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A Brief Guide to PMDD

Many women suffer from some degree of premenstrual discomfort. However, what you may not know is there is a more severe form of PMS that many women deal with as well. This premenstrual syndrome, known as PMDD, or premenstrual dysphoric disorder, affects between 3 and 8 percent of American women, with some experiencing severe premenstrual symptoms that can be extremely debilitating.

Premenstrual Dysphoric Disorder

PMS and PMDD are both nuisances to women but PMDD symptoms are much more severe than those of PMS, making them very different conditions. Medical professionals link PMDD to hormonal changes during the menstrual cycle. With that said, we do not know the exact cause. PMDD symptoms can not only be physical but also emotional and they can often interfere with daily life.

Studies have revealed a link between PMDD and reduced levels of a chemical in the brain called serotonin. Serotonin transmits nerve signals controlling mood, attention and focus, sleep and also pain. Hormonal changes experienced during the menstrual cycle can reduce serotonin levels to drop, which brings on the PMDD symptoms.


What is PMS?

Around 85% of women experience PMS or premenstrual syndrome with symptoms that include cramps, lethargy, and emotional changes. Symptoms are generally quite mild, lasting from a few days before a period until shortly after it has started. However, when PMS symptoms become severe, it can sometimes signal a more complex condition like PMDD.

The most common symptoms of PMS include:

    • Fatigue and lethargy
    • Bloating as a result of fluid retention
    • Temporary weight gain
    • Breast tenderness
    • Acne or similar skin conditions
    • Interrupted sleep patterns
    • Certain food cravings and possible overeating

What is PMDD?

Most women experience unpleasant changes in their bodies during their menstrual cycle. However, although around 75% of menstruating women have some symptoms of PMS, premenstrual dysphoric disorder (PMDD) is a very different condition. Symptoms of PMDD are often severe and sometimes debilitating, preventing sufferers from participating fully at work, school, or home. The more emotional PMDD symptoms can also lead to difficulties in close personal relationships.

PMDD Symptoms

Symptoms of PMDD or Premenstrual Dysphoric Disorder include the following with varying degrees of severity:

  • Extreme and uncontrollable mood swings
  • Warped sense of logic and feelings of hopelessness
  • Depression and Anxiety, sometimes prolonged
  • Tension, quick temper and irritability
  • Reduced concentration and lack of focus
  • Insomnia and chronic fatigue
  • Change in appetite and consequent weight gain/loss
  • Physical symptoms such as uncomfortable bloating, extreme breast tenderness, and sometimes chronic pelvic pain

PMDD Diagnosis

PMDD impacts a woman’s emotional wellbeing because it causes hormonal changes in her menstrual cycle. In fact, some of the more emotional symptoms of PMDD are the same as other conditions like depression. For this reason, a doctor is likely to rule out these conditions before continuing the medical exploration to find a diagnosis.

Your physician will have to rule out a number of other gynaecological conditions as well. These conditions include: fibroids, menopause, endometriosis, polycystic ovary syndrome, and other hormone-related problems.  When the physician rules out all of these issues, the only other diagnosis left is generally PMDD.

Symptoms that take place during the luteal phase (starting around a week before menstruation) and disappear once a woman’s period starts generally indicate PMDD. Another factor in the diagnosis of PMDD is the level to which the condition is affecting the daily life of the sufferer. Symptoms that are severe and present throughout the menstrual cycle are unlikely to be caused by the premenstrual dysphoric disorder.

PMDD Treatment: How is PMDD treated?

Women can benefit from being prescribed the right dosages of medications to reduce the severity of PMDD symptoms. Many of the same approaches used for PMS are also helpful in lessening PMDD symptoms. Treatment for PMDD includes:

Good nutrition: Women with PMDD should reduce the amount of refined sugar, caffeine, alcohol, and salt in their diet, especially before and during the luteal phase. These often serve to aggravate premenstrual dysphoric disorder or PMDD symptoms and also have little nutritional value. Supplements for magnesium and vitamins B6 and E are useful in improving the nutritional balance and lessen PMDD symptoms. St John’s Wort has also shown to improve mood as well.

Exercise: Exercise can help soothe women suffering severe premenstrual symptoms. Low-impact activities in particular, such as swimming or yoga, has been shown to improve PMS and PMDD symptoms in combination with medications (see below).

Therapy: There have been various studies on the benefits of therapy for women with PMDD. Therapies that borrow from mindfulness practices like yoga and meditation can be highly effective. Some women find enormous relief in the coping mechanisms they can learn from these approaches, particularly for pain management. Reflexology and relaxation therapy are also useful in combating the severe and uncomfortable PMDD symptoms.

Behavioral Therapy: Cognitive-Behavioral Therapy or CBT is an approach to adjusting responses and reactions to certain stimulus. In terms of PMDD symptoms, CBT can alleviate mood swings by altering how a woman responds to stressors. This enables women experiencing severe mood swings with the premenstrual dysphoric disorder to better manage their state of mind.

PMDD Medication: What is the Medical Treatment of PMDD?

There are some over-the-counter painkillers and meds to reduce water retention or bloating that may help to lessen PMDD symptoms. Medications called selective serotonin reuptake inhibitors (SSRIs), or antidepressants, are also effective treatments for the premenstrual dysphoric disorder (PMDD). For the PMDD symptom of painful joints, non-steroidal anti-inflammatory drugs can be taken to reduce discomfort.

Hormones can be used to treat some PMDD symptoms. As a last resort; oral contraceptives or birth control pills can be used to stop ovulation altogether. However, this approach doesn’t address the root cause of the premenstrual dysphoric disorder.

Two commonly used medications for the treatment of premenstrual dysphoric disorder or PMDD are:


Commonly prescribed for conditions such as depression, anxiety, and also PMDD symptoms, Sarafem is one of the selective serotonin reuptake inhibitors mentioned above. This SSRI works by re-balancing serotonin levels for better control over emotions and mood swings.

Sarafem has been shown to improve sleep patterns, appetite, and energy levels and is effective in moderating PMDD symptoms. Sarafem boosts energy so women can function better at work or school with improved focus and less extreme mood swings.


Zoloft is a medication that re-balances serotonin levels to improve the mood swings experienced with PMDD symptoms or other mood disorders. These SSRIs are effective treatments for mental illnesses such as depression, OCD, PTSD, social anxiety disorder, and also PMDD.

Many women find PMDD symptoms can be heightened through lack of sleep, loss of appetite, and fatigue. Zoloft improves the balance of serotonin which is responsible for sending messages about mood, thoughts, and feelings to the brain.

Getting Help for Premenstrual Dysphoric Disorder

Menstruation is a fact of life for all women of child-bearing age and yet we are all very different. What is a mildly uncomfortable experience for some is debilitating in others. However, there are plenty of effective treatment options available to them. It’s easy for women to not realize their symptoms are severe, especially as we tend to share our bad experiences. We are so conditioned into thinking heavy, painful periods are normal that some women don’t know there is treatment available.

Premenstrual Dysphoric Disorder can cause a great deal of difficulty in a woman’s life. In some cases, there is potential to cause problems with spouses or partners. Many women find it uncomfortable talking to their partners about women’s health and their other halves often feel the same. However, if menstrual problems are damaging a woman’s life, she should consult a doctor as a matter of priority.

Remember: Chronic pain and emotional turmoil is not a normal part of being a woman.







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