Is It More Than PMS?

(By Jill Ross) It’s that time of the month and you’re cranky, weepy, moody and even the dog hides when he sees you. You may think you’ve got PMS, but it may be PMDD.

PMDD? Yes, PMDD. Very simply, PMDD (premenstrual dysphoric disorder) is a severe form of PMS (premenstrual syndrome). PMDD symptoms typically go well beyond what are considered manageable or normal premenstrual symptoms. They occur the week before and disappear a few days after the onset of menstruation, medical experts say.

Those premenstrual days, though, can be agonizing. With both conditions, women can feel irritable, tense, emotional, sad and tired while experiencing roller-coaster mood swings. They also may have physical symptoms, such as bloating and breast tenderness. However, chances are with PMDD, you will have more severe mood swings and have trouble functioning at home or at the office.

“Women (who have PMDD) mostly find that they are pretty irritable and out of control,” says Diane Dell, a gynecologist, obstetrician and psychiatrist at Duke University Medical Center in Durham, N.C., and a former president of the American Medical Women’s Association.

Unless they have physical symptoms, most women with PMDD go to work even though they feel overwhelmed, Dell says. Even in the office, they may find it difficult keeping it all together. They are prone to angry outbursts and clashes with co-workers or family members.

Who has PMDD?

At least half of menstruating women experience PMS as opposed to 3 percent to 5 percent who experience PMDD, according to the American Psychiatric Association.

While most women have heard of PMS, a national survey of 500 women found that 84 percent were unaware of PMDD. The survey was commissioned by the Society for Women’s Health Research.

Though the majority of women surveyed reported experiencing premenstrual symptoms in the previous year, 45 percent said they had never discussed PMS with their doctors. Even among women with strong or severe symptoms, 27 percent never talked with their physicians about the problem, despite the fact that their symptoms interfered with daily activities.

Some women wait for years to ask a doctor about premenstrual problems, says Jean Endicott, Ph.D., director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center. “They fear becoming the target of jokes or that seeking help is a sign of weakness,” she says.

Keeping a diary

If you think you may have PMS or PMDD, speak with your health care provider and keep a diary of your symptoms, Dell says.

“A diary allows both the physician and a patient to make sure the symptoms are occurring just in premenstrum and not during other times in the menstrual cycle,” Dell says. In that way, it can help a physician diagnose whether you have PMS, PMDD, or depression or another condition.

For some women, premenstrual symptoms can actually mask symptoms of depression. If the severe mood symptoms do not go away within a few days of menstruation, be sure to tell your health care provider. Also, if you already have a psychiatric disorder such as depression or even a medical disorder such as diabetes or asthma, you should know that PMS or PMDD could make it worse.

“Whatever you have, it’s going to get worse premenstrually,” Dell says.

Researchers aren’t exactly sure what causes PMS or PMDD. One theory is that they are related to hormonal changes because of the menstrual cycle. Recent research has shown a connection between premenstrual symptoms and low levels of serotonin, a neurotransmitter in the brain.

What works for PMS and PMDD?

Making some lifestyle changes by getting regular aerobic exercise, reducing stress and cutting back on caffeine and carbohydrates may be helpful with PMS but don’t really help much with PMDD, according to Dell.

If you have PMDD, she suggests talking to your health care provider about drug therapy. Treatment guidelines published by the American College of Obstetricians and Gynecologists recommend antidepressants known as selective serotonin reuptake inhibitors (SSRIs) as the initial drug of choice for the treatment of severe mood and physical premenstrual symptoms.

SarafemĀ® (fluoxetine hydrochloride) is the first and only drug approved by the U.S. Food and Drug Administration for both the mood swings and physical symptoms of PMDD. Sarafem has the same active ingredient as ProzacĀ®, the best-known SSRI.

While most antidepressants take some time to take effect, Sarafem can be taken intermittently or continuously to treat PMDD and acts quickly, according to Dell. However, do not take Sarafem if you take another type of antidepressant called an MAO inhibitor.

Your PMDD checklist

Think about how you feel the week before your menstrual period. If you answer “yes” to some of the following questions, discuss your answers with your doctor to determine whether you have PMDD. Symptoms can vary from cycle to cycle, which is why it is a good idea to keep a daily record of both your mood and physical symptoms for two or three menstrual cycles to aid in discussions with your doctor.

Are you bothered by intense:

  • Irritability
  • Fatigue
  • Tension
  • Bloating
  • Sensitivity
  • Food cravings
  • Sadness
  • Breast tenderness
  • Feelings of being overwhelmed
  • Sudden mood changes for no reason

Do these symptoms cause problems with your:

  • Work
  • Social activities
  • School
  • Relationships (family, friends, etc.)

Do these problems go away soon after your period starts?

  • Yes
  • No

External Resources

American College of Obstetricians and Gynecologists