What is PMS/PMDD?
Premenstrual syndrome (PMS) is a term that refers to a group of physical and emotional symptoms that occur in a cyclic pattern during the second half of a women’s menstrual cycle and may interfere with some aspects of her life. Mild PMS symptoms can affect up to 75% of women with regular menstrual cycles. The most common symptoms are bloating, fatigue, irritability, and anxiety. Other symptoms can include:
- Breast Tenderness and/or swelling
- Mood Swings, Irritability, or Anger
- Depression or Anxiety
- Food Cravings and Increased appetite
- Hypersomnia or Insomnia
- Feeling overly sensitive, crying easily, feeling overwhelmed
- Social withdrawal
- Constipation or diarrhea
- Gastrointestinal upset
- Poor Concentration and fatigue
- Hot Flashes
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS. PMDD symptoms are severe enough to interfere with a woman’s daily life and activities. PMDD can also negatively impact relationships with family and friends. Approximately 3-8% of women have PMDD.
Women must have at least 5 or more symptoms and meet diagnostic criteria defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Editions (DSM-IV).
What causes PMS/PMDD?
The cause of PMS and PMDD is not clear but studies suggest that rising and falling estrogen and progesterone levels cause changes in brain chemicals including serotonin which affects mood. It is not clear why some women develop symptoms of PMS or PMDD and others do not. It may be that some women may be more sensitive to the hormonal fluctuations than others.
How is PMS/PMDD diagnosed?
PMS and PMDD are not diagnosed with a blood test but is assessed by keeping track of symptoms and when they occur during the menstrual cycle for at least 2 full cycles. PMS/PMDD symptoms usually occur during the second half of the menstrual cycle. These symptoms usually begin 5 to 7 days prior to the start of the menstrual cycle. Blood tests may be ordered to help rule out other disorders. A careful history will be taken about symptom timing, severity of symptoms and how long symptoms last with each cycle. Other problems like depression and anxiety have similar symptoms but are usually noticeable throughout the cycle.
How is PMS/PMDD treated?
Some women with PMS will experience relief of symptoms with adequate sleep, regular exercise and relaxation techniques to reduce anxiety, tension and fatigue. Vitamin and mineral supplements can also be helpful. These recommendations have few or no side effects. Calcium carbonate supplements of 600mg twice daily have been shown to reduce symptoms after 3 months in some women. Vitamin B6 (up to 100mg daily) may also have some benefit.
Magnesium 400mg daily may help to reduce fluid retention and bloating.
Maintaining a healthy diet, avoiding salt, caffeine, alcohol and nicotine will contribute to feeling better overall.
Exercise and relaxation therapy may help to decrease stress, tension, anxiety and depression.
NSAIDS (ibuprofen or naproxen) taken before or at the onset of your period may ease PMS cramps and breast tenderness.
Prescription medications can be added as a second option. Selective serotonin reuptake inhibitors (SSRIs) are anti-depressant medications that have been proven to be very effective in reducing symptoms of PMS and PMDD. These medications may need to be taken every day or sometimes for the 2 weeks before the next period starts. SSRIs need to be taken for at least 2 menstrual cycles to decide if they are relieving symptoms.
Birth control pills may relieve symptoms of PMS/PMDD in some women. Continuous use of birth control pills may prevent the cyclic hormonal changes that affect mood.
Medroxyprogesterone acetate (Depo Provera) may be used for severe PMS or PMDD as this injection temporarily stops ovulation during its use.
One birth control pill (Yaz) has been approved for treatment of PMDD. Your practitioner will work with you to determine which treatment is appropriate for you.
Other suggested treatments have been proven to provide no benefits. These include progesterone, diuretics, and other anti-depressant medications. Dietary supplements also proven to provide no benefit include evening primrose oil, ginkgo biloba and essential free fatty acids.
What to Expect…
You may see some relief in the first month but expect gradual improvement over 2-3 months. Because PMS/PMDD is on ongoing process, it takes time to regulate it. It is important to maintain commitment to lifestyle changes and give supplements or medication time to reduce symptoms. Always follow up with your health care provider with any persistent or worsening symptoms to discuss treatment options.
Hormone Health Network: www.hormone.org
National Institutes of health: www.nlm.nih.gov/medlineplus/healthtopics.html