Introduction

Premenstrual Dysphoric Disorder (PMDD) is a condition that affects millions of women worldwide, yet it remains widely misunderstood and often overlooked. While PMS is relatively common and may cause discomfort or mild mood changes before menstruation, PMDD involves more severe symptoms that can significantly interfere with daily life. Here we'll delve into the symptoms, causes, diagnosis, and treatment of PMDD, aiming to provide a comprehensive understanding of this often-misunderstood condition.

PMDD is a severe form of premenstrual syndrome, affecting approximately 3-8% of women of reproductive age. Women with PMDD experience intense mood swings, irritability, depression, anxiety, and physical symptoms such as bloating, breast tenderness, and fatigue in the days leading up to menstruation. These symptoms can be so severe that they interfere with work, school, and relationships.

Symptoms of PMDD

PMDD is characterized by a range of physical, emotional, and behavioral symptoms that typically occur in the luteal phase of the menstrual cycle, which is the two weeks before menstruation. These symptoms are more severe than those experienced with PMS and can include:

1. Mood swings: Intense mood changes, including sadness, hopelessness, irritability, or anger.

2. Depression or anxiety: Persistent feelings of depression, anxiety, or tension that may interfere with daily activities.

3. Severe fatigue: Overwhelming tiredness or lethargy not relieved by rest.

4. Difficulty concentrating: A diminished capacity to maintain focus or attention on tasks.

5. Changes in appetite: Significant changes in appetite, including food cravings or overeating.

6. Sleep disturbances: Insomnia or excessive sleeping.

7. Physical symptoms: Physical symptoms such as breast tenderness, bloating, joint or muscle pain, and headaches may also be present.

These symptoms must occur consistently in the luteal phase and improve or disappear shortly after the onset of menstruation to be diagnosed as PMDD.

Causes of PMDD

The exact cause of PMDD is not fully understood, but it is believed to involve a combination of biological, hormonal, and genetic factors. Some hypotheses suggest that fluctuations in hormone levels, particularly estrogen and progesterone, play a significant role in the development of PMDD. These hormonal changes can affect neurotransmitters in the brain, such as serotonin, which regulates mood.

Additionally, genetic factors may contribute to an individual's susceptibility to PMDD. Research has shown that individuals with a family history of mood disorders or PMDD may be more likely to experience the condition themselves. Psychological factors like stress, trauma, and other psychological factors can exacerbate PMDD symptoms in susceptible individuals.

Diagnosis of PMDD

PMDD diagnosis entails carefully assessing symptoms and how they affect day-to-day functioning. A healthcare provider will typically review the individual's medical history, conduct a physical examination, and order blood tests to rule out other underlying conditions. Keeping a symptom diary tracking mood changes, physical symptoms, and the timing of menstruation can also help in the diagnosis process.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for diagnosing PMDD, including the presence of at least five mood or physical symptoms.

Treatment

Diagnosing PMDD requires monitoring symptoms across multiple menstrual cycles and eliminating the possibility of other medical conditions that might produce similar symptoms. Once diagnosed, treatment options for PMDD aim to alleviate symptoms and improve overall quality of life. Here are some common approaches:

1. Lifestyle Changes: Adopting healthy lifestyle habits such as regular exercise, adequate sleep, stress management techniques, and a balanced diet can help reduce the severity of PMDD symptoms.

2. Medication: For women with severe PMDD symptoms, medication may be necessary. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and sertraline, are often prescribed to help regulate mood. Hormonal contraceptives, such as birth control pills, may also be effective in some cases by stabilizing hormone levels throughout the menstrual cycle.

3. Cognitive-behavioral Therapy (CBT): CBT is a type of talk therapy that can be beneficial for managing PMDD symptoms. It helps individuals identify and challenge negative thought patterns and develop coping strategies to deal with mood swings and other symptoms.

4. Supplements: Some women find relief from PMDD symptoms by taking certain supplements, such as calcium, magnesium, vitamin B6, and omega-3 fatty acids. But before beginning any new supplement regimen, it's imperative to speak with a healthcare professional.

5. Support Groups and Therapy: Connecting with others who understand what it's like to live with PMDD can provide valuable emotional support. Online support groups, therapy, and peer counselling can all be beneficial for individuals struggling with PMDD.

Conclusion

Premenstrual Dysphoric Disorder is a complex and challenging condition that can significantly impact the lives of those affected. By understanding the symptoms, causes, diagnosis, and management options for PMDD, individuals can seek appropriate support and treatment to improve their quality of life. If you suspect you may have PMDD, it's essential to consult with a healthcare provider for an accurate diagnosis and personalized treatment plan.

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that significantly impacts the emotional and physical well-being of those affected. The exact causes of PMDD are not fully understood, but it is believed to be linked to hormonal fluctuations and neurotransmitter abnormalities. Effective treatment for PMDD often involves a combination of lifestyle changes, medication, and therapy. Online counseling has emerged as a convenient and accessible option for individuals seeking support, offering the flexibility to connect with top psychologists in India who specialize in women's mental health. This holistic approach can help manage symptoms and improve the quality of life for those suffering from PMDD.

Additionally, you may schedule an appointment with the top professional psychologists and receive Mental health counselling at the Psychowellness Center, which has many locations in Delhi NCR, NOIDA, Faridabad, Janakpuri, Dwarka, and Vasant Vihar.

Contributed by: Dr (Prof) R K Suri, Clinical Psychologist & Life Coach &  Ms. Meghna Mohan, Counselling Psychologist

References:

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• Choudhari, S., Rajshri, I., Inamdar, S., Mutalik, N., Akasalli, V., Mara, B. (2017). A study of co-morbid depression and anxiety in pre-menstrual dysphoric disorder (PMDD) among undergraduate medical students: A descriptive study. Medica Innovatica, 6(1).

• Padhy, S. K., Sarkar, S., Beherre, P. B., Rathi, R., Panigrahi, M., & Patil, P. S. (2015). Relationship of Premenstrual Syndrome and Premenstrual Dysphoric Disorder with Major Depression: Relevance to Clinical Practice. Indian Journal of Psychological Medicine, 37(2).

• Epperson, C. N., Steiner, M., Hartlage, S. A., & Eriksson, E. (2012). Premenstrual Dysphoric Disorder: Evidence for a New Category for DSM-5. American Journal of Psychiatry, 169(5), 465-475. https://doi.org/10.1176/appi.ajp.2012.11081302.