Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder: When monthly hormonal fluctuations become torture

Many women are familiar with the mood swings and physical discomfort associated with the luteal phase of the menstrual cycle - more commonly known as premenstrual syndrome (PMS). These symptoms can be uncomfortable, but for some women they reach unbearable levels and significantly affect their quality of life1-3. This condition is known as premenstrual dysphoric disorder syndrome (PMDD) and deserves special attention and education. In fact, only a few reliable figures on the frequency of PMS can be found in scientific literature. This is mainly due to the fact that there is no standardized definition for PMS. The picture is somewhat clearer for the most severe form of PMS, PMDD, which affects around 5-8% of all women4

What is PMDD?

In PMDD, women usually experience significant emotional and physical symptoms which are only present in the second half of the cycle, about a week before their period begins. Typically, the symptoms disappear with the onset of menstruation.

Compared to premenstrual syndrome (PMS), which affects many women to varying degrees, the symptoms of PMDD are far more severe and can have a significant impact on daily life1-3

Women suffering from PMDD often experience a rollercoaster of emotions and physical discomfort that goes far beyond the usual premenstrual discomfort.

The 5 core symptoms of PMDD:

  1. Severe depression:
    Women with PMDD can face intense sadness and low mood during the premenstrual phase, which can severely affect their overall well-being.
  2. Extreme irritability:
    Irritability can be so pronounced in PMDD that interpersonal relationships and job performance suffer greatly.
  3. Anxiety:
    A significant feature of PMDD is persistent anxiety and worry, which can be heightened during this time.
  4. Mood swings:
    Women with PMDD can switch rapidly and extremely between different moods, from intense anger and frustration to deep despair.
  5. Sleep problems:
    Disturbed sleep or insomnia can be another challenging symptom that affects quality of life.

These symptoms can occur individually or in combination and vary in intensity and duration from woman to woman. A diagnosis of PMDD requires that at least 1 symptom occurs  in the second half of the cycle,over several cycles, and has a significant impact on everyday life.

What are the causes of PMDD?

Despite intensive research efforts, the exact causes of PMDD are not yet fully understood. One major factor associated with this condition is hormonal changes in the menstrual cycle. Normally, the menstrual cycle should be controlled by a sophisticated interplay of different hormones, including oestrogen and progesterone. These hormones influence a woman's mood, sleep patterns, and sensitivity to pain.

However, women with PMDD appear to have an increased sensitivity to these hormonal fluctuations. One possible explanation for this could lie in the role of the neurotransmitter serotonin. Serotonin is a chemical messenger in the brain that plays a key role in the regulation of mood and emotional well-being. It is thought that hormonal changes during the menstrual cycle can affect serotonin levels, which in turn exacerbates the emotional symptoms of PMDD.

Treatment of PMDD

When it comes to the treatment of PMDD, it is important to note that there is currently no standard treatment for this complex condition. PMDD can occur differently from woman to woman and the causes are varied. For example, some sufferers are particularly sensitive to changes in progesterone levels, while others are more affected by fluctuations in oestrogen. Therefore, finding the right treatment is an individualized process.

The main goal in treating PMDD is to control and mitigate the symptoms as much as possible to allow those affected to live a better life. It is important to understand that the sensitivity to hormones in PMDD is neurobiological and therefore the condition is often considered chronic. In many cases, a combination of different treatment approaches can be useful to achieve the best possible results.

An important step in the treatment of PMDD is the consistent tracking of symptoms. This not only helps those affected to better understand their symptoms, but also enables doctors and therapists to understand and adapt the effectiveness of the various treatment approaches.

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Author: Dr. Niels van de Roemer

Quellen:

1) https://psycnet.apa.org/record/2013-14907-000

2) https://pubmed.ncbi.nlm.nih.gov/26351143/

3) https://pubmed.ncbi.nlm.nih.gov/26377947/

4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118460/