What is premenstrual dysphoric disorder, and how is it different from PMS?

PMDD typically manifests in the luteal phase of the menstrual cycle, which occurs in the two weeks before menstruation. “The exact cause of PMDD is not fully understood, but hormonal fluctuations, particularly changes in serotonin levels, are believed to play a role. Serotonin is a neurotransmitter that regulates mood, and its imbalance can lead to emotional symptoms associated with PMDD,” said Dr Sushruta Mokadam, consultant obstetrician, Motherhood Hospital, Kharadi, Pune.

Symptoms

The symptoms of PMDD can be both emotional and physical. Dr Mokadam said that emotional symptoms may include severe irritability, sadness, anxiety, and mood swings. “Individuals with PMDD may also experience difficulty concentrating, fatigue, and a sense of being overwhelmed. Physical symptoms can include bloating, breast tenderness, headaches, and joint or muscle pain.”

What distinguishes PMDD from PMS?

It is the severity and duration of symptoms. According to Dr Mokadam, PMDD symptoms are more intense and disruptive, significantly impacting a person’s ability to function in their daily life, relationships, and work. “The disorder can have a profound effect on mental health, and individuals with PMDD may be at a higher risk of developing other mood disorders.”

Diagnosing PMDD involves tracking symptoms over several menstrual cycles, ruling out other potential causes, and ensuring that the symptoms are not solely related to an existing psychiatric condition, said Dr Mokadam.

Know more about how PMDD affects your daily functioning (Source: Freepik)

Diagnosis

There is no specific test for PMS, and diagnosis is based on the presence of recurring symptoms about the menstrual cycle but diagnosis of PMDD involves tracking symptoms over several menstrual cycles and ruling out other potential causes. The symptoms must be severe enough to impact daily functioning significantly, said Dr Shobha Gupta, medical director, gynecologist and IVF specialist, Mother’s Lap IVF Centre in New Delhi and Vrindavan.

Given that both PMS and PMDD are associated with underlying depression and anxiety, the hormonal fluctuations associated with the menstrual cycle may exacerbate the symptoms of mood disorders. “While PMDD is a more severe and serious disorder that may necessitate medical intervention, PMS is thought to be a natural component of the menstrual cycle and affects many women to varied degrees. It is essential to speak with a healthcare provider if someone thinks they may have PMDD so they can be properly assessed and managed,” said Dr Gupta.

Treatment

Dr Mokadam said that treatment options for PMDD include lifestyle changes, such as regular exercise and a healthy diet, as well as psychotherapy and medication. “Selective serotonin reuptake inhibitors (SSRIs) are often prescribed to help regulate serotonin levels and alleviate mood-related symptoms.”

She added that while PMDD can significantly impact the quality of life, seeking support from healthcare professionals, and mental health experts, and building a strong support system can contribute to the effective management of this challenging condition.

It’s important to remember that each person responds differently to treatment, and a medical practitioner will customise the plan based on the needs of each patient. Dr Gupta stressed that treatment plan modifications and routine monitoring may be required. “Keeping lines of communication open with medical professionals is also essential for resolving any issues or negative effects related to the selected course of treatment.”