Severe Form of PMS May Have Roots in Stress

From the WebMD Archives

May 4, 2001 -- For years, a small percentage of women with a severe form of PMS were told the monthly mood swings, irritability, and depression that coincides with their monthly menstrual period was all in their heads.

"These women are so frustrated with dealing with the traditional medical community -- but hopefully, things are changing and improving," says Susan S. Girdler, PhD.

As Girdler and other experts know only too well, what these women suffer from is not standard PMS but a more severe condition known as PMDD.

PMDD, or premenstrual dysphoric disorder, is characterized by severe, abrupt monthly changes in mood with increased anxiety and anger as well as physical symptoms that interfere with everyday life, including a woman's relationships with her family and friends. PMDD typically occurs the week before, and disappears a few days after, the onset of menstruation.

An estimated 5-10% of women in their reproductive years have PMDD. But despite the serious nature of the problem, many women, their doctors, and their loved ones are unaware of what it is or what can be done about it.

Do you get PMS? Think it might actually be PMDD? Talk it over on WebMD's Women's Health message board, moderated by Jane Harrison-Hohner, RN, RNP.

A recent survey conducted by the Society for Women's Health Research found that 84% of women did not know that PMDD even existed or that it can be diagnosed and treated. About 25% of women in the survey who described their premenstrual symptoms as strong or severe were among those unaware that these severe symptoms have been officially classified as PMDD.

In some women the symptoms are so severe they meet the criteria for diagnosis of depression, says Girdler, assistant professor of psychiatry at the University of North Carolina, Chapel Hill.

The problem is that the depression, though severe, only lasts for a short time each month, leaving some doctors reluctant to treat it as they would traditional depression that has lasted for weeks or months.

But Girdler says advances in research are helping bring about a better understanding of PMDD. In a new study published this month in the journal Biological Psychiatry, she and her colleagues report that women with PMDD appear to have abnormal bodily responses to stress.


Unlike healthy women, who respond to stressful situations by increasing their body's production of a hormone called allopregnanolone, women with PMDD produce less, not more, of the hormone when stressed. Oddly enough, Girdler says women with PMDD actually have more of the hormone present in their bodies most of the time than women without PMDD, but it doesn't increase at times when it should.

"One possibility is that they have normal levels [of allopregnanolone] but they [break it down] abnormally," she says. Allopregnanolone is a substance that results from the breakdown of the sex hormone progesterone.

An early treatment idea was to give women with PMDD progesterone therapy to boost their abnormal levels, but Girdler says the studies clearly show that it doesn't work.

One thing that does work in some women is antidepressant therapy.

Last year, Sarafem became the first prescription medication approved for the treatment of PMDD. Like Prozac, which shares the same active ingredient as Sarafem, it helps to correct an imbalance of serotonin, a chemical responsible for communication between nerves in the brain. Serotonin is thought to be involved in depression.

Sarafem has also been found to reduce some physical complaints of PMDD such as bloating.

More research and more public attention is good news for PMDD sufferers who haven't been given much hope for treatment until the last decade or so, says Jean Endicott, PhD.

"I think it's a relief for many women to know it is a recognized condition, that it has biological underpinnings, and that people are trying to find something that will work," says Endicott, director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center, in New York. "It's moved a long way certainly from the '80s when we had virtually nothing to offer women."