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Premenstrual dysphoric disorder

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Illustrations

Depression and the menstrual cycle
Depression and the menstrual cycle

Alternative Names    Return to top

PMDD

Definition    Return to top

Premenstrual dysphoric disorder (PMDD) is a condition marked by severe depression, irritability, and tension before menstruation. These symptoms are more severe than those seen with premenstrual syndrome (PMS).

Causes    Return to top

The causes of PMS and PMDD have not been identified, although social, cultural, biological, and psychological factors all appear to be involved. Researchers estimate that PMDD affects between 3% and 8% of women in their reproductive years.

Major depression is very common with PMDD, although PMDD can occur in women who do NOT have a history of major depression.

Studies have found that women who have seasonal affective disorder (SAD), a form of depression characterized by annual episodes of depression during fall or winter that improve in the spring or summer, are likely to also have PMDD.

Symptoms    Return to top

The symptoms of PMDD are similar to those of PMS, but they are generally more severe and debilitating. Symptoms occur during the last week of most menstrual cycles and usually improve within a few days after the period starts.

Five or more of the following symptoms must be present:

Exams and Tests    Return to top

There are no physical examination findings or lab tests specific to the diagnosis of PMDD. A complete history, physical examination (including a pelvic exam), and psychiatric evaluation should be conducted to rule out other potential conditions.

Keeping a calendar or diary of symptoms can help women identify the most troublesome symptoms and the times they are likely to occur. This information may help the health care provider diagnose PMDD and determine the appropriate treatment.

Treatment    Return to top

Women with PMDD may be helped by the following:

In addition, it is important to keep a diary or calendar to record the type, severity, and duration of symptoms.

Selective serotonin-reuptake inhibitors (SSRIs) are antidepressant drugs that can treat PMDD. SSRIs include fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa).

Nutritional supplements -- such as vitamin B6, calcium, and magnesium -- may be recommended. Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramping and breast tenderness. Diuretics may be useful for women who have significant weight gain due to fluid retention.

Outlook (Prognosis)    Return to top

After proper diagnosis and treatment, most women with PMDD find that their symptoms go away or drop to tolerable levels.

Possible Complications    Return to top

PMDD symptoms may become severe enough that they interfere with a woman's daily life. Women with depression may have worse symptoms during the second half of their cycle and may require medication adjustments.

As many as 10% of women who report PMS symptoms, particularly those with PMDD, have had suicidal thoughts. The incidence of suicide in women with depression is significantly higher during the latter half of the menstrual cycle.

PMDD may be associated with eating disorders and smoking.

When to Contact a Medical Professional    Return to top

Call 911 immediately if you are having suicidal thoughts.

Call for an appointment with your health care provider if:

Update Date: 11/8/2006

Updated by: Audra Robertson, MD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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