premenstrual dysphoric disorder


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Related to premenstrual dysphoric disorder: premenstrual syndrome

Premenstrual Dysphoric Disorder

 

Definition

Premenstrual dysphoric disorder (PMDD) is a collection of physical and emotional symptoms that occurs 5 to 11 days before a woman's period begins, and goes away once menstruation starts. The most severe form of premenstrual syndrome (PMS) is PMDD.

Description

PMS is estimated to affect 70-90% of childbearing age. The more severe form of the disorder, PMDD, affects 3-5% of women of childbearing age. Up to 40% of women have PMDD symptoms that are so severe they interfere with their daily activities. It is more common in women in their late 20s and early 40s, who have at least one child and a history of depression, anxiety/tension, affective lability, or irritability/anger.

Causes and symptoms

Although the actual cause of PMDD is not known, it is believed to be related to hormonal changes that occur before menstruation. There are more than 150 signs and symptoms attributed to PMDD, and every woman experiences different ones at different times. There seem to be socioeconomic and genetic factors that precipitate PMDD. Twin studies have demonstrated a positive correlation with heritability and PMDD symptoms. Anti-anxiety medications have been shown to help improve symptoms associated with PMDD. The most common symptoms include headache, swelling of ankles, feet, and hands, backache, abdominal cramps, heaviness or pain, bloating and/or gas, muscle spasms, breast tenderness, weight gain, recurrent cold sores, acne, nausea, constipation or diarrhea, food cravings, anxiety or panic, confusion, difficulty concentrating and forgetfulness, poor judgment, and depression.

Diagnosis

PMDD is diagnosed when symptoms occur during the second half of the menstrual cycle (14 days or more after the first day of a woman's period), are absent for about seven days after the period ends, increase in severity as the cycle progresses, go away when the menstrual flow begins or shortly thereafter, and occur for at least three consecutive menstrual cycles. There are no tests to diagnose it. The diagnosis of PMDD emphasizes and requires psychologically important mood symptoms.

Treatment

Recently, the Food and Drug Administration approved the first prescription drug for the treatment of PMDD, Serafem (fluoxetine). Additionally, non-steroidal anti-inflammatory drugs, such as ibuprofen and aspirin, may help with bloating and pain; beta-blockers may help with migraines; anti-anxiety medications, such as buspirone or alpraxolam, may help with anxiety; and certain other antidepressants in addition to Serafem may help with depression.

Alternative treatment

Non-pharmaceutical treatments include a variety of lifestyle changes, such as following a healthy diet, exercise, stress relief therapies, and even such alternative therapies as aromatherapy. Certain vitamins and supplements may also help, such as vitamin B6, calcium, magnesium, and vitamin E. Certain herbs may also help with symptom relief, including vitex, black cohosh, valerian, kava kava, and St. John's wort.

Prognosis

The prognosis varies for each woman, and is largely dependent on how much work she is willing to do in terms of lifestyle changes. Additionally, planning for PMDD symptoms, joining a support group, and communicating with her spouse and family can help minimize the negative effects of PMDD and its impact on a woman's home and work environments.

Prevention

Some women may find their PMDD disappears periodically. Diet and nutritional supplements can have the greatest impact in preventing PMDD.

Resources

Organizations

Advancement of Women's Health Research. 1828 L Street, N.W., Suite 625 Washington, DC 20036. 202-223-8224. http://www.womens-health.org.
National Association for Premenstrual Syndrome. 7 Swift's Court, High Street, Seal, Kent TN15 0EG UK +44 (0) 1732 760011 〈www.PMDD.org.uk〉.

