What Is Premenstrual Dysphoric Disorder? Exploring PMDD Treatment And Symptoms
Premenstrual dysphoric disorder (PMDD) is a condition typically characterized by extreme physical and emotional symptoms that begin in the days preceding menstruation and subside within a few days after the start of menstruation. The symptoms of PMDD tend to be similar to those associated with premenstrual syndrome (PMS), but they are usually much more severe and disruptive to daily life. Though statistics vary, studies suggest that approximately three to 8% of menstruating women in their reproductive years meet the diagnostic criteria for PMDD. This article explores PMDD, its potential causes and risk factors, and its symptoms. It also outlines some of the most common treatments for PMDD and provides suggestions for when it may be time to speak with a mental health professional.
PMDD debate
Although PMDD was added to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) in 2013, there is still debate over its official recognition as a psychological disorder. Some argue that an official diagnosis can offer more targeted and effective patient care. Others liken the term PMDD to the term "hysteria," used as a social construct to pathologize a woman's ordinary life experiences as a type of mental disorder—a belief that may be supported by differences in PMDD prevalence rates around the world. Additionally, some critics argue that the inclusion of PMDD in diagnostic manuals may have been driven by pharmaceutical companies seeking to market new medications.
PMDD causes and risk factors
PMDD is believed to result from a complex combination of biological, psychological, and lifestyle factors, including hormonal fluctuations, genetic predispositions, and stress. Risk factors for developing PMDD include a family history of PMDD, PMS, or mood disorders, a personal history of trauma or abuse, and certain mental health conditions, like anxiety and depression.
PMDD symptoms and diagnosis
According to the DSM, to qualify for a PMDD diagnosis, women must experience at least five of the symptoms listed below in the week before the onset of menses. These symptoms must begin to improve within a few days of menstruation and subside completely in the week after menstruation.
Symptoms of PMDD include the following:
- Sudden and severe mood swings (anger, irritation, sadness, or increased sensitivity to rejection)
- Marked depression, self-deprecating thoughts, and/or a sense of hopelessness
- Marked tension or anxiety
- Decreased interest in once-pleasurable activities
- Trouble concentrating
- Fatigue and lethargy
- Changes in appetite or sleep patterns
- A sense of overwhelm
- Physical symptoms, such as bloating or weight gain, breast tenderness, swelling, and joint or muscle pain
For a diagnosis of PMDD, these symptoms must cause significant distress or interference with daily life and relationships. Further, the symptoms cannot be associated with another condition, such as major or persistent depressive disorder, personality disorders, or panic disorder.
Medical treatment options
Some people experience a decline in, or absence of, premenstrual symptoms when treated with medication, including hormonal therapies and antidepressants. These treatments can be highly effective for some. However, some experts express concerns over unnecessary medication, overmedication, and potential side effects.
Please note that the information in this article is not medical advice and cannot replace the guidance of a licensed medical provider. Speak to your doctor or psychiatrist before starting, stopping, or changing the way you take medication.
Antidepressants (SSRIs and SNRIs)
Selective serotonin reuptake inhibitors (SSRIs) are often the first-line treatment for PMDD, as they may regulate mood and reduce premenstrual symptoms like irritability and anxiety. They can be taken continuously or intermittently, with symptom-onset dosing during the luteal phase (a treatment called luteal phase sertraline treatment).
Hormonal therapies
Some hormonal birth control pills can be effective in managing PMDD symptoms. These pills usually work by suppressing ovulation, which can reduce the fluctuation in hormone levels that seems to trigger PMDD symptoms. Hormone replacement therapies (HRT) can be used to address hormonal fluctuations that may cause PMDD. GnRH agonists are also sometimes used to suppress ovarian function, causing temporary menopause. They can be effective in treating severe PMDD but are often combined with HRTs to manage side effects like bone loss.
Cognitive and behavioral therapies
While medications may relieve symptoms on the surface, addressing the emotional and cognitive aspects of the disorder can provide a deeper, more comprehensive, and longer-lasting result. Psychotherapeutic interventions are often tailored to the individual’s unique needs and can be effective in addressing other psychological disorders like anxiety and depression.
Cognitive behavioral therapy (CBT)
CBT can help individuals identify and modify negative thoughts and behavioral patterns that worsen PMDD symptoms, potentially leading to a reduction in symptom severity and improved well-being. CBT can also teach techniques for managing stress, such as relaxation exercises, to help individuals cope with PMDD symptoms. Many psychologists use CBT as a psychoeducational tool to help individuals better understand PMDD, its symptoms, and potential coping strategies.
