Premenstrual dysphoric disorder (PMDD) is much more than your run of the mill PMS. For those with PMDD, hormonal fluctuations cause severe emotional and physical symptoms for 1-2 weeks leading up to the menstrual cycle. These symptoms can be disruptive to your life for as long as half of the month, but there is relief. Both through pharmacotherapy and psychotherapy, you can manage and reduce your symptoms so that they do not dominate your daily life.
Understanding PMDD
- Feelings of hopelessness, worthlessness, or depression
- Anxiety and irritability, feeling constantly on edge or overwhelmed
- Self-critical thoughts
- Acute rejection sensitivity
- More frequent crying
- Lack of interest in usual activities
- Fatigue and lethargy
- Changes in diet or sleep
- Breast swelling and tenderness, headaches, muscle aches, or bloating
Comorbidities of PMDD
PMDD can be even more severe and disruptive for those who already suffer from mood or personality disorders. It has high comorbidity rates with seasonal affective disorder, bipolar disorder, and generalized anxiety disorder (GAD), as well as perinatal depression and dysthymic disorder (otherwise known as persistent depression).3
For those who already have mood disorders, PMDD can heighten the intensity of the mood swings and feelings of depression or lethargy that are often symptoms. PMDD lasts for about 1-2 weeks each month, meaning that during those weeks, mood symptoms can feel overwhelming. This is especially true without treatment. Fortunately, there are a number of treatments available.
Treatments for PMDD
There are both therapeutic and medication treatments for PMDD. In addition, lifestyle changes may help to reduce symptoms. Some patients may respond better to one type of treatment compared to others. However, often a combination of treatments proves most effective.
Therapy for PMDD
Talk therapy may help you cope with symptoms of PMDD, especially behavioral or emotional symptoms. Through therapy, you can vent your frustrations in a safe and non-judgmental space as well as come up with coping mechanisms to manage your symptoms. Behavioral therapies such as cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT) may be especially helpful for symptoms of PMDD. Therapy is also an excellent option if you suffer from a comorbidity of PMDD.
Medication for PMDD
Psychiatrists often prescribe SSRIs to provide relief from PMDD. SSRIs work by increasing the levels of serotonin in your brain, which help to relax you and boost your mood. By reducing stress, you may even notice a reduction in physical symptoms of PMDD. If you do not have a comorbidity for which SSRIs are prescribed, you may only need to take this medication during the week that your PMDD symptoms rear their head.
An OBGYN might also prescribe birth control medication to help you regulate your menstrual cycle and symptoms. This can offer relief in terms of both physical and emotional symptoms. Over the counter pain medication or anti-inflammatory medication may also help with physical symptoms.
Lifestyle Changes for PMDD
If you suffer from PMDD, it’s especially important to take care of your body. Physical health and emotional health are interconnected, especially when it comes to a disorder based on hormonal fluctuations like PMDD.
Make sure to get enough sleep each night and to eat a balanced, nutritious diet. Try to avoid alcohol, caffeine, or excess sugar where you can as these can exacerbate symptoms. Aerobic exercise like walking, swimming, and biking can help reduce physical symptoms as well as boost your mood and energy. And taking daily vitamins can help to counteract the hormonal fluctuations and symptoms that come from them.
Other Treatments for PMDD
Other treatments for PMDD include gonadotropin releasing hormone (GnRH) analogue injections or, in extreme cases, surgery. These treatments are usually only recommended when other PMDD treatments have proven ineffective. GnRH injections bring about a temporary menopause for patients, which can lead to a relief from symptoms. Due to potential side effects, GnRH treatments are usually limited to six months and taken in combination with HRT (hormone replacement therapy).
In severe cases, a doctor might recommend a hysterectomy or a bilateral salpingo-oophorectomy (an operation which removes the ovaries and fallopian tubes rather than the uterus). This would permanently end your menstrual cycle and stop PMDD symptoms, though it would then lead to menopause. These surgeries are non-reversible and therefore only recommended in extreme cases when no other treatment has been found effective.
The skilled and compassionate clinicians at Rivia Mind are here to help you find relief from your PMDD symptoms through therapy and medication management. Contact us today to learn more about how we can help you or to find one of our providers for yourself. We also offer a free 15-minute consultation.
Resources:
- Premenstrual Syndrome (PMS) – Office on Women’s Health
- New data shows prevalence of Premenstrual Dysphoric Disorder – University of Oxford
- The association between premenstrual dysphoric disorder and depression: a systematic review – ScienceDirect
