Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (PMDD) is an acute menstrual condition affecting 3-8% women of menstrual age. Go through this article to find out all about the causes, symptoms, diagnosis, treatment options and more about this disorder.

What is Premenstrual Dysphoric Disorder?

It is a serious type of premenstrual syndrome arising in women before menstruation. Primarily associated with the luteal phase of the menstrual cycle, the disorder gives rise to severe mental and physical complications such as:

  • Irritability
  • Depression
  • Tension
  • Rapid breathing
  • Headache

The condition is listed as a type of depressive disorder in the DSM-IV. The manual does not provide any specific information about the condition and it is included in the appendix of DSM-IV as a disorder that requires further study.

Premenstrual Dysphoric Disorder Incidence

PMDD is relatively rare compared to many other similar disorders. It affects only 3% to 8% women with regular menstrual cycles.

Premenstrual Dysphoric Disorder Causes

The exact etiology of PMDD is still being researched by scientists. However, certain factors have been supposed to be responsible for the development of this condition. These include:

Genetic factors

PMDD is often believed to be an inherited condition. Heredity is supposed to be an important factor which is responsible for the development of this disease. According to studies, identical twins have greater chances of having the disease as compared to non-identical twins. Women suffering from this syndrome are more likely to have daughters with the ailment.

Estrogen receptor alpha genes have some variants that are associated with the disorder. Women having these genetic variants have greater chances of suffering from PMDD. Studies also show that the disorder only affects women with a variant of the gene COMT or Catechol-O-methyl transferase. COMT regulates the functioning of a vital regulator of mood known as the prefrontal cortex.


Women suffering from some bipolar disorder are often reported to have this illness.

Other factors

PMDD may also be a result of various psychological, cultural and social factors. However, these factors alone cannot cause the condition. They only work as stimulators.

Premenstrual Dysphoric Disorder Risk Factors

Some of the factors that increase the risk of having this condition include:

  • Family history of the disorder
  • History of severe Premenstrual Syndrome in the family
  • SAD or Seasonal Affective Disorder
  • Severe depression
  • Stress

Premenstrual Dysphoric Disorder Signs and Symptoms

The symptoms of PMDD arise after ovulation (the middle of every monthly cycle) and worsen during the week or a few days before menstruation. These tend to disappear by themselves a few days after the beginning of menstruation. A PMDD patient displays the symptoms in this pattern almost every month. The condition can also cause various flu-like symptoms.

Following symptoms are studied when diagnosing PMDD. All the symptoms may not be present in the patient at a specific time and they may also vary from one month to another. According to the DSM IV criteria, PMDD can be confirmed when at least five of these symptoms are present (including a minimum of one symptom from the first four).

  • Deep sadness and despair
  • Intense tension and anxiety
  • Panic attacks
  • Intense sensitivity to criticism and rejection
  • Rapid, severe mood changes
  • Crying uncontrollably several times for short periods
  • Severe anger and irritability
  • Increased interpersonal conflicts
  • Reduced interest in relationships and daily activities
  • Chronic fatigue
  • Difficulty in concentrating
  • Forgetfulness
  • Increased craving for some certain foods
  • Insomnia (inability to sleep) or Hypersomnia (excessive sleep)
  • Sensation of being overwhelmed and out of control

PMDD is also manifested through some physical symptoms, which include:

  • Breast tenderness and swelling
  • Gastrointestinal upset
  • Weight gain
  • Acne
  • Headaches
  • Heart palpitations
  • Muscle and joint pain
  • Swelling of the face and nose
  • Bloating

Premenstrual Dysphoric Disorder in Teenagers

According to many studies, teenagers are more prone to this disease. The offset of this disorder often occurs during adolescence. Young girls suffering from severe PMS often develop the symptoms of PMDD. In around 5% of all teenagers, this condition interferes many of their daily activities.

Premenstrual Dysphoric Disorder Prevention

The precautions one can take to prevent this ailment include:

  • Following a nutritional and well balanced diet plan including lots of vegetables, fruits and whole grains
  • Exercising a lot
  • Drinking plenty of water
  • Managing stress
  • Avoiding caffeine, sugar and alcohol

Premenstrual Dysphoric Disorder Tests and Diagnosis

Before actually diagnosing PMDD, a thorough physical examination of a patient is carried out to eliminate the possibility of some underlying psychiatric condition (which might be causing the symptoms). It is also ensures that the symptoms are not a result of any other physical causes.

Once the possibility of a psychiatric and physical disorder has been ruled out, the patient is asked to make a chart of the daily symptoms experienced by her over a period of at least two months. The charting is done to make sure that the occurrence of the symptoms is actually related to the menstrual cycle and are also recurring in nature. A woman is positively diagnosed with PMDD if she experiences the symptoms from the time of ovulation to the first few days of menstruation. Diagnosis can also be confirmed if these symptoms tend to recur almost every month.

