What is Premenstrual dysphoric disorder?
Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS). It causes a range of emotional and physical symptoms every month during the week or two before your period. It is sometimes reffered to as 'severe PMS'.
PMDD occurs during the luteal phase of your menstrual cycle. This is the time between when you ovulate and when your period starts. The luteal phase lasts approximately two weeks for most people but can be longer or shorter.
During this time you may experience PMDD symptoms every day or for a few days within this phase. The NHS website has more information on the stages of the menstrual cycle and when they occur.
Many of us may experience symptoms of PMS, but if you have PMDD, these symptoms are much worse and can have a serious impact on your life. Experiencing PMDD can make it difficult to work, socialise and have healthy relationships. In some cases, it can also lead to suicidal thoughts.
Symptoms of PMDD
If you have PMDD, you might find that you experience some symptoms listed below. But it's different for different people, so you might experience other kinds of feelings which aren't listed here:
Emotional experiences: mood swings
- feeling upset or tearful
- lack of energy
- less interest in activities you normally enjoy
- feeling hopeless
- feeling angry or irritable
- suicidal feelings
- feeling anxious
- feeling tense or on edge
- feeling overwhelmed or out of control
- diffculty concentrating
Physical and behavioural experiences
- breast tenderness and swelling
- pain in muscles and joints
- headaches
- feeling bloated
- changes in appetite such as overeating or having specific food cravings
- sleep problems
- increased anger or conflict with people around you
- becoming very upset if you feel that others are rejecting you
How is PMDD diagnosed?
To get a diagnosis of PMDD the best place to start is visiting your doctor. To help them understand your symptoms your doctor may:
- ask you to keep a detailed record of your symptoms for at least two months, to see if your symptoms have a pattern over time. This may be in your diary or they may give you some questionnaires to fill out
- ask about your medical history, such as any history of mental health problems
- ask about your lifestyle, such as if you smoke, drink alcohol or are overweight
- give you a physical examination along with some blood tests, so they can rule out other medical problems.
When youre asked to keep a record of your symptoms over several months, getting a diagnosis can feel like a very slow process. This can be frustrating if youre having to wait for treatment.
What if im struggling to get a diagnosis?
- Keep your own detailed record of symptoms over time
- Take the PMDD treatment guidelines with you to your GP appointments
- Ask at your GP surgery if you could speak to a doctor who specialises in mental health, gynaecology, or endocrinology.
- consider finding an advocate
Treatment of PMDD
SSRIs
SSRIs (selective serotonin reuptake inhibitor) are a type of antidepressant. They are often the first recommened treatment for PMDD as they are rhe only type of antidepressant shown to work for PMDD.
Combined oral contraceptives
Oral contraceptives (often called "the pill") may reduce symptoms of PMDD by controlling or stopping your periods, but the evidence for the pill as a treatment for PMDD is mixed. Some people do find it helps to reduce their symptoms but others find it makes their symptoms worse. The pill can cause side effects and is not appropriate if you are trying to get pregnant.
Talking therapy and counselling
To help manage the psychological symptoms you experience you may want to consider seeing a therapist for talking treatment. Cognitive behavioural therapy (CBT) has shown to be effective for some people with PMDD.
Painkillers and anti-inflammatory drugs
Your doctor may suggest you take painkillers or anti-inflammatory drugs (eg ibuprofen) to help manage the physical symptoms of PMDD such as headaches, joint and muscle pains.
GnRH analogue injections
Gonodotropin releasing hormone (GnRH) analogues can be helpful for some people as they reduce the symptoms of PMDD by bringing on a temporary menopause. They typically come as injections.
Surgery
In very severe cases, your doctor may talk to you about the possibility of a total hysterectomy (an operation to remove the uterus) with bilateral salpingo-oophorectomy (an operation to remove ovaries and fallopian tubes). The aim of the surgery is to get rid of your PMDD symptoms by permanently stopping your monthly cycle.
Vitamins and supplements
There is some limited evidence that certain supplements may reduce premenstrual symptoms. Some examples are:
- Calcium carbonate- some research indicates this may help to reduce physical and psychological symptoms
- Vitamin B6- this may help to relieve symptoms, but if you take too much it may lead to a condition called peripheral neuropathy which is a condition where you lose feeling in your arms and legs
- Angus castus ( a herb known as chasteberry)- some research has shown that this may help reduce symptoms of irritability, anger, headaches and breast pain. It is not recommened if you are trying to get pregnant or breastfeeding.