Overview
Over 20-40% of females experience moderate to severe premenstrual syndrome (Premenstrual Syndrome). Premenstrual Syndrome is a set of symptoms women experience about 2 weeks to a few days before their period.
These symptoms include physical symptoms such as water retention, breast tenderness, headache, joint pain, muscle tenderness, skin blemishes, digestion problems, sleep problems and food cravings. Psychologically, they may experience feelings of irritability, mood swings, insecurity, listlessness, anger, exhaustion, etc.ย
While Premenstrual Syndrome itself can be quite debilitating, Premenstrual Dysphoric Disorder is experiencing Premenstrual Syndrome, but at a much more severe level.
Females who suffer from Premenstrual Dysphoric Disorder, often complain about mood swings, feelings of sadness or feeling tearful, irritability, depressed mood and feelings of hopelessness, anxiety, tension,etc. Physically, they may feel lethargic, have specific food cravings, bloating, joint or muscle pain, headaches, etc.
There is marked mood elevation once the period starts and the person returns to normal functioning once their periods have passed. These symptoms cause impairment in daily life functioning and adding on to the disease burden.
Women with Premenstrual Syndrome and Premenstrual Dysphoric Disorder have higher work and school absence rates, higher medical expenses and lower health related quality of life.ย
There is poor understanding of what causes Premenstrual Dysphoric Disorder. Several studies link hormonal changes in the luteal phase of the menstrual cycle to symptoms of Premenstrual Syndrome and Premenstrual Dysphoric Disorder.
As the female person approaches the luteal phase, there is a drop in the estrogen and luteinizing hormone levels and an increase in progesterone levels.
As the person approaches their menses, 7-8 days before, their progesterone as well as estrogen levels drop causing symptoms of Premenstrual Syndrome and Premenstrual Dysphoric Disorder.
Both estrogen as well as progesterone have effects on brain and body functioning. Gonadal hormone function affects serotonin, noradrenaline, dopamine, acetylcholine as well as upregulates GABA receptors.
These neurotransmitters are involved in the regulation of mood, behaviour and cognitive functions. However, these fluctuations of hormones are observed in women who do not undergo Premenstrual Syndrome or Premenstrual Dysphoric Disorder symptoms, further complicating the cause of Premenstrual Dysphoric Disorder. Genetic components may be involved, but the genes are yet to be identified.
Common Signs and Symptoms
Common Signs and Symptoms include:
- Mood swings
- Irritability
- Depressed mood
- Feeling sad and tearful
- Anxiety
- Dysphoria
- Difficulty concentrating
- Feeling fatigued and tired
- Feeling hopeless
- Feeling overwhelmed and out of control
- Increased weight
- Feeling bloated
- Lack of interest in daily activities
- sleepless nights or sleeping a lot
- Breast tenderness or swelling, joint pain or muscle pain.
These symptoms often occur 2 weeks to a few days before the onset of menses and last until the period passes. The person is often able to go back to regular functioning. However, during the time period of symptoms there is marked distress and impairment in daily functioning.
Risk Factors
The prevalence of Premenstrual Dysphoric Disorder ranges from 1.5 – 5.8%. Although causes are not known, there are several overlapping factors between atypical depression and Premenstrual Dysphoric Disorder.
30-76 % of women diagnosed with Premenstrual Dysphoric Disorder have a lifetime history of depression. DSM-5 lists environmental factors, stress induced lifestyle, interpersonal trauma and genetic factors linked to Premenstrual Dysphoric Disorder.
Diagnosis
To be diagnosed with Premenstrual Dysphoric Disorder, following criteria must be met:
- At least one of the following must be present in the weeks leading to the menses:
- Marked affective lability (feeling sad or tearful suddenly, increased sensitivity to rejection)
- Irritability or anger
- Depressed mood, feelings of hopelessness or self deprecating thoughts.
- Marked anxiety, tension or feeling keyed up or on edge
Alongside these, at least one of the following must be present:
- Decreased interest in daily activities
- Difficulty concentrating
- Lethargy, easy fatigability, lack of energy
- Change in appetite or specific food cravings
- Insomnia or hypersomnia
- Feeling overwhelmed or out of control
- Physical symptoms such as breast tenderness or swelling, joint tenderness or muscle pain, feeling bloated or weight gain.
At least five symptoms must be present for a diagnosis. There is marked impairment and disturbance. Psychologists are to rule out other mental disorders or physical conditions including effects of substance abuse.
Treatment
Treatment for Premenstrual Dysphoric Disorder revolves around relieving physical and psychiatric symptoms. Medication can be given to address hormonal issues and increasing serotonergic activity. Ovulation suppressors may be administered. Selective Serotonin Reuptake Inhibitors are the primary approved mode of treatment for reducing psychiatric treatment. Oral contraceptives are administered to reduce physical symptoms of bloating, muscle pain, joint pain, etc. Calcium and Vitamin D supplements are also advisable.
Psychotherapy in the form of Cognitive Behaviour Therapy has shown to help and reduce depression like symptoms of Premenstrual Dysphoric Disorder. Mindfulness-based exercises and acceptance based CBT are prescribed, but further research is warranted.
Differential Diagnosis
1. Premenstrual syndrome: Premenstrual syndrome differs from premenstrual dysphoric disorder as a minimum of five symptoms is not required, and there is no stipulation of affective symptoms for individuals who have premenstrual syndrome.
2. Dysmenorrhea: Dysmenorrhea is a syndrome of painful menses, but this is distinct from a syndrome characterized by affective changes. Moreover, symptoms of dysmenorrhea begin with the onset of menses, whereas symptoms of premenstrual dysphoric disorder, by definition, begin before the onset of menses, even if they linger into the first few days of menses.
3. Bipolar disorder, major depressive disorder, and persistent depressive disorder (dysthymia): Many women with bipolar or major depressive disorder or persistent depressive disorder believe that they have premenstrual dysphoric disorder. However, the symptoms do not follow a premenstrual pattern.
4. Use of hormonal treatments: Some women with moderate to severe premenstrual symptoms may be using hormonal treatments, including hormonal contraceptives. If such symptoms occur after exogenous hormone use, the symptoms may be due to the use of hormones rather than due to the condition of premenstrual dysphoric disorder. If the woman stops hormones and the symptoms disappear, the same is true for substance/medication-induced depressive disorder.
Comorbidity
Premenstrual dysphoric disorder is found to be comorbid with major depressive episodes, bipolar disorders, anxiety disorders, bulimia nervosa, substance use disorders and other medical conditions such as migraine, asthma, allergies, seizure disorders.
In Conclusion
Depression and, in the most extreme cases, suicide can result from untreated PMDD. The condition can have a significant impact on relationships and professions as well as create serious emotional suffering.
It may be less probable for PMS to develop into PMDD if preexisting depression or anxiety are treated. However, PMDD might be brought on because of the way your hormones function, and you might not be able to stop it. In that situation, treatment may provide comfort.
Get in touch with Anandaโs professionals to start early diagnosis.
