Image from Freepik.com/dragana-gordic
What if your PMS is actually something more worrying?
How’s your period health? There’s PMS… And then there’s Premenstrual Dysphoric Disorder (PMDD), a disorder characterised by more severe symptoms that occurs in three to eight percent of women – up to 90 percent of whom go undiagnosed.
So I’m super-irritable… How do I know if it’s PMS or PMDD?
“A reproductive disorder whereby women experience transient physical and emotional changes around the time of their period, PMDD is associated with a level of impairment that is similar to major depressive disorder and poorer quality of life compared with community norms, therefore it should be considered a serious health condition. PMDD can have adverse consequences on a woman’s social functioning, relationships, work productivity and healthcare use,” says Dr Eileen Thomas, a specialist psychiatrist at Akeso Clinic Milnerton.
She adds that to be diagnosed with PMDD “a woman must experience at least five of 11 possible symptoms in the week before menstruation starts (the luteal phase). Symptoms must improve once menstruation has begun and the symptoms must be absent the week after menstruation has ended. Women with PMDD report a normal mood and functioning during the follicular phase of the menstrual cycle (i.e. the first day of the menstrual cycle until ovulation).”
Who Is At Risk Of PMDD?
While any woman can develop PMMD, women with a personal or family history of depression, postpartum depression, or other mood disorders are particularly at risk. Women who experience abuse (emotional, physical or sexual) in early life places are at higher risk for PMS in the middle-to-late reproductive years, Thomas adds.
What Are The Symptoms Of PMDD?
As defined in the American Psychiatric Association (APA) Diagnostic and Statistical Manual, Fifth Edition (DSM-5), one of required symptoms to make a diagnosis must come from this list of four:
– Irritability or anger.
– Anxiety and tension.
– Depressed mood or feeling hopeless.
– Marked affective lability (e.g. mood swings, feeling suddenly sad or tearful or increased sensitivity to rejection).
“Other symptoms include difficulty concentrating, fatigue, changes in appetite or specific food cravings, sleep disturbances, feeling overwhelmed and physical symptoms such as breast tenderness or abdominal bloating. These symptoms occur recurrently, typically in the same constellation-set and in the majority of menstrual cycles.”
I Tick All The Boxes. What’s My Next Step?
Chart your symptoms daily for two consecutive cycles and take this info to your doc. “Your doctor will also ask you about your medical and psychiatric history, medication and substance use. It’s important to provide accurate and thorough information to distinguish PMDD from mimics, like dysmenorrhea,” Thomas stresses.
Treatment generally comprises both lifestyle and pharmacological interventions.
Decrease or eliminate caffeine, sugar and sodium. Other helpful lifestyle modifications include decreasing alcohol and nicotine use, ensuring adequate sleep and regular aerobic exercise. Herbal remedies include calcium carbonate and chaste berry.
“The first line pharmacological treatment to reduce both the physical and emotional symptoms is serotonergic antidepressant drugs, particularly selective serotonin reuptake inhibitors (SSRIs). In general, women respond to low doses of SSRIs, and this treatment response usually occurs rapidly, often within several days,” says Thomas.
“Women may choose to take the antidepressant continuously throughout the whole month, or only in the luteal phase (the week leading up to period). Other pharmacological options include hormonal treatment such as oral contraceptives that contain drosperinone – an antidiuretic or short-term anxiolytic use.”
Does It Ever Stop?
“Treatment generally continues for the duration of a woman’s reproductive life. If one considers that a female typically menstruates 300-500 times during her lifetime, timely identification and initiation of appropriate treatment may prevent impairment. This, together with support and TLC from loved ones or spouses, can go a long way in improving the quality of life of PMDD sufferers,” says Thomas.