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Premenstrual Dysphoric Disorder

Premenstrual Dysphoric DisorderBy, Joe Briggs

What is Premenstrual Dysphoric Disorder?PMDDSevere PMS (Premenstrual Syndrome)Depression, tension and irritability are common.

Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS).PMS refers to a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when or shortly after her period begins

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Causes of PMDDThe Causes are NOT KNOWN.Hormones play some sort of role.Symptoms Disappear if ovaries are removed.Ovarian function may affect changes in brain chemistry.

The causes of PMS and PMDD have not been found.PMDD symptoms disappear if the ovaries are removed or not functioning (e.g., menopause). Current theories suggest that normal ovarian function may trigger changes in brain chemistry in women predisposed to PMDD. One brain chemical that may be especially important is serotonin, a neurotransmitter. The serotonin system has a close relationship to the female hormones, and imbalances of the serotonin system may play an important role in causing PMDD3

Incidence of PMDDOccurs in in 8% of woman who are having their menstrual cycle.May have a genetic disposition. Daughters of mothers with PMDD are likely to have the disorder as well.93% of Identical twins will both have PMDD.44% of Fraternal twins will both have PMDD.

PMDD affects roughly 8% of women during the years when they are having menstrual periods.

People sometimes wonder if PMDD is inherited. Genetics may play a role. Studies have shown that identical twins are more likely to share the disorder (93%) than non-identical twins (fraternal) (44%), and daughters of mothers with PMDD are more likely to have it themselves. However, no specific genes have been identified to account for PMDD. Perhaps it is best to simply say that there may be a genetic predisposition to developing the disorder.4

Risk FactorsAnxietyMajor DepressionSeasonal affective disorderAlcohol abuseOverweightSedentary lifestyleFamily History

Other factors that may play a role include: Alcohol abuse Being overweight Drinking large amounts of caffeine Having a mother with a history of the disorder Lack of exercise5

SymptomsSimilar to PMS, more severe.Occur during the week before menstrual bleeding.Examples (5 or more must be present):Disinterest in ADLsFatigue or low energySuicidal thoughts Binge eatingPanic attacksHeadaches and/or joint or muscle painPersistent irritability SleeplessnessTrouble concentrating

The symptoms of PMDD are similar to those of PMS. However, they are generally more severe and debilitating and include a least one mood-related symptom. Symptoms occur during the week just before menstrual bleeding and usually improve within a few days after the period starts.Five or more of the following symptoms must be present to diagnose PMDD, including one mood-related symptom:

Disinterest in ADLsFatigue or low energySuicidal thoughts Binge eatingPanic attacksHeadaches and/or joint or muscle painPersistent irritability SleeplessnessTrouble concentrating

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Do I have PMDD ?No physical exam or lab test can diagnose PMDD.Psychiatric evaluation is used to rule out other conditions.Keep a calendar or diary of symptoms when they occurred to help with a diagnosis and best course of treatment.

No physical examination or lab tests can diagnose PMDD. A complete history, physical examination (including a pelvic exam), and psychiatric evaluation should be done to rule out other conditions.Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times when they are likely to occur. This information may help the health care provider diagnose PMDD and determine the best treatment.8

Treatment of PMDDA healthy lifestyle is the first step to managing PMDD.Eat a Balanced DietGet sufficient sleepExerciseKeep a track of your symptomsOther Treatments:Birth control PillsDiureticsNutritional supplementsAntidepressantsCBT (Congenital behavioral Therapy)

A healthy lifestyle is the first step to managing PMDD.Eat a Balanced DietGet sufficient sleepExerciseKeep a track of your symptomsOther Treatments:Birth control PillsDiureticsNutritional supplementsAntidepressantsCBT (Congenital behavioral Therapy)

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ComplicationsADLsWorse in second half of menstrual cycleSuicidal ThoughtsHarder to resist cravingsMeds will most likely need to be adjusted

PMDD symptoms may be severe enough to interfere with a woman's daily life. Women with depression may have worse symptoms during the second half of their cycle and may need changes in their medication. It is almost never the right dose at the start.As many as 10% of women who report PMS symptoms, especially those with PMDD, have had suicidal thoughts. Suicide in women with depression is much more likely to occur during the second half of the menstrual cycle.PMDD may be associated with eating disorders and smoking.10

Expectations

After proper diagnosis and treatment, most women with PMDD find that their symptoms go away or drop to tolerable levels

After proper diagnosis and treatment, most women with PMDD find that their symptoms go away or drop to tolerable levels11

References

Vigod SN. Understanding and treating premenstrual dysphoric disorder: an update for the women's health practitioner. Obstet Gynecol Clin North Am. 2009;36:907-924, xii. [PubMed]Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 36

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