By Kathie Gonzales, ARNP-BC
Many women, up to 40% say they experience some type of premenstrual symptoms (PMS). Common symptoms include fatigue, bloating, breast tenderness, and irritability. But, for women with premenstrual dysphoric disorder (PMDD) symptoms are much more severe and often incapacitating, affecting their quality of life. PMDD, like PMS symptoms, occur in the later or luteal phase of the menstrual cycle and improve at the onset of menstrual bleeding. A multitude of negative symptoms occurs as a result of the rapid rise and fall of estrogen and progesterone. It is not considered to be the result of a hormonal imbalance, but the body’s abnormal response to the shift hormones. PMDD is diagnosed after symptoms reoccur over two to three menstrual cycles and include at least five or more of the following symptoms according to the International Association for Premenstrual Disorders:
- Feelings of sadness or despair or even thoughts of suicide
- Feelings of tension or anxiety
- Panic attacks, mood swings, or frequent crying
- Lasting irritability or anger that affects other people
- Lack of interest in daily activities and relationships
- Trouble thinking or focusing
- Tiredness or low energy
- Food cravings or binge eating
- Trouble sleeping
- Feeling out of control
- Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
Symptoms tend to worsen over time and particularly after big hormonal shifts from giving birth or a miscarriage, placing these women at risk for postpartum depression and even suicidal thoughts.
There is evidence from previous studies of families that PMDD has an inherited genetic component that in part, may account for the abnormal emotional responses some women have to changes in sex hormones and their receptors. The National Institutes of Health (NIH) found that women with PMDD had an altered cellular response to hormonal changes when compared to asymptomatic women. Many providers believe that PMDD is affected by high estrogen levels and low progesterone levels in the luteal phase of the menstrual cycle however, attempting to balance hormones by giving patients progesterone or birth control will make symptoms worse in those patients.
Women with PMDD incur repeated mental and personal harm as a result of their detrimental behaviors towards themselves and others close to them. Treatment for PMDD needs to be individualized to each woman suffering from this complex condition, requiring patience and compassion from their healthcare providers. There is limited scientific data available related to specific treatments for PMDD and other premenstrual disorders, however, Dr. Les Cole and the staff at St. Pete Health and Wellness have found several treatment options to be safe and effective.