Premenstrual dysphoric disorder
| Premenstrual dysphoric disorder | |
|---|---|
| Other names | Late luteal phase dysphoric disorder |
| Specialty | Psychiatry |
| Symptoms | Severe mood swings, depression, irritability, agitation, uneasiness, change in appetite, severe fatigue, anxiety, anger insomnia/hypersomnia, breast tenderness, decreased interest in usual social activities, reduced interest in sexual activity, difficulty in concentration |
| Usual onset | Can occur anytime during reproductive years |
| Duration | 6 days – 3 weeks of cycle |
| Causes | Likely neuro-sensitivity to reproductive hormones |
| Risk factors | Family history, history of violence/trauma, smoking, presence of other mental health disorders |
| Diagnostic method | Based on symptoms & criteria |
| Differential diagnosis | Premenstrual syndrome, depression, anxiety disorder |
| Treatment | Medication, counselling, lifestyle change, surgery |
| Medication | SSRIs, drospirenone-containing oral contraceptives, GnRH analogs, cognitive behavioral therapy (CBT) |
| Frequency | Up to about 8% of menstruating women |
Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptoms occur in the luteal phase (between ovulation and menstruation), improve within a few days after the onset of menses, and are minimal or absent in the week after menses. PMDD has a profound impact on a woman's quality of life and dramatically increases the risk of suicidal ideation and even suicide attempts. Many women of reproductive age experience discomfort or mild mood changes before menstruation, but 5–8% experience severe premenstrual syndrome (PMS), causing significant distress or functional impairment. Within this population of reproductive age, some will meet the criteria for PMDD.
PMDD's exact cause is unknown. Ovarian hormone levels during the menstrual cycle do not differ between those with PMDD and the general population. But because symptoms are present only during ovulatory cycles and resolve after menstruation, it is believed to be caused by fluctuations in gonadal sex hormones or variations in sensitivity to sex hormones.
In 2017, National Institutes of Health researchers discovered that women with PMDD have genetic changes that make their emotional regulatory pathways more sensitive to estrogen and progesterone, as well as their chemical derivatives. The researchers believe this increased sensitivity may cause PMDD symptoms.
Studies have found that those with PMDD are more at risk of developing postpartum depression after pregnancy. PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013. It has 11 main symptoms, of which five must be present for a PMDD diagnosis. Roughly 20% of females have some PMDD symptoms, but either have fewer than five or do not have functional impairment.
The first-line treatment for PMDD is with selective serotonin reuptake inhibitors (SSRIs), which can be administered continuously throughout the menstrual cycle or intermittently, with treatment only during the symptomatic phase (approximately 14 days per cycle). Hormonal therapy with oral contraceptives that contain drospirenone have also demonstrated efficiency in reducing PMDD symptoms. Cognitive behavioral therapy, whether in combination with SSRIs or alone, has shown to be effective in reducing impairment. Dietary modifications and exercise may also be helpful, but studies investigating these treatments have not demonstrated efficacy in reducing PMDD symptoms.