Beyond the basics of PMS and PMDD
PMS and PMDD overview
Premenstrual syndrome (PMS) describes symptoms a woman may have one or two weeks before her menstrual cycle. Premenstrual dysphoric disorder (PMDD) is a more severe form of PMS. Common symptoms of PMS and PMDD include irritability, anger, depression, and aches.
Mild PMS is common, and is said to affect high percentages of women with regular menstrual cycles. Only 3 to 8 percent of women are affected by PMDD.
PMS and PMDD causes
There is no one reason why some women develop PMS or PMDD and others don’t.
The physical and emotional symptoms associated with menstruation are thought to be related to (but not caused by) rising and falling levels of hormones (e.g., estrogen and progesterone). The body’s responses to hormone fluctuations may influence chemicals in the brain, including a brain chemical called serotonin, which affects mood.
PMS and PMDD Symptoms
The most common PMS and PMDD symptoms include:
- abdominal cramping
Other symptoms include:
- feelings of worthlessness
- frequent tearfulness
- difficulty concentrating
- changes in appetite
- breast tenderness
- feelings of being overwhelmed or out of control
Disorders that imitate PMS and PMDD
There are conditions that have symptoms similar to those of PMS and PMDD but are different ailments. Depression, anxiety disorders, bipolar disorder, and perimenopause (the four- to five-year period before menopause) require different treatments than needed in cases of PMS or PMDD.
There are also medical disorders that worsen before or during menstruation, including migraines; chronic fatigue syndrome (CFS); pelvic and bladder pain; or irritable bowel syndrome. Doctors can look at a woman’s medical history and should be able to pinpoint from which disorder she is suffering.
Of course, it is possible for a woman to have both PMDD and another medical condition.
PMS and PMDD Diagnosis
There is not a simple test to take to diagnose PMS or PMDD. Women need to keep track of their symptoms and then look at the whole picture.
Symptoms must occur only during the second half of the menstrual cycle, usually five to seven days before the menstrual period begins. There must be physical and behavioral symptoms. Moreover, symptoms should not be present between days 4 through 12 of a 28-day menstrual cycle in women with PMS or PMDD.
Blood tests — A doctor may recommend a blood test to screen for different medical conditions like anemia or hypothyroidism, which both have similar symptoms to PMS and PMDD. A blood test is not needed to diagnose PMS or PMDD.
Tracking symptoms — It is vital to record symptoms on a daily basis for at least two full menstrual cycles before diagnosing PMS or PMDD.
PMS and PMDD Treatment
Medication is usually the best treatment for women with PMDD.
Exercise and relaxation treatments — Regular exercise, relaxation techniques, or vitamin and mineral supplements are usually the first line of treatment recommended for PMS. These therapies can help reduce stress, tension, anxiety and other psychological conditions. They do not work on everyone. If there is not sufficient relief, prescription medications may be offered.
Exercise and relaxation treatments are also recommended for women with PMDD, along with a prescription medication.
The best medications for PMS or PMDD are selective serotonin reuptake inhibitors (SSRIs). SSRIs include fluoxetine (Prozac and Sarafem), sertraline (Zoloft), citalopram (Celexa), and paroxetine (Paxil). Research shows that between 60 and 75 percent of women with PMDD improve with an SSRI.
Some women with PMS or PMDD have noted that birth control pills help relieve symptoms. Others find the opposite to be true and say that the birth control pill aggravates their PMS symptoms.
More information, please
Your health care provider should be the first person you contact for more information. There are also many health-oriented sites dedicated to PMS and PMDD.