Key terms

Antidepressant — A medication used to relieve the symptoms of clinical depression.
Beta blockers — Class of drug, including Corgard (nadolol), and Lanoxin (digoxin), that primarily work by blunting the action of adrenaline, the body's natural fight-or-flight chemical.
Nonsteroidal anti-inflammatory drugs — This class of drugs includes aspirin and ibuprofen, and primarily works by interfering with the formation of prostaglandins, enzymes implicated in pain and inflammation.

premenstrual

 [pre-men´stroo-al]
preceding menstruation.
premenstrual dysphoric disorder premenstrual syndrome viewed as a psychiatric disorder.
premenstrual syndrome (PMS) the presence of symptoms in the period before menstruation or in the early days of the menstrual period; also called premenstrual tension. Definition and diagnosis depend on the timing and the cyclic nature of symptoms rather than on specific clinical manifestations, which can vary greatly from one patient to another but follow a consistent pattern in the individual from cycle to cycle.

Various psychological and emotional causes of this syndrome have been proposed; only recently has serious attention been paid to it as a physical as well as a psychological phenomenon. Research has shown that onset and increased severity of symptoms often occur when rapid hormonal changes are taking place, e.g., at puberty, after a pregnancy, or when oral contraceptives are discontinued. A transient increase in water retention seems to account for edema, weight gain, bloating, and breast changes. Other etiologic factors may be an estrogen-progesterone imbalance, hypoglycemia, vitamin deficiencies, prostaglandins, and psychogenic disturbances.
Symptoms. Symptoms may begin at the time of ovulation and increase until the menses, or they may appear at ovulation, abate, and then reappear and increase until menses. In some cases they arise only a few days before the onset of menstruation. In true PMS the symptoms cease with the onset of menses or last no more than a few days into the cycle.

Premenstrual syndrome can affect virtually every system of the body and produce behavioral changes that have significant psychosocial impact. Physical symptoms may include headache, vertigo, or paresthesias; common colds, rhinitis, asthma, sinusitis, or sore throat; abdominal bloating, nausea, or food cravings; breast tenderness and engorgement; backache, joint pain, and edema; and others. Psychological or emotional symptoms may include irritability, tiredness with sleep disturbance, mood swings, depression, and altered libido.
Treatment. Successful management of the syndrome is difficult and protocols vary greatly, probably because there is no clear understanding of the causes. Therapies include progesterone therapy, administration of vitamin B6 daily, and curtailment of intake of sodium, methylxanthines (coffee, tea, and chocolate), and nicotine. Additionally, the patient may be advised to restrict the intake of refined sugar, alcohol, and animal fats. Increasing the intake of vegetable oils may be recommended in order to enhance prostaglandin formation.
Patient Care. A major goal of intervention is the promotion of self-care strategies. For example, the patient is encouraged to keep a menstrual calendar to validate cyclic changes and to give her a sense of purposeful management of her life. She may then plan to avoid stressful events during the time symptoms are present. Counseling can help identify sources of stress and effective mechanisms to deal with stressful situations. Sufficient sleep and rest are needed because fatigue tends to exaggerate the symptoms. Moderate exercise can increase the patient's sense of well-being. A nutritious diet is also helpful, especially the inclusion of foods that are natural sources of the B vitamins and magnesium. The intake of sodium, caffeine, and refined sugar should be limited and alcohol and tobacco avoided.

Severe premenstrual symptoms can seriously disrupt vital human relationships, leading to domestic problems including child abuse and other acts of violence. Health care providers will need to be aware of the psychosocial ramifications of premenstrual syndrome and to facilitate positive coping behaviors, make referrals to agencies prepared to deal with these kinds of problems, and provide support and counseling when indicated.

premenstrual dysphoric disorder (PMDD),

1. a pervasive pattern occurring during the last week of the luteal phase in most menstrual cycles for at least a year and remitting within a few days of the onset of the follicular phase, with some combination of depressed mood, mood lability, marked anxiety, or irritability; various specific physical symptoms; and significant functional impairment; the symptoms are comparable in severity with those seen in a major depressive episode, distinguishing this disorder from the far more common premenstrual syndrome.
See also: premenstrual syndrome.
2. a specified set of criteria in the DSM, proposed for the purpose of futher research.

