5 Facts about PMDD from a Sexologist

Facts about PMDD – Premenstrual Dysphoric Disorder:

Premenstrual dysphoric disorder (PMDD) is a severe form of Pre menstral Syndrome that includes physical and behavioral symptoms that usually resolve with the onset of menstruation. It happens in the week or two before your period starts as hormone levels begin to fall after ovulation. PMDD causes more severe symptoms than PMS, including severe depression, irritability, and tension.

Approximately 5.5% of women and AFAB individuals around the world have PMDD during their reproductive years. That’s about 1 in 20. 

PMDD can begin at any time during the reproductive life cycle – for some it begins at puberty and for others it may not become evident until pre-menopause. It is a suspected cellular disorder in the brain with symptoms often worsening over time and sometimes worsening around reproductive events such as menarche, pregnancy, birth, miscarriage, and pre-menopause.

Causes of PMDD-

Researchers do not know for sure what causes PMDD. Hormonal changes throughout the menstrual cycle may play a role. It is suggested that PMDD stems from the brain’s abnormal response to a woman’s fluctuation of normal hormones during the menstrual cycle. This, in turn, could lead to a deficiency in the neurotransmitter serotonin. It is more likely than others to experience PMDD, including those who have had a personal or family history of postpartum depression, mood disorders, or depression.

Signs & Symptoms of PMDD-

Symptoms are typically present during the week before menses and resolve within the first few days after menstrual onset. Those who experience PMDD are often unable to function at their normal capacity while symptoms are present. The condition can affect relationships and disrupt routines at home and work.

  • Lasting irritability or anger that may affect other people
  • Feelings of sadness or despair, or even thoughts of suicide
  • Feelings of tension or anxiety
  • Panic attacks
  • Mood swings or crying often
  • Lack of interest in daily activities and relationships
  • Trouble thinking or focusing
  • Tiredness or low energy
  • Food cravings or binge eating
  • Trouble sleeping
  • Feeling out of control
  • Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain

How to Diagnose PMDD-

The symptoms of PMDD can be similar to those of other conditions, so health care providers will likely perform a physical exam, obtain a medical history, and order certain tests to rule out other conditions when making a diagnosis.

Guidelines from the American Psychiatric Association (APA) Diagnostic and Statistical Manual 5th Edition (DSM-V) require that the symptoms of PMDD be present for a minimum of two consecutive menstrual cycles before making a diagnosis of PMDD.

You must have at least five or more PMDD symptoms including one mood related symptoms to be diagnosed with PMDD. 

Patients saw an average of 6.15 providers before receiving a diagnosis of PMDD. 90% of those with PMDD are thought to be undiagnosed.

Treatment-

Two types of medication may help with PMDD: those that affect ovulation and those that impact the central nervous system (CMS).

Treatments for PMDD include:

Antidepressants called selective serotonin reuptake inhibitors (SSRIs). SSRIs change serotonin levels in the brain. The Food and Drug Administration (FDA) approved three SSRIs to treat PMDD. It includes- Sertraline, Fluoxetine, Paroxetine HCI

Birth control pills: The FDA has approved a birth control pill containing drospirenone and ethnyl estradiol to treat PMDD.

Pain relievers may help relieve physical symptoms, such as cramps, joint pain, headaches, backaches, and breast tenderness. These include: Ibuprofen, Naproxen, and Aspirin

Stress management, such as relaxation techniques and spending time on activities you enjoy.

Facts about PMDD-

  • It is a severe and debilitating disorder that, like PMS, has mood related symptoms that recur monthly during the luteal phase of the menstrual cycle then cease when the period begins.
  • It affects 2–5% of menstruating people.
  • Symptoms can include severe irritability and overreactions, depression, feelings of hopelessness, conflict with other people and intense white-hot uncontrollable rage.
  • It is classified as a “depressive disorder not otherwise specified”. Some were concerned that diagnostic inclusion would give ammunition to stereotypes that “women go crazy in their periods” or would anthologize the normal happenings of the menstrual cycle. Others note that PMDD is disordered PMS, and not normal.
  • Taking birth control pills and skipping the placebo week can be a helpful treatment (because no period = no period disorders). But even though there is no medical benefit for anyone to take the placebo pills, and even if a doctor prescribes skipping the placebo pills in treatment of this disorder it’s still not used as a treatment.

Tips to treat PMDD – Alternative medicine

Dietary changes include:

  • decreasing intake of sugar, salt, caffeine, and alcohol
  • increasing protein and intake of complex carbohydrates

Exercise, stress management techniques, and help in viewing menstruation in a positive light may help.

Other strategies that may help include:

  • taking it easy on the days leading up to menstruation
  • talking to a partner or trusted friend
  • finding relaxing activities that relieve tension, such as reading, watching a movie, going for a walk, or having a bath

Impact on relationships & work –

  • About half of individuals with PMDD report losing an intimate partner relationship due to PMDD
  • 98% feel PMDD puts a significant strain on their current intimate partner relationship
  • 97% feel PMDD places a significant strain on their family relationships
  • 42.7% of those with children report problems with parenting due to PMDD
  • 10.5% report that they felt completely unable to parent during PMDD
  • 16.8% report having lost a job due to PMDD

Speak with your health care provider right away if you think you may be experiencing symptoms of PMDD. As the symptoms of PMDD can be long-lasting, it is advisable to seek treatment as soon as possible.

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