Premenstrual Dysphoric Disorder (PMDD): What You Should Know

Do you know?

• At least 90% of women in the reproductive age group experience unpleasant physical and emotional symptoms before their period.
• 3–6% of them experience PMS of severe intensity, amounting to significant social and occupational disturbance.
• PMDD may be caused by an altered sensitivity of serotonergic receptors in the brain.

Are you noticing mood swings, irritability, sensitivity to rejection, sleep disturbances, fluctuations in confidence, self-esteem, or motivation, fatigue, lethargy, or headaches disturbing your relationships and work performance — more so during the 1–2 weeks before your period starts? It could be PMDD.

More about PMS and PMDD

Many women in their reproductive years experience transient physical and emotional changes around the time of their period. In fact, at least 90% of women with regular menstrual cycles report unpleasant physical or psychological symptoms premenstrually. For most women, these symptoms are mild and tolerable. For a certain group of women, however, these symptoms can be disabling and cause significant disruption in their lives.

Premenstrual Syndrome (PMS) typically refers to a general pattern of physical, emotional, and behavioural symptoms occurring 1–2 weeks before, and remitting with the onset of, menstruation. PMS is common, affecting 30–80% of women of reproductive age, though clinically significant PMS symptoms have been reported in 3–8% of patients.

Psychological, physical, and behavioural symptoms

Psychological symptoms include anger, anxiety, depression, irritability, a sense of feeling overwhelmed, sensitivity to rejection, and social withdrawal.

Physical symptoms include abdominal bloating, appetite disturbance (usually increased), breast tenderness, headaches, lethargy or fatigue, muscle aches and/or joint pain, sleep disturbance (usually hypersomnia), and swelling of the extremities.

Behavioural symptoms include fatigue, forgetfulness, and poor concentration.

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) refers to a severe manifestation of PMS, causing significant social and occupational dysfunction. A recent study found that women with untreated PMDD were likely to experience a loss of three quality-adjusted life years over their lifetime as a result of their premenstrual symptoms — not including menstruation-free periods, such as pregnancy, breastfeeding, and menopause.

The cause of PMDD is uncertain, but researchers have noted that women with PMDD are hypersensitive to hormonal changes during the cycle, and that PMS occurs due to fluctuating levels of oestrogen and progesterone. Fluctuating oestrogen and progesterone also affect the hormones that control mood and behaviour, such as serotonin and dopamine.

What makes your risk higher?

• A history of mood disorders and anxiety disorders
• A family history of mood disorders, anxiety disorders, or PMDD
• Obesity
• Stress
• Being 20–30 years of age

Management

PMDD needs to be treated with medication and counselling, especially for those whose symptoms are disabling. To manage the depressive and anxiety symptoms, antidepressants and anxiolytics are typically started. Counselling and psychoeducation are also provided to the family, to help them understand the illness better.

Assessment can help you manage your PMDD symptoms. If the days before your period are consistently affecting your mood, relationships, or work, it's worth talking to a psychiatrist about what you're experiencing. For a broader look at emotional wellbeing across the reproductive years, see Pregnancy and Your Mental Health: What to Expect, and When to Ask for Help.