premenstrual dysphoric disorder

n.
A severe form of premenstrual syndrome characterized by affective symptoms, such as mood swings, irritability, depressed mood, and anxiety, that cause significant disturbances in relationships or social adaptation and that cease shortly after the onset of menses.

premenstrual dysphoric disorder (PMDD)

a mental health condition in women that begins 1 or 2 weeks before menstrual flow. Symptoms include depression, tension, mood swings, irritability, decreased interest, difficulty in concentrating, fatigue, changes in appetite or sleep, physical symptoms, and a sense of being overwhelmed. The condition affects 3% of menstruating women, usually between 25 and 30 years of age. Compare premenstrual syndrome.

premenstrual dysphoric disorder

The official American Psychiatric Association Diagnosis and Statistical Manual, 4th ed. (DSM-IV), term for premenstrual syndrome (PMS).

premenstrual dysphoric disorder

The official term for PMS–premenstrual syndrome, see there.

pre·men·stru·al dys·phor·ic dis·or·der

(PMDD) (prē-men'strū-ăl dis-fōr'ik dis-ōr'dĕr)
A pervasive pattern occurring during the last week of the luteal phase in most menstrual cycles for at least a year and remitting within a few days of the onset of the follicular phase, with some combination of depressed mood, mood lability, marked anxiety, or irritability; various specific physical symptoms; and significant functional impairment; the symptoms are comparable in severity to those seen in a major depressive episode, distinguishing this disorder from the far more common premenstrual syndrome.
See also: premenstrual syndrome

pre·men·stru·al dys·phor·ic dis·or·der

(prē-men'strū-ăl dis-fōr'ik dis-ōr'dĕr)
Pervasive pattern occurring during last week of luteal phase in most menstrual cycles for at least 1 year and remitting within a few days of onset of follicular phase, with some combination of depressed mood, mood lability, marked anxiety, or irritability.
References in periodicals archive ?
Relationships of premenstrual dysphoric disorder to major depression and anxiety disorders: A re-examination.
Treatment of the emotional and physical symptoms of premenstrual dysphoric disorder (PMDD) in women who choose to use an oral contraceptive as their method of contraception.
The syndrome of more severe depression, irritability and tension occurring seven to 10 days prior to the start of the menstrual period is known as premenstrual dysphoric disorder (PMDD) (also called late-luteal dysphoric disorder).
Twenty women aged 18-45 years with documented premenstrual dysphoric disorder were enrolled in a single-blind, placebo phase (one cycle), during which they received a placebo 14 days before expected menses.
conduct disorder (15%), premenstrual dysphoric disorder (11%), and attention-deficit hyperactivity disorder (7%).
PARIS -- Treatment of premenstrual dysphoric disorder may be more effective if a selective serotonin reuptake inhibitor is used throughout the luteal phase and not withheld until symptoms appear.
These sales were achieved through a marketing campaign that presented the medications as more than mere birth control pills and touted them as treatments for premenstrual dysphoric disorder, premenstrual syndrome and moderate acne.
These symptoms, called premenstrual dysphoric disorder (PMDD), can include irritability, fatigue, moodiness, feeling anxious and bloating.
SAN FRANCISCO -- Women with premenstrual dysphoric disorder usually respond rapidly to the first treatment cycle of an antidepressant, allowing intermittent dosing that follows the menstrual cycle, Dr.
Earlier this year, sertraline joined fluoxetine as an approved medication for premenstrual dysphoric disorder, both in intermittent and continuous dosing schedules.
Teva's Fluoxetine Capsules are the AB-rated generic equivalent of Eli Lilly's Sarafem[R] Pulvules[R], and are indicated for the treatment of premenstrual dysphoric disorder (PMDD).
But the new lower-dose formulation (20 mcg of EE/3 mg drospirenone) given over a 24-day period with only 4 hormone-free days can significantly reduce symptoms of premenstrual dysphoric disorder (PMDD) compared with placebo, said Dr.