of the women especially of child bearing age group experience some degree of emotional or physical discomfort a few days before their menstrual period begins each month. About 40% go through PMS which they hardly discuss with their doctors. Around 5% of menstruating women suffer from PMDD and approach health care mainly with the feeling of unwell with vague symptoms.
What can be the possible cause?
The pathophysiology is still uncertain that why exactly the normal physiological hormones cause these problems in some while others are not much affected. Oestrogen and progesterone are the two main hormones playing major role in menstrual cycle. To understand it better let’s have a look at below picture.
During ovulation there is peaking of the hormones with sudden dip whereas progesterone starts raising including oestrogen in luteal phase. Scientists believe that these hormonal changes and these hormonal imbalance also trigger the neurotransmitter called serotonin which is the main cause for mood fluctuations and certain physical symptoms. Serotonin is considered as a feel good hormone and decrease in its level causes depressive feeling.
- Depressed mood
- Tension, Irritability
- Mood swings from anxiety to depression
- Decreased interest in usual activities
- Lack of energy
- Insomnia or hypersomnia
- Physical symptoms such as fluid retention, bloating and breast tenderness
- Difficulty concentrating
- General symptoms like Head ache, leg cramps, hot flushes, skin allergy
- Marked change in appetite
- Feeling overwhelmed
There are no exact laboratory tests for this. Your consultant may rule out certain medical conditions and then asses for PMDD. One must have at least five or more of the symptoms listed above and at least one or more of these symptoms must be severe depressed mood, tension, mood swings or irritability. These should be present atleast for two consecutive cycles 1. Symptoms are present a week or two before the onset of menses with resolution after the start.
Treatment and precaution:
- Medications include: SSRI antidepressants, Oral contraceptives, Gonadotropin-releasing hormone analogs, Anti-inflammatory medications(pain killers)
- Dietary changes
Most of the time depending on the severity of the symptoms medication is advised mainly for the mood related symptoms. Pain killers like ibuprofen, mefenemic acid relieve symptoms such as headache, backache, cramps, and breast tenderness. Along with medications, dietary modifications and exercise act as a great adjuvants.
Exercise: In some cases the severity of symptoms can be managed by dietary means and exercise itself. Stress is the major factor in todays life specially in anxiety personality and one of the way to get out of it is regular Exercise and self motivation. Women with mood swings, anxiety and depression have shown to improve with exercise and meditation as these are said to release mood elevating and pain relieving endorphins.
Diet : A healthy diet is important for both physical and mental wellness. Try avoiding too much of caffeine and alcohol. Start your break fast with high lean protein and good fat. Include more of calcium rich food, vegetables including complex carbohydrates which helps in elevating serotonin levels, Omega 3 fatty acids, eggs and bananas(best for cramps and sleep). Vitamins specially Magnesium and vitamin B complex are said to be womens best nutrition for PMDD. Try having more small meals which help to stabilise energy levels during luteal phase.
Education : Know that you will feel better once your period starts. While the symptoms of PMDD may vary from month to month, once you understand whats PMDD and your symptoms how they affect your physical health and moods it becomes easy to deal with. Learn to cope up with the day to day life problems to decrease anxiety and irritability prior to your periods.
There is no doubt that PMDD can greatly affect a woman’s quality of life including the lives of her family and friends. The seriousness of this condition is something that most of the people are not aware of. Educate your partner regarding PMDD. He might be total clueless about what you are going through and your actions. Once he knows he might be a great support. Speak out to your mom and friends. Educate them and convey them that the phase passes by and they are not just alone with this. Hang out with friends or do that which makes you happy or elevates your mood. One may take the help of counseling with a psychologist if nothing seems to help.
It’s a beautiful phrase I came across which sits perfect for what all is faced regularly. Every body is unique, understand your body and its physiology and try to handle accordingly. So face the PMDD with appropriate measures, feel good and eat good having a thought that its going to pass and you will be all fine.
1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Washington, DC American Psychiatric Association, 1994