Frequently Asked Questions - Premenstrual Dysphoric Disorder (PMDD)

What is Premenstrual Syndrome (PMS)?

PMS is characterized by troublesome physical and/or emotional symptoms that are present in the last seven to 10 days of the menstrual cycle (before the menstrual flow).  

What is Premenstrual Dysphoric Disorder (PMDD)?

PMDD is a condition associated with predominantly severe psychological symptoms which cause disruption of the daily lives of affected women. Dysphoria is derived from the Greek word dusphoros, which means hard to bear. The symptoms of PMDD are recurrent. They usually start seven to 10 days before menstruation and decrease within a few days of the onset of menstrual flow. Then, they disappear completely until the next premenstrual phase.

How prevalent are PMS and PMDD?

PMS is present in about 30% of women in their child bearing years.  

Studies have found that up to 8% of women with PMS meet the criteria for PMDD. 

Who is at risk for developing PMDD?

A few studies suggest that women with a personal or family history of postpartum depression,unipolar depression, and mood changes induced by oral contraceptives may be at greater risk of developing PMDD. 

What are the symptoms of PMS and PMDD?

Some of the symptoms of PMS include:

  • Bloating
  • Headaches
  • Irritability
  • Weight gain
  • Food cravings
  • Mood swings
  • Fatigue
  • Breast tenderness
  • Tearfulness.

Each affected woman presents a different combination of some of these symptoms, which may also differ from month to month.

Unlike PMS, PMDD symptoms are very severe, completely disrupting the lives of women affected by it. Women diagnosed with PMDD usually present 5 or more of the following symptoms:

  • Very depressed mood, feelings of hopelessness
  • Marked anxiety,tension, feelings of being “on edge”
  • Marked mood shifts (e.g., suddenly feeling tearful orextremely sensitive)
  • Persistent or marked anger or irritability or increased interpersonal conflicts
  • Decreased interest in usual activities (e.g., work,school,friends, hobbies)
  • Difficulty concentrating
  • Fatigue,tiredness, loss of energy
  • Marked change in appetite, overeating, food cravings
  • Insomnia (difficulty sleeping) or sleeping too much
  • Feeling out of control or overwhelmed
  • Physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain, “bloating”, weight gain

These symptoms do not necessarily occur every cycle, but they are present in the majority of the cycles. Some months may be worse than others. For an accurate diagnosis of PMDD, it is important to keep a mood chart for at least two consecutive months.

Also, it is important to have a complete medical evaluation and laboratory tests in order to rule out other possible medical problems

 

What do I need to tell my doctor?

  • Write down symptoms you’ve had and when
  • Write down key personal information
  • Make a list of all medications you are taking
  • Write down questions to ask your doctor
  • Take a family member or friend along

Discuss all of your symptoms with your doctor and describe how they are affecting your life (e.g. depressed mood making it difficult for you to get to work or appointments in time). Your doctor can suggest or provide appropriate therapy.Based on your symptoms, discuss all of the available treatments and medications and their benefits and side effects before making any decisions.

What are the treatment options for PMDD?

There are three main approaches that can be used to alleviate the symptoms of PMDD:

Psychological  

Stress reduction (e.g., rearranging schedule to decrease stress during the premenstrual week)

Cognitive-behaviour therapy

Take a daily dose of vitamin B6, calcium (speak with your health care provider about this and other dietary supplements)

Medications 

Antidepressants(SSRIs)

Anti-anxiety medication

Hormone therapy 

Relaxation techniques

Healthy lifestyle

Dietary changes: reduce salt, alcohol, caffeine

Reduce or stop smoking

Exercise

What are the things I need to do to get well?
  • Stick to your treatment plan. Don’t skip psychotherapy sessions. Even if you’re feeling well, continue to take medication as prescribed.
  • Set realistic expectations. Be kind to yourself. Don’t pressure yourself to do everything. Ask for help when you need it.
  • Learn about PMS and PMDD. Empower yourself by learning about your condition.
  • Pay attention to the warning signs. Find out what may trigger your symptoms, or make them worse. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes. Ask friends or family to watch out for warning signs.
  • Get exercise. Physical activity may help reduce symptoms. 
  • Maintain an adequate diet. The Canada Food Guide is a useful reference in helping you choose how to eat well.
  • Avoid alcohol and illicit drugs. It may seem like they lessen your problems, but in the long run, they generally worsen symptoms.
  • Get adequate sleep. This is especially important. Speak to your doctor if you are having trouble sleeping.
What else can I read about PMDD?

Concise Guide to Women’s Mental Health. Vivien Burt and Victoria Hendrick. American Psychiatric Publishing Inc., Second Edition, 2001.

DSM-IV-TR– Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. Fourth Edition, 2000.

PMDD: A guide to coping with Premenstrual Dysphoric Disorder.  

James E. Houston & Lani C. Fujitsubo. New Harbinger Publications, Inc., First Edition, 2000. 

Where else can I go to learn more about PMDD?