Premenstrual Dysphoric Disorder Treatment and Medication

The treatment for PMDD focuses on preventing its symptoms. The various treatment options used for remedying the condition include use of:


Various PMDD symptoms including fatigue, sleep problems and food cravings can be cured by using SSRIs or Selective serotonin reuptake inhibitors like Fluoxetine (Prozac), Sertraline (Zoloft) and Citalopram (Celexa). Escitalopram, another similar drug, is also used sometimes for treating the disorder. However, it is generally avoided as it causes various side effects. SSRI medicines can be taken all month or only during the phase between ovulation and period.

However, the antidepressant medicines that are generally prescribed to PMDD patients are not recommended to be used by pregnant and breastfeeding women. Due to this reason, one should receive psychotherapy and natural treatments to handle the symptoms during pregnancy and when breastfeeding. Following a balanced diet and maintaining a healthy lifestyle also helps to keep the symptoms in check.

Birth Control Pills

Birth Control Pills stop ovulation while stabilizing hormone fluctuations. Combination oral contraceptives comprising of Drospirenone are often considered to be more effective that regular birth control pills. These pills lower the levels of estrogen hormone, thus giving relief to PMDD sufferers. At present, various third-generation lower-estrogen contraceptives including Mircette, Ortho Try-Cyclen Lo, Ortho Tri-Cyclen and their different genetic forms are used for the purpose. Yasmin, another new pill, and its lower dose Yaz have been proved to be able to control the problems caused by PMDD.

Hormone Therapy

It is used for completely stopping the menstrual cycle of a woman in severe stages of the condition.

Nutritional Supplements

Daily consumption of 1,000 milligrams supplemental and dietary calcium can help to reduce the emotional and physical symptoms of the disease. Vitamin B-6, L-tryptophan and magnesium are also used for treating the condition.


It can help patients to deal with the symptoms of the disorder. The stress reduction, relaxation and meditation techniques taught in Psychotherapy are very effective in treating the condition.

Premenstrual Dysphoric Disorder Natural Treatments

Various herbal remedies are used for effectively controlling both the physical and psychological symptoms of PMDD. Herbal and homeopathic medications are able to restore the hormonal balance of a sufferer. Unlike conventional medications, these remedies do not give rise to any side effects.

Medicinal herbs including Sweet Fennel (Foeniculum vulgare), Lemon Balm (Melissa officinale) and Pasque Flower (Pulsatilla vulgaris) help promote hormonal balance, stability of mood and feeling of wellbeing in women during the premenstrual days.

Premenstrual Dysphoric Disorder Prognosis

Proper treatment can cure this syndrome completely. In most cases, the symptoms do not come back again. in some patients, however, the symptoms tend to persist (although these are not very severe).

Premenstrual Dysphoric Disorder and Premenstrual Syndrome

Premenstrual Syndrome or PMS is a common condition that affects around 75% women. PMS leads to the occurrence of several behavioral and physical symptoms in a recurring pattern during the menstrual cycle. PMDD is a very severe type of Premenstrual Syndrome. Although causing similar symptoms, the condition is found to give rise to much more serious consequences as compared to those of PMS.

Premenstrual Dysphoric Disorder and Menopause

Menopause is the period when a woman has her last menstrual cycle. The average age for menopause is 51 years, although it can occur at anytime between the late 40’s and the late 50’s. Menopause occurs earlier if the ovaries become non-functional or are surgically removed due to some reason. The symptoms of PMDD generally go away after menopause. However, there are many other disorders which lead to similar effects that persist even after menopause. A woman may experience symptoms similar to PMDD if she undergoes hormone-replacement therapy after menopause.

Premenstrual Dysphoric Disorder and Endometriosis

PMDD and Endometriosis are often mistaken for each other due to the similarity of the symptoms that they produce in women. These two disorders, however, are different in a few respects. The symptoms of Endometriosis can occur at anytime although they are generally most severe at the time of menstruation. PMDD symptoms, on the other hand, occur only between the time of ovulation and the first few days of period.

Premenstrual Dysphoric Disorder Complications

Women suffering from the disease are more likely to develop other conditions including postpartum depression in case they are not treated properly. Fortunately, PMDD does not cause infertility.

Premenstrual Dysphoric Disorder is a serious chronic condition that requires proper treatment. Women having this condition continue to experience severe symptoms that return every month and hamper their daily life unless diagnosed and treated in time. There are numerous support groups that provide guidelines to PMDD patients about how to cope with the symptoms. If you have a PMDD sufferer in your home, get early medical treatment and support to ensure faster recovery for your patient.


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