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Could It Be More Than Just PMS?

Cramps, bloating, irritability--most women are familiar with the symptoms of PMS. In fact, the American College of Obstetricians and Gynecologists estimates that at least 85 percent of menstruating women have at least one PMS symptom during their period. A lot of women seem to manage the symptoms by taking over the counter medications, getting extra sleep, or even just weathering the storm until symptoms subside.

PMS symptoms can vary but include:

  • Acne
  • Swollen or tender breasts
  • Feeling tired
  • Trouble sleeