Premenstrual Dysphoric Disorder
Syndrome and Disorder Overview
Premenstrual syndrome (PMS) is related to a group of physical and behavioral symptoms that appear in a cyclic pattern during the second half of the menstrual cycle. Premenstrual dysphoric disorder (PMDD) is the severe form of PMS. Common symptoms are anger, irritability, and internal tension that are severe enough to get involved with daily activities.
Mild PMS is oridinary, affecting up to 75 percent of women with regular menstrual cycles; PMDD affects only 2 to 8 percent of women. This condition affects women of any socioeconomic, cultural, or ethnic backgrounds..
PMDD is commonly a chronic condition that can have a serious strike on a woman's quality of life. favorably, a variety of treatments and self-care measures can effectively control the symptoms in most women.
Causes
Tissues throughout the body are delicate to hormone levels that change throughout a woman's menstrual cycle (figure 1). Studies advices that growing and falling hormone levels may also influence chemicals in the brain, including a substance called serotonin, which affects mood.
However, it is not clear why some women develop PMS or PMDD and others don't. Levels of estrogen and progesterone are same in women with and without these conditions. These explanation likely, based upon several studies, is that women who develop PMDD are exquisitely sensitive to changes in hormone levels.
Symptoms
These are the most common symptoms of PMS and PMDD are fatigue, bloating, irritability, and anxiety. Other symptoms include the following :
- Feeling sad, hopeless, or worthless
- Feeling tense, anxious, or "on edge"
- Variable moods with frequent tearfulness
- Persistent irritability, anger, and conflict with family, coworkers, or friends
- Decreased interest in usual activities
- Difficulty concentrating
- Feeling fatigued, lethargic, or lacking in energy
- Changes in appetite, which may include binge eating or craving certain foods
- Sleeping excessively or difficulty sleeping
- Feeling overwhelmed or out of control
- Breast tenderness or swelling, headaches, joint or muscle pain, weight gain
Disorders that mimic PMDD — Other conditions have symptoms that are correlative to those of PMS and PMDD, including depression, anxiety disorders, and perimenopause. It is foremost to distinguish between underlying depression (which often worsens before menses) and true PMS or PMDD because the treatments are quite different.
Women with underlying depression often feel better during or after menses, but their symptoms do NOT resolve completely. On the other hand, women with PMS or PMDD have a complete resolution of symptoms when their menses begin. Some women who think they have PMS or PMDD actually have depression or an anxiety disorder. (See "Patient information: Depression in adults".)
There are other medical disorders that deteriorate before or during menstruation, such as migraines, chronic fatigue syndrome, pelvic and bladder pain, or irritable bowel syndrome. A attentive and acurate medical history should be able to distinguish among these disorders. It is also possible for a woman to have PMDD in addition to another medical condition. (See "Patient information: Headache causes and diagnosis in adults" and "Patient information: Irritable bowel syndrome" and "Patient information: Painful bladder syndrome and interstitial cystitis".)
Diagnosis
There is no single test that can diagnose PMS and PMDD. The symptoms must occur only during the second half (luteal phase) of the menstrual cycle, most frequent during the five to seven days before the menstrual period, and there must be physical as well as behavioral symptoms. In women with PMS or PMDD, these symptoms should not be present between days 4 through 12 of a 28-day menstrual cycle.
Blood tests — Blood tests are not compulsory to diagnose PMS/PMDD. A blood count may be recommended to screen for other medical conditions that cause fatigue, such as anemia. Thyroid function tests can detect hypothyroidism (an underactive thyroid gland) or hyperthyroidism (an overactive thyroid gland), both of which have similar signs and symptoms to PMS/PMDD. (See "Patient information: Hypothyroidism" and "Patient information: Hyperthyroidism".)
Recording symptoms — Although a woman's symptoms may suggest PMDD, a clinician may request that she carefully record her symptoms on a daily basis for two full menstrual cycles (algorithm 1). Using this calendar, a woman can rate the severity of 10 physical symptoms and 12 behavioral symptoms on a 4-point scale.
Treatment
Conservative treatments — Conservative remedies for PMS may be recommended first, including regular exercise, relaxation techniques, and vitamin and mineral supplementation. These therapies relieve symptoms in some women and have few or no side effects. If these therapies do not bring adequate relief, prescription medication can be considered as a second option
Conservative treatments are also recommended for women with PMDD, along with a prescription medication.
Exercise — Exercise can help to reduce stress, tension, anxiety, and depression. A simple way to start exercising is to walk at a comfortable speed for a distance that is easily tolerated.
The greatest benefits of exercise are seen when it is done at least 5 days per week for at least 30 minutes.After all, exercising only one or two days per week is better than not exercising at all. In addition, exercise does not need to be uninterrupted to be beneficial; it can be broken up into three or four ten-minute sessions per day. (See "Patient information: Exercise".)
Relaxation therapy — PMS and PMDD can be worsened by stress, anxiety, depression, and other psychological factors. Furthermore, living with PMS or PMDD can cause difficulties in interpersonal relationships, at work or school, and with general day to day living. Relaxation therapy can help to ease the stress and anxiety of daily life, and may include techniques such as meditation, progressive muscle relaxation, self-hypnosis, or biofeedback.
Agnus castus fruit extract — The fruits of Vitex agnus castus (the chasteberry tree) have been used to remedy the symptoms of PMS. In one small trial, women with PMS felt an betterment in PMS symptoms after three months of treatment with chasteberry [1]. However, further study is needed to ensure that chasteberry is safe and effective. Updated information about \ chasteberry can be found at the National Center for Complementary and Alternative Medicine's web site (http://nccam.nih.gov/health/chasteberry/).
Vitamin and mineral supplements — Many clinical trials have calculated the benefit of calcium supplements for women with PMS. After three months, women who took 600 mg of calcium twice daily had fewer symptoms distinguished to those who took a placebo [2]. Calcium is an economical treatment with few side effects and is a reasonable option for women with mild to moderate symptoms of PMS.
A small clinical trial studied vitamin B6 (up to 100 mg/day) and found that it may have some benefit for women with mild PMS. No more than 100 mg of vitamin B6 should be taken per day.
Click here to read about the symptoms of PMS