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PMS Health Center

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Your Guide to Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder, or PMDD, is a severe form of premenstrual syndrome (PMS). The symptoms of PMDD are similar to those of PMS but are severe enough to interfere with work, social activities, and relationships.

How Common Is PMDD?

PMDD occurs in 2% to 10% of menstruating women. Women with a personal or family history of depression or postpartum depression are at greater risk for developing PMDD.

What Causes PMDD?

As with PMS, the exact cause of PMDD is not known. Most researchers, however, believe PMDD is brought about by the hormonal changes related to the menstrual cycle. Recent studies have shown a connection between PMDD and low levels of serotonin, a chemical in the brain that helps transmit nerve signals. Certain brain cells that use serotonin as a messenger are involved in controlling mood, attention, sleep, and pain. Therefore, chronic changes in serotonin levels can lead to PMDD symptoms.

What Are the Symptoms of PMDD?

The symptoms of PMDD can include any of the following:

  • Mood swings
  • Depressed mood or feelings of hopelessness
  • Marked anger, increased interpersonal conflicts
  • Tension and anxiety
  • Irritability
  • Decreased interest in usual activities
  • Difficulty concentrating
  • Fatigue
  • Change in appetite
  • Feeling out of control or overwhelmed
  • Sleep problems
  • Physical problems, such as bloating, breast tenderness, swelling, headaches, joint or muscle pain.

How Is PMDD Diagnosed?

If you have any of the above listed PMDD symptoms, you should see your doctor. He or she will review your symptoms and medical history and give you a thorough medical exam. Psychiatric evaluation may also be included.

Before a doctor makes a diagnosis of PMDD, he or she will rule out other emotional problems, such as depression or panic disorder, as the cause of the symptoms. In addition, underlying medical or gynecological conditions, such as endometriosis, fibroids, menopause, and hormonal problems that could account for symptoms, also must be ruled out.

PMDD is diagnosed when at least five of the above listed symptoms (including at least one of the first four) occur for most of the time during the seven days before menstruation and go away within a few days of the start of the menstrual period. If these symptoms are present every day and do not improve with menstruation, they are unlikely due to PMDD.

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