Premenstrual Dysphoric Disorder

For some women, the week before their menstrual periods can be challenging. Premenstrual syndrome (PMS) brings a few days of physical discomfort and mood changes. However, premenstrual dysphoric disorder (PMDD) is more severe. PMDD significantly affects daily functioning, making it hard to work, connect with loved ones, or even get out of bed.
          “With PMS, you might feel a bit anxious or irritable. Symptoms include bloating, breast tenderness, and mood swings. PMDD, on the other hand, is classified as a depressive disorder. It involves cyclic, intense mood swings, dysphoria, and anxiety—typically occurring in the second half of the menstrual cycle.”

Approximately 75% of individuals who menstruate experience premenstrual syndrome (PMS), while only 2% to 5% experience premenstrual dysphoric disorder (PMDD). While PMS symptoms typically resolve within the first few days of menstruation and may be bothersome, PMDD significantly disrupts daily life.

Dr. Eynav Accortt, a clinical psychologist and director of Cedars-Sinai’s Reproductive Psychology Program, explains: “For most of the month, individuals with PMDD don’t experience depression, anxiety, or other mental health issues. However, in the days leading up to menstruation, they can suddenly feel almost incapacitated. Symptoms may include suicidal thoughts, overwhelming anxiety, and a sense of being unable to cope.”
The exact cause of PMDD remains uncertain, but experts believe that affected individuals are more sensitive to hormonal fluctuations—specifically estrogen and progesterone—during the menstrual cycle. PMDD typically emerges after ovulation, when hormone levels drop.

Unfortunately, some people with PMDD are misdiagnosed with general mood or anxiety disorders because the cyclical nature of their symptoms often goes unnoticed. Timing when evaluating patients: “Patients diagnosed with generalized anxiety disorder may not experience anxiety interfering with their functioning—except during the week before their period. Asking about symptom timing is crucial.”

    
                                                         When diagnosing PMDD, there are no specific tests available. Instead, doctors rule out other conditions. They conduct blood tests to check for thyroid disorders and assess whether the patient has global anxiety, depression, or any other mental health condition.

•Treatments for PMDD:

•Selective Serotonin Reuptake Inhibitors (SSRIs):

•Although primarily used as antidepressants, SSRIs may also improve PMDD symptoms.

•Some doctors advise patients to take SSRIs only on days when symptoms are present, while others recommend daily use to avoid confusion.

•Continuous Birth Control:

•Taking birth control pills continuously (without the placebo pills) suppresses ovulation and often alleviates PMDD symptoms.

•Continuous birth control helps maintain stable estrogen levels, reducing hormonal fluctuations.

•Other Options:

•If SSRIs or continuous birth control do not yield satisfactory results, alternative treatments are available.

•An anti-inflammatory diet may benefit individuals with mild-to-moderate premenstrual symptoms.

•Cognitive behavioral therapy and dialectical behavioral therapy can be helpful for moderate PMDD.