While many are familiar with premenstrual syndrome (PMS), fewer are aware of the severe emotional and physical toll of premenstrual dysphoric disorder (PMDD), which can involve depression, suicidal thoughts, and isolation.
Introduction
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that affects individuals of childbearing age. It is a chronic condition characterized by extreme mood swings, irritability, depression, and physical symptoms that occur in the luteal phase of the menstrual cycle. PMDD significantly impacts daily life and requires medical attention. While lifestyle changes, such as diet, exercise, and stress management, can alleviate symptoms, treatment may also involve medications like antidepressants, hormonal therapies, or pain relievers to help manage the condition effectively.
Etiology
The exact cause of Premenstrual Dysphoric Disorder (PMDD) is still unknown. However, it is thought to result from an abnormal reaction to the hormonal changes during the menstrual cycle. These hormonal fluctuations, particularly in estrogen and progesterone, may lead to a deficiency in serotonin, a neurotransmitter that plays a key role in mood regulation. Serotonin is naturally found in the brain and intestines, and its deficiency can cause mood disturbances and physical symptoms, such as irritability, depression, and fatigue, which are commonly experienced in PMDD.
Epidemiology
Premenstrual symptoms affect nearly all women of reproductive age, from menarche to menopause. In the U.S., about 70-90% of women in this group report some premenstrual discomfort, with around one-third experiencing symptoms severe enough to be diagnosed with PMS. The most severe form, Premenstrual Dysphoric Disorder (PMDD), affects 3-8% of these PMS cases. Additionally, transgender individuals with ovaries can also experience PMDD, making it a significant health concern across the lifespan for anyone with ovaries.
Diagnosis and Treatment
Premenstrual Dysphoric Disorder (PMDD) is diagnosed through symptom tracking, medical history, and ruling out other conditions. Symptoms must occur in most menstrual cycles over a year, causing significant distress and impacting daily functioning. Treatment includes dietary changes, exercise, stress management, supplements, anti-inflammatory medications, selective serotonin reuptake inhibitors (SSRIs), and birth control pills. For some, symptoms may worsen over time, requiring long-term treatment until menopause.
The different Phases of PMDD
1. Ovulation Phase
During the ovulation stage of the menstrual cycle, typically around day 14 of a 28-day cycle, the ovary releases an egg, leading to a significant spike in luteinizing hormone (LH) and a decrease in estrogen and progesterone levels. This hormonal fluctuation is thought to trigger the fatigue, depression, and anxiety experienced by individuals with Premenstrual Dysphoric Disorder (PMDD) after ovulation. Before this, individuals often feel a sense of joy and contentment, reflecting the cyclical rise and fall of hormones that contribute to the mood swings characteristic of PMDD.
2. Luteal Phase
In Premenstrual Dysphoric Disorder (PMDD), the luteal phase is the time in the menstrual cycle that begins after ovulation and lasts until menstruation starts. They experience a range of severe psychological, neurological, and gastrointestinal symptoms. These can include anger, irritability, anxiety, suicidal thoughts, food cravings, changes in appetite, mood swings, insomnia, bloating, constipation, backache, vomiting, fainting, and muscle spasms. These symptoms are often so debilitating that they impair daily functioning at home, work, and in relationships.
3. Menstruation
During the menstrual stage of Premenstrual Dysphoric Disorder (PMDD), the intense symptoms experienced during the luteal phase typically begin to subside. This phase starts with the onset of menstruation and usually lasts for a few days. The distress typically lessens with the onset of menstruation. Treatments such as hormonal birth control, selective serotonin reuptake inhibitors (SSRIs), and pain medications can help alleviate symptoms, offering relief from the intense challenges faced during the luteal phase
4. Follicular Phase
Between days 6 and 14 of the menstrual cycle, individuals experience the follicular phase, during which a follicle develops in the ovary and matures into an egg for ovulation. During this time, estrogen and follicle-stimulating hormone levels rise, leading to eventual spike in luteinizing hormone (LH) that triggers the luteal phase. To manage these symptoms, taking proactive steps such as consulting a healthcare provider, preparing balanced meals with less sugar and more protein and carbohydrates, and increasing exercise is important. For those with a 28-day cycle, day 14 marks the start of a new cycle and can feel like a point of inevitable distress, as one individual described it, where their life feels like it’s unraveling due to the onset of PMDD symptoms.
Healthcare Outcomes
Differentiating PMDD from PMS and other psychiatric disorders like anxiety or depression is essential, and requires strong coordination among the healthcare team, including primary physicians, gynecologists, and psychiatrists. Effective interprofessional management includes educating patients about symptoms, encouraging them to keep a symptom diary, and involving a therapist to help with coping strategies alongside medication. This collaborative approach enhances patient care and helps in managing the emotional and physical challenges of PMDD.
Conclusion
Discussing menstruation without addressing Premenstrual Dysphoric Disorder (PMDD) overlooks the severe impact it has on 5–8% of people who experience debilitating psychological, neurological, and gastrointestinal symptoms before their period. Unlike typical PMS, PMDD can be profoundly distressing and varies greatly among individuals. Raising awareness and fostering empathy are crucial for supporting those affected and encouraging open discussions about their struggles.
Citations
1. Premenstrual Dysphoric Disorder (PMDD). (2024b, April 26). Johns Hopkins Medicine.
2. Key, A. P. (2024, March 6). What Causes Premenstrual Dysphoric Disorder (PMDD)? WebMD. https://www.webmd.com/women/pms/premenstrual-dysphoric-disorder
3. WIS. (2024, May 23). Beyond the Monthly Struggle: Raising Awareness and Encouraging Empathy - AWIS.
4. Mishra, S., Elliott, H., & Marwaha, R. (2023, February 19). Premenstrual Dysphoric Disorder. StatPearls - NCBI Bookshelf.
Comentários