Pmdd

Premenstrual Dysphoric Disorder (PMDD) is a significant condition linked to the menstrual cycle, featuring a variety of symptoms that impact both mental and physical health. Although it shares similarities with premenstrual syndrome (PMS), PMDD symptoms are notably more severe. The mood disruptions associated with PMDD are intense enough to classify it as a mental health disorder. While many individuals experience changes before their period, PMDD's severe symptoms affect less than 10% of the population.

Causes

The precise cause of PMDD is not fully understood, but several contributing factors have been identified:

• The brain's unusual response to hormonal changes during the menstrual cycle.

• A strong link between PMDD and serotonin, a brain chemical regulating mood, pain, and sleep. Variations in serotonin levels may influence PMDD symptoms.

Risk factors for developing PMDD include:

• A family history of PMS or PMDD

• Personal or family history of depression, including postpartum depression.

• Personal or family history of anxiety or other mood disorders.

• Alcohol or substance abuse.

• High stress levels.

• A history of trauma.

• Tobacco use and obesity.

Recognizing these factors can aid in managing and treating PMDD effectively.

Symptoms

PMDD is characterized by a range of symptoms affecting physical and mental health, typically emerging 1 to 2 weeks before menstruation. Common PMDD symptoms include:

• Physical Symptoms:

• Appetite changes, including cravings or binge eating

• Cramps

• Breast tenderness

• Bloating

• Headaches

• Weight gain

• Joint or muscle pain

• Mental Health Symptoms:

• Persistent irritability or anger

• Depressed mood, feelings of sadness or despair, sometimes suicidal thoughts

• Tension or anxiety

• Panic attacks

• Mood swings

• Reduced interest in usual activities

• Difficulty concentrating

• Fatigue or low energy

• Excessive sleeping or insomnia

• Feeling overwhelmed

These symptoms widely vary among individuals, significantly affecting daily life and well-being.

Diagnosis

Diagnosing PMDD involves a detailed clinical evaluation as there are no specific tests for identification. A comprehensive medical history and physical examination, along with some blood tests, help exclude other potential causes. PMDD diagnosis is mainly based on reported symptoms. Keeping a symptom diary is helpful for diagnosis, as PMDD requires experiencing at least five symptoms in the week leading to menstruation, improving once the period begins. These symptoms must notably affect work, social, or personal life, persist for at least two consecutive cycles, and not be linked to another medical condition.

Treatments

Managing PMDD involves addressing both physical and emotional symptoms with a personalized treatment plan developed with your healthcare provider. Besides medications, effective non-medication strategies include lifestyle changes and complementary treatments. Incorporating certain vitamins and supplements can alleviate symptoms, such as Calcium for fatigue and mood swings, Vitamin B6 for depression, Vitamin E for breast tenderness, chaste tree berry for headaches, and Evening Primrose Oil for tenderness.

Regular aerobic exercise, like walking, running, or swimming for 30 minutes daily, releases mood-enhancing endorphins. Diet changes, like choosing complex carbohydrates and reducing salt, caffeine, and alcohol, can stabilize mood and improve sleep. Stress reduction via Cognitive Behavioral Therapy (CBT), yoga, mindfulness, and acupuncture also aids management.

Medications

Several medications are used to treat PMDD depending on individual symptoms and responses:

• Selective Serotonin Reuptake Inhibitors (SSRIs):

• Medications such as Fluoxetine, Sertraline, Paroxetine, and Citalopram increase serotonin to improve mood and sleep.

• Dosing options vary: continuous, intermittent, semi-intermittent, or symptom-onset, depending on the patient's needs.

• Combination Oral Contraceptive Pills (OCPs):

• Contain estrogen and progestin to prevent hormone fluctuations, suitable for those intolerant to SSRIs or needing birth control.

• Gonadotropin-Releasing Hormone (GnRH) Agonists:

• Medications inducing medical menopause by stopping estrogen production, useful for those who cannot tolerate other treatments.

• Surgical Management:

• In rare cases, a hysterectomy might be considered for those intolerant to other treatments.