Health Encyclopedia

Premenstrual dysphoric disorder

Alternative Names

PMDD

Definition

Premenstrual dysphoric disorder (PMDD) is a condition marked by severe depression, irritability, and tension before menstruation. These symptoms are more severe than those seen with premenstrual syndrome (PMS).

Causes, incidence, and risk factors

The causes of PMS and PMDD have not been identified, although social, cultural, biological, and psychological factors all appear to be involved. Researchers estimate that PMDD affects between 3% and 8% of women in their reproductive years.

Major depression is very common with PMDD, although PMDD can occur in women who do NOT have a history of major depression.

Studies have found that women who have seasonal affective disorder (SAD), a form of depression characterized by annual episodes of depression during fall or winter that improve in the spring or summer, are likely to also have PMDD.

Symptoms

The symptoms of PMDD are similar to those of PMS, but they are generally more severe and debilitating. Symptoms occur during the last week of most menstrual cycles and usually improve within a few days after the period starts.

Five or more of the following symptoms must be present:

Feeling of sadness or hopelessness, possible suicidal thoughts
Feelings of tension or anxiety
Panic attacks
Mood swings marked by periods of teariness
Persistent irritability or anger that affects other people
Disinterest in daily activities and relationships
Trouble concentrating
Fatigue or low energy
Food cravings or binge eating
Sleep disturbances
Feeling out of control
Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain

Signs and tests

There are no physical examination findings or lab tests specific to the diagnosis of PMDD. A complete history, physical examination (including a pelvic exam), and psychiatric evaluation should be conducted to rule out other potential conditions.

Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times they are likely to occur. This information may help the health care provider diagnose PMDD and determine the appropriate treatment.

Treatment

Women with PMDD may be helped by the following:

Regular exercise 3-5 times per week
Adequate rest
A balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine)

In addition, it is important to keep a diary or calendar to record the type, severity, and duration of symptoms.

Selective serotonin-reuptake inhibitors (SSRIs) are antidepressant drugs that can treat PMDD. SSRIs include fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa).

Nutritional supplements -- such as vitamin B6, calcium, and magnesium -- may be recommended. Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramping and breast tenderness. Diuretics may be useful for women who have significant weight gain due to fluid retention.

Expectations (prognosis)

After proper diagnosis and treatment, most women with PMDD find that their symptoms go away or drop to tolerable levels.

Complications

PMDD symptoms may become severe enough that they interfere with a woman's daily life. Women with depression may have worse symptoms during the second half of their cycle and may require medication adjustments.

As many as 10% of women who report PMS symptoms, particularly those with PMDD, have had suicidal thoughts. The incidence of suicide in women with depression is significantly higher during the latter half of the menstrual cycle.

PMDD may be associated with eating disorders and smoking.

Calling your health care provider

Call 911 immediately if you are having suicidal thoughts.

Call for an appointment with your health care provider if:

PMS symptoms do not improve with self-treatment
PMS symptoms are interfering with your daily life

Review Date:11/8/2006
Reviewed By:Audra Robertson, MD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.