PMDD: “It’s Like PMS on Steroids”

For years, premenstrual syndrome (PMS) has been the punchline of many jokes and used as a possible explanation anytime a woman behaves in a way other than extremely pleasant. Even though it is discussed in a way that would lead you to believe that it could happen at any time, there is actually a definition and explanation for the disorder.

Defining the Cycle: What is PMS?

PMS refers to a cluster of symptoms that usually begin the week or two before your period and end shortly after the start of your period. Symptoms can typically be broken into two categories: behavioral and physical. The most common symptoms include:

Behavioral

• Mood swings
• Tearfulness
• Anxiety
• Irritability
• Appetite changes
• Appearing overly sensitive
• Physical

Physical

• Abdominal bloating
• Breast tenderness
• Fluid retention/weight gain
• Fatigue
• Acne
• Pain increase (headaches, joints)
• Hot flashes

Doctors typically define PMS as the presence of at least one symptom occurring within the two weeks before your period and ending shortly after it starts, with some sort of impairment in functioning.

RELATED: Premenstrual Dysphoric Disorder (PMDD): Not Your Regular PMS

PMDD: When PMS Becomes Disabling

While many women experience some combination of symptoms prior to their periods, about three to eight percent of childbearing age women have a more serious disorder, premenstrual dysphoric disorder (PMDD), and this is the bully that none of us would wish on our worst enemy.

PMDD is a psychiatric disorder and is characterized by symptoms that can be disabling. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines PMDD as follows:

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Symptoms occurring in the majority of menstrual cycles, with at least five symptoms present in the final week before the onset of the period, that start to improve within a few days after the onset of the period, and are essentially absent the week after the period.

You may experience one or more of the following:

• Mood changes (mood swings; feelings of sudden sadness or tearfulness; increased sensitivity to rejection)
• Increase in irritability, anger, or conflicts with others
• Depression, feeling hopeless, or thoughts of low self-worth
• Feeling anxious, keyed up, or on edge
• One or more of the following
• Decreased interest in usual activities
• Difficulty concentrating
• Fatigue
• Appetite changes (increase or decrease)
• Sleep pattern changes (increase or decrease)
• Feeling out of control
• Physical symptoms such as breast tenderness, joint or muscle pain, bloating, or weight gain

The thing to remember is that PMDD is impairing and disabling for many. The symptoms often lead to dysfunction if left untreated.

RELATED: 7 Period-Related Issues You Should Never Ignore

Signs that you may have PMDD

• You are consistently depressed for one to two weeks per month. If you log the symptoms, you would see them begin shortly before your period and end afterward.
• You have been diagnosed with bipolar disorder, but your up moods are only occurring during the one to two weeks before your period and end afterward, even without treatment
• You have difficulty getting along with people around you during the one to two weeks before your period, and then things go back to normal afterward.

Diagnosis and Treatment

The good news is that all is not lost, and this disorder can be treated. The first step is to see your primary care physician or gynecologist to discuss this issue. Having a routine physical exam and workup can rule out other disorders that may present with similar symptoms.

If you are thought to have PMDD, treatment options include:

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SSRI antidepressants

Antidepressants can be taken daily or only during the time frame in question. Women may choose continuous therapy if they sometimes have milder depressive symptoms between periods or if they don’t want the hassle of having to remember when to start them.

Other women will choose to take them just during the week or two before their period because they otherwise don’t have symptoms and don’t like the idea of taking medication daily for a disorder that is only present for less than half of the time.

Estrogen-progestin birth control pills

Typically, doctors are prescribing what are known as monophasic pills for PMDD. This refers to pills that maintain a constant hormone level throughout the cycle, compared to multiphasic pills that adjust the hormone dosage throughout the month to mimic your body’s natural cycle.

Cognitive Behavioral Therapy (CBT)

CBT may provide some relief from the intensity of symptoms and allow you to improve on the coping skills that can be used to help you manage symptoms.

Supplements

Supplements such as omega-3 fatty acids, vitamin B6, vitamin D, calcium, and magnesium have been shown to possibly improve PMS and PMDD symptoms.

Behavioral changes

Changing your diet to avoid foods that will make symptoms worse, achieving adequate sleep, meditation, and engaging in the right exercises can all help you deal with the symptoms of PMS or PMDD.