What is Premenstrual Dysphoric Disorder (PMDD)? (“Sharon’s* Story”)

Learn what PMDD is and what you can do to deal with PMDD symptoms.

Sharon is a 16 year old girl who is normally a calm person; usually things don’t get to her. However, during the week before her period, things dramatically change. She is unable to sleep well at night and has difficulty fitting into her usual clothing during that week. She finds herself yelling at her mother in the morning for minor things and is often late to school. She has a hard time concentrating in class and bursts into tears when someone tells her she looks tired. In gym class she cries because she has cramps and proceeds to yell at her best friend for no reason. It seems that everything is going wrong. While she normally enjoys hanging out with her friends, during the week that she gets her period, she simply wants to go home and crawl on the couch. Her relationships with her family and friends are affected by this, as is her schoolwork. At the suggestion of her pediatrician, Sharon goes to talk with a therapist who is able to explain to both Sharon and her mother why this is happening month after month. Together they come up with a treatment plan for her PMDD symptoms which is very successful and which allows Sharon to function as the happy, outgoing person that she is at other times during the month. This greatly improves her ablity to deal with both social and academic responsibilities. When Sharon is ready to go off to college, she will already have learned how to identify what PMDD symptoms are and what is not, and she will have developed the skills to deal with her PMDD symptoms when she feels them coming on., Having already established the proper course of treatment for her premenstrual dysphoric disorder, Sharon will be ready to cope with the challenges and embrace the milestones that are ahead of her.

To some degree all women experience PMS. Whether it is the fatigue, bloating, moodiness, irritability or pain, women often accept that this is just a part being a woman. However, approximately 5% of women will experience a more severe premenstrual condition known as premenstrual dysphoric disorder (PMDD). What is PMDD exactly? It is a worsening of mood that interferes significantly with a woman’s quality of life. In the one to two weeks before her period, a woman’s PMDD symptoms may exhibit themselves as anger or moodiness that seems out of control to her and to others.

In order to be diagnosed with premenstrual dysphoric disorder, a woman must have five of the following PMDD symptoms before her menstrual flow begins:

• markedly depressed mood or feelings of hopelessness
• anxiety or tension
• shift in mood-for example feeling suddenly tearful or overly sensitive
• persistent anger or irritability, increased conflicts
• loss of interest in usual activities
• difficulty concentrating and focusing attention
• marked lack of energy; feeling easily tired out
• change in appetite, overeating, or food cravings
• sleeping too much, or having a hard time sleeping
• feeling overwhelmed or out of control
• physical symptoms such as breast tenderness or joint or muscle pain

These PMDD symptoms usually interfere significantly with work, school, social activities or relationships. Once menstruation begins, the symptoms resolve. In order to be diagnosed with PMDD, there must be a clear interval of at least 7 to 10 days during each cycle when a woman feels physically and emotionally well. Premenstrual dysphoric disorder can begin at any age after a woman begins to menstruate. To confirm a diagnosis of PMDD and distinguish it from other conditions that are not related to the phase of the menstrual cycle, women may be asked to keep a diary of daily symptoms for two months before treatment for premenstrual dysphoric disorder is begun.

There are various ways to treat PMDD, including behavioral approaches and nutritional strategies. Behavioral approaches to treat PMDD symptoms include regular exercise, relaxation techniques, meditation and yoga. Regular aerobic exercise has been shown to have beneficial effects on both the physical and emotional symptoms of PMS and PMDD. PMDD can also be managed nutritionally. Women are advised to limit their consumption of alcohol, caffeine and salt, as well as sugar and more complex carbohydrates. Decreasing nicotine use and ensuring adequate sleep is also important. A diet composed of frequent high protein and low refined sugar meals is strongly recommended. Nutritional supplementation with vitamin B6, calcium and magnesium has been researched as well. Specific types of psychotherapies such as cognitive behavioral therapy may also be helpful. With proper diet, exercise, and medical supervision, what is PMDD-related is often quite manageable, which means that your PMDD symptoms do not have to take over your life each month.

To treat the emotional symptoms of PMDD, experts may recommend using antidepressant medication which can help with both the emotional and physical symptoms. Depending on the case, medication can be given continuously or only during the two weeks before a woman’s period. Birth control pills have also been shown to be effective in treating PMDD symptoms, as they suppress ovulation which is often thought to be involved in etiology of premenstrual syndromes. Each woman should discuss the risks/benefits of starting birth control pills with her doctor. In addition to taking medication for the emotional symptoms, additional medication can be given to relieve severe physical PMDD symptoms. Over-the-counter pain medication can be used to treat headache and muscle ache or diuretics prescribed by a physician can be used to treat the bloating. Living with premenstrual dysphoric disorder may seem overwhelming, but our caring, dedicated physicians, licensed psychologists, nutritionists, and other professionals are here to help you deal with all aspects of your PMDD symptoms, whether emotional, physical, or both.

How can I get an appointment?

For a consultation with Dr. Naomi Greenblatt about PMDD, call The Rocking Chair at (201) 308-5325.

* Pseudonym