One of the more surprising findings in practice has been the prevalence of silent suffering among women dealing with Premenstrual Dysphoric Disorder. This has been followed by the benefit of patients being seen and heard; of identifying the cause of mood dysregulation, and walking through the options for treatment.
What it is:
Premenstrual Dysphoric Disorder (PMDD) is a severe type of Premenstrual Syndrome (PMS) which affects between 1.6% to 8% of menstruating women globally (Gao et al., 2022).
PMDD can cause severe dysfunction, both relationally in one's personal life, impact one's functioning at work and causing challenges with parenting. The difficulty is that PMDD isn't diagnosed by a blood or hormone test. Many women think they just have really bad PMS and it takes a thorough provider to hear the symptoms severity and not simply write it off.
During the 7-10 days prior to the onset of menses, called the luteal phase, women may experience the following symptoms according to the DSM-5:
Heightened anxiety or tension
Low mood
Sudden mood changes
Irritability
Loss of interest in daily activities
Difficulty concentrating
Decreased energy
Food cravings and appetite changes
Insomnia or hypersomnia
Physical symptoms, such as breast tenderness or bloating
These symptoms interfere with activities, work, school, or relationships
These symptoms are not due to a cyclical exacerbation of another disorder, such as depression, bipolar disorder, anxiety or ADHD
Documentation by daily symptom ratings for at least two menstrual cycles
To meet criteria for PMDD, women need to experience five or more symptoms. It is worth seeing a Psychiatric Mental Health Nurse Practitioner or Psychiatrist to explore the symptoms as PMDD can look similar to other psychiatric disorders like depression, anxiety, hypothyroidism or bipolar disorder when untreated.
Currently, the only way to diagnose PMDD is to track symptoms for two months and share that information with your psychiatric provider for further evaluation.
How to Track:
Some people benefit from a pencil and paper option and there are many to be found online. Important information to identify include changes to sleep, mood rating, physical symptoms experienced, difficulty with concentration and irritability.
Mental Health Apps to Aid in Tracking:
Available on Apple
A Health fitness app that can help track mood as it correlates with your cycle, sleep patterns, and provides suggestions for nutrition that may positively impact mood.
How Treatment could Impact Your Life:
With PMDD, it's worth noting that a core component of diagnosis is that symptoms significantly impact various areas of one's life. Treating PMDD appropriately can bring balance, restoration and even empowerment - as many of the treatment options include lifestyle and dietary changes that have cumulative benefit for overall wellbeing.
Options for treatment can include:
Referral to women's health practitioner for hormonal treatment options
Discussion of dietary changes and supplements such as calcium, B6 and Magnesium that may provide benefit for symptoms
Use of Selective Serotonin Reuptake Inhibitors during the luteal phase of the menstrual cycle for targeted treatment.
For those who notice symptoms aligning with PMDD, implementing a mood tracker for two months and scheduling time to discuss symptoms with your Psychiatric Nurse Practitioner would be appropriate.
No content on this site should ever be used as a substitute for direct medical advice from your PMHNP or Doctor. Haelen Mental Health does not receive any financial endorsements from the products mentioned above.
References:
Gao M, Zhang H, Gao Z, Cheng X, Sun Y, Qiao M, Gao D. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8735714/Medicine (Baltimore). 2022 Jan 7;101(1):e28528. doi: 10.1097/MD.0000000000028528. PMID: 35029919; PMCID: PMC8735714.
Harvard Health Publishing. (Jan 2022). Treating Premenstrual Dysphoric Disorder. https://www.health.harvard.edu/womens-health/treating-premenstrual-dysphoric-disorder
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