Mindfulness-based therapy
Mindfulness-based therapies, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), can help individuals manage the emotional and physical symptoms of PMDD, such as irritability, mood swings, depression, anxiety, and physical pain. Such approaches can help individuals learn to mitigate the impacts of PMDD on their everyday lives, such as diminished motivation and relationship conflict.
Lifestyle modifications for management of PMDD symptoms
Lifestyle modifications like regular exercise, nutritious eating habits, adequate sleep, and stress management techniques may reduce PMDD symptoms. Activities that nourish and bring joy, such as creative projects, mindful movement techniques like yoga or tai chi, and leisure time in nature, can improve physical and mental well-being.
Nutrition
Nutritious foods like fruits, vegetables, whole grains, and lean proteins may help manage PMDD. Although definitive research is ongoing and updated evidence is needed, some experts recommend limiting or avoiding caffeine, alcohol, and simple sugars, as they can worsen mood and energy fluctuations.
Eating habit recommendations may vary depending on individual needs and sensitivities. A registered dietitian or healthcare professional can provide personalized guidance and support. Changes in eating habits should be part of a broader holistic approach to PMDD management, which may also include stress reduction techniques and psychological support.
Physical activity
Exercise, particularly aerobic exercise, can be a beneficial strategy for managing PMDD symptoms. Exercise can boost mood and reduce stress by stimulating the release of endorphins. Regular exercise may also contribute to hormonal regulation and improve the ability to cope with the emotional symptoms of PMDD. Like nutrition, physical activity should be used as a complement to stress reduction techniques and psychological support.
Adequate sleep
PMDD can significantly impact sleep, sometimes leading to insomnia, changes in sleep patterns, and a lack of restful sleep. These sleep disturbances can also lead to daytime consequences like poor concentration, daytime sleepiness, and decreased alertness. Practicing good sleep hygiene, such as maintaining a regular sleep schedule, creating a relaxing bedtime routine, and ensuring a comfortable sleep environment, may improve sleep quality.
The role of stress in PMDD
Stress can significantly worsen PMDD symptoms by impacting the brain's emotional processing abilities and the body's hormonal balance. Stress can lead to increased rumination, self-focused attention, and difficulty regulating emotions, all of which can exacerbate PMDD symptoms like mood swings, anxiety, and depression. Additionally, chronic stress can disrupt the body's stress response system, leading to hormonal imbalances that can further exacerbate PMDD symptoms.
Strategies like meditation, journaling, and breathwork can help individuals manage and mitigate stress. Such activities can help individuals recognize the sources of their stress so they can develop targeted coping strategies. Regular practice of stress management techniques can be key to achieving long-term benefits.
Support systems
Peer support and the opportunity to share lived experiences can be highly beneficial for individuals with PMDD by providing validation, reducing isolation, and offering practical coping strategies. By connecting with others who understand the unique challenges of PMDD, individuals may feel less alone and gain valuable insights into managing their symptoms.
Online forums and social media groups dedicated to PMDD may provide a space for individuals to share their experiences, offer support, and learn from one another. Some find support groups, peer-to-peer counseling, or mentoring programs offer a more personal and interactive setting for connecting with others.
When to seek professional help for premenstrual dysphoric disorder (PMDD)
Individuals may consider seeking professional help for PMDD when self-care strategies like lifestyle changes or eating habit adjustments do not alleviate symptoms. Similarly, if PMDD symptoms like extreme mood swings, intense sadness, hopelessness, irritability, or anger significantly impact daily function, relationships, or work, it’s generally recommended to seek professional help. PMDD symptoms can be overwhelming and leave individuals feeling emotionally drained. Early intervention may be key for positive outcomes.
Online therapy for premenstrual dysphoric disorder (PMDD)
Despite its benefits, some people don't seek talk therapy for PMDD. There are many potential reasons for this. For example, conditions like PMDD can lead to serious difficulties with motivation, making it challenging to get out of bed, much less travel to and from therapy sessions. Scheduling or accessibility might create barriers for some; others might believe they can't afford therapy or that it won't work for them. Others may not go to therapy because of the stigma around mental health challenges.
Internet-delivered treatment can offer an excellent solution to these obstacles, making therapy more accessible and convenient for people who could benefit from professional support. Platforms like BetterHelp give people access to a wide pool of mental health professionals with diverse backgrounds and experience, and they empower individuals to attend therapy sessions from the comfort of their homes on a schedule that fits their needs. Additionally, online therapy is often more affordable than traditional treatment without insurance.
Research suggests that internet-delivered cognitive behavioral therapy (iCBT) can be an effective method for treating PMDD. In a 2019 study, nearly 200 women with PMDD participated in a placebo-controlled clinical trial. Half of these women participated in the targeted eight-week iCBT program. At the study’s conclusion, participants in the treatment group reported improvements in symptoms, including reduced functional impairment and severity. This study is the first to focus on PMDD and the efficacy of online treatment, emphasizing its potential benefits as an alternative to in-person therapy and medication options.
Takeaway
PMDD can cause significant distress for those who have it, often leading to a sense of helplessness to change their symptoms and find relief. However, PMDD is a treatable condition that individuals can manage with the proper support. If you have severe, overwhelming PMS symptoms that could indicate PMDD, speak to a healthcare professional or therapist. Reaching out, whether in person or online, can be the first step toward relief.
How can I cure my PMDD naturally?
Many women experience PMS symptoms like cramps and food cravings, but PMDD goes beyond typical PMS symptoms. It’s often viewed as a significant women’s behavioral health issue that may require professional support. However, you may manage PMDD symptoms naturally by implementing a variety of healthy habits. Eating nutritious food, exercising regularly, staying hydrated, getting plenty of sleep, engaging in hobbies you enjoy, and spending time with loved ones can be helpful.
How do you help your partner with PMDD?
Offering your partner empathy and patience can be beneficial. You might also encourage your partner to seek professional support and effective treatment to manage their symptoms and improve their quality of life. A variety of treatment options are available, including oral contraceptives for ovarian suppression, intermittent dosing or luteal phase dosing of antidepressants, and multiple types of talk therapy. While many of these treatment options are well-tolerated, it’s crucial to speak to your doctor or psychiatrist before starting or stopping any form of medication.
Is PMDD a form of bipolar disorder?
Premenstrual dysphoric disorder is not a form of bipolar disorder. PMDD symptoms begin during the luteal phase of the menstrual cycle and typically resolve within a few days of the onset of the menstrual period. They are often described as more severe PMS symptoms. Meanwhile, bipolar disorder typically involves periods of depression alternating with periods of mania or hypomania.
At what age does PMDD peak?
According to a 2022 study, premenstrual mood symptoms do not appear to vary by age group. Instead, menstruating women seem to experience persistent mood changes related to their menstrual cycles throughout their reproductive years.
What vitamins help with PMDD?
Calcium, magnesium, vitamin B6, and herbal remedies have been studied as potential treatments for PMDD. However, there isn’t yet any conclusive evidence supporting these options. It may be best to speak to your doctor to determine whether you’re experiencing any nutrient deficiencies before adding supplements to your regimen.
What is the best therapy for PMDD?
Cognitive behavioral therapy (CBT) is frequently used to treat PMDD. In CBT, a therapist helps the client identify and adjust negative thought patterns. This can positively affect emotions and behavior.
What are the coping mechanisms for PMDD?
A variety of coping skills can be used to manage PMDD symptoms. Relaxation practices, grounding exercises, healthy habits, and regular exercise are a few examples.
What hormone causes PMDD?
Fluctuations in sex hormones like estrogen and progesterone are believed to contribute to PMDD symptoms. However, it’s thought that other factors play into the experience of PMDD as well. Past traumatic experiences like sexual abuse may increase the risk of a woman experiencing PMDD, for example.
More research is needed on the causes of PMDD. Researchers like Ripal Shah, an associate professor at Stanford Medicine, focus on PMDD and other aspects of reproductive psychiatry.
Is PMDD a disability?
PMDD may be considered a disability in certain circumstances, but this isn’t always the case. Severe cases of PMDD that impact a woman’s ability to function and maintain employment tend to be more likely to be considered disabilities.
What happens if PMDD is left untreated?
When PMDD is left untreated, it can negatively impact a person’s overall quality of life and ability to function during certain parts of the month. Symptoms like intense mood changes and physical discomfort can significantly affect women’s health. Most women find that they can improve mood symptoms by seeking therapy and implementing healthy lifestyle habits, but other treatments may also be considered.
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