PMDD Or Severe PMS
PMDD is a severe form of the premenstrual syndrome(PMS).
The acronym stands for the Premenstrual dysphoric disorder.
like PMS, it used to be an issue of ‘it is all in your head’. There is
some debate today about the realities of these conditions. However, it
is increasingly being recognized as a separate disease entity.
I will discuss the definition, symptoms, some debates amongst experts as well as its treatment.
What Is PMDD?
The Premenstrual dysphoric disorder (PMDD) is a severe form of
premenstrual syndrome(PMS). It comprises similar behavioral, emotional
and physical symptoms associated with the luteal phase of the menstrual
It is estimated to affects about 3 to 8% of
menstruating women. Symptoms are often more severe in younger women than
those closer to the perimenopause period.
This condition is often associated with related psychiatric disorders such as anxiety disorders and major depression.
Despite the severity of the condition, there are actually no
acceptable known causes. Whenever I counsel people suffering from
diseases like this one, it is often hard to relate things like this. In
fact neither does anyone like to hear this. Handling a serious disease
with an unknown cause seems to be double trauma to deal with.
Nevertheless, no known causes does not no available treatment. It is
similar to primary menstrual cramps with no known specific causes.
theories have come up to explain the mechanisms behind this
condition.Whatever this may be,it is certain it is related to the
luteal phase processes of the menstrual cycle including the hormones
especially estrogen. Some research is suggesting some links with the
neurotransmitter serotonin.Similarly, genetic factors have been raised
as a contributing factor in some women.
Other factors that may play a role include:
- Alcohol abuse
- Drinking large amounts of caffeine
- Having a mother with a history of the disorder
- Lack of exercise
Essentially, the symptoms are also divided into physical, emotional and behavioral as in PMS.
What Kind Of Disease Is It?
There has been some debate amongst experts about the reality of this
disease. In 1993, the American Psychiatric Association gave the name
PMDD to replace its former appellation ‘late luteal phase dysphoric
disorder(LLPDD)’. They classified it as a disease that ‘requires further
Some experts have argued that PMDD is just a
medicalization of normal human behavior to make diseases where they
really do not exist.Some have even accused some pharmaceutical companies
of trying to make people believe it does exist for marketing of their
Some nations in Europe do not yet accept it as a
distinct disease entity. Maybe the widespread sensitization for this
condition may lead to an over-diagnosis.
Whatever the case, we should guard against over diagnosis and take care of those who have debilitating symptoms!
It is important the diagnosis be made by a physician. I have had
young women who were told by close ones they have the disease and just
took it as ‘Gospel truth’. Over-diagnosis must be avoided.
are really no lab or imaging tests that could be done to make the
diagnosis. By a careful history and physical examination including a
pelvic and psychiatric examinations, your doctor will be able to make
the diagnosis. Lab test may be requested to exclude other possibilities.
calender of symptoms is very useful for diagnosis and treatment.
Because these symptoms occur in a predictable pattern, the type and
timing of the most serious symptoms can be recorded on a calender or
diary by the woman which may be very helpful in providing targeted
The treatment of this condition is basically the same as PMS treatment
except for specific symptom treatment like PMS depression.
How Long Will I Deal With This?
Since there is no curative treatment, most women will to control
symptoms until the cycles stop at menopause. The symptoms are generally
worse in younger women but get less severe in older women as they
approach perimenopause. In principle, they are suppose to rapidly
decline and vanish with menopause.
There is now an effective
treatment at least for most of the symptoms so each woman should ensure
adequate medical care throughout the cycle years.
PMDD may result in some complications during the menstruation years.
- Daily life debilitation.
The quality of a woman’s life can be severely affected by the
symptoms. Most especially, meaningful relationships may be ruptured
leading to a cycle of more stress and symptoms.
- Suicide. This is the most feared complication of depression.
- Associated psychiatric illness. Diseases such as eating disorders, anxiety disorders or even major depression may be common in these women.
When To seek medical care
Suicidal thoughts should be treatment as an emergency. Contact the
emergency unit nearest to you as soon as you note these thoughts.
regular medical visit should be sought if symptoms are not improving
with current treatment or they are having having important consequences
on your daily life.
Resources For More Reading
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