What is PMDD?
Pre-menstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). It involves physical and psychiatric symptoms that occur during the luteal phase of the menstrual cycle and resolve after the period starts. The cause of PMDD is thought to be an abnormal response to a metabolite of progesterone (allopregnanolone) at the GABA receptor in the brain, or sensitivity to rapidly changing hormone levels. Having a family member with the condition or experiencing early childhood trauma are associated with an increased risk of PMDD.
Diagnosis and Symptoms
PMDD is not caused by abnormal hormone levels or a specific hormone condition, but rather by how the body responds to hormones. This makes it a clinical diagnosis, which is why tracking menstrual and symptom cycles is so important. Conditions like menstrual migraines and endometriosis can present similarly and should also be considered. PMDD is diagnosed if five or more criteria are met on at least two cycles that resolve after the period starts. Symptoms include both mental health issues (anxiety, depression, sensitivity to criticism, hopelessness) and physical symptoms (joint pain, muscle aches, severe fatigue, sleep issues).
Treatment Options
Treatment for PMDD involves a combination of lifestyle changes, medications, and supplements. Lifestyle measures are critical and include proper nutrition, regular exercise, adequate sleep, and limiting alcohol intake.
Medications
The most effective medical treatment for PMDD is an SSRI or SNRI antidepressant. Fluoxetine is often used due to its long duration of action, which means it can be taken just during the luteal phase or continuously. It is also safe for use during pregnancy and breastfeeding. Despite their efficacy, antidepressants sometimes receive criticism, but like depression, PMDD can be disabling and there should not be a stigma around their use.
Other Treatments
The oral contraceptive pill (OCP) can be used and generally improves mood during the luteal phase but may worsen it during the follicular phase. Supplements with some evidence of effectiveness include Vitex, B6 (with caution for neuro-toxicity), magnesium, omega-3, zinc, and calcium.
Severe PMDD
In severe cases of PMDD, some patients may trial medical menopause, and if effective, consider an oophorectomy with or without low-dose hormone replacement therapy (HRT). This is very uncommon but can be necessary for a small subset of patients for whom PMDD is completely disabling despite all other treatments.
For more information and support, @iapmdglobal is a great resource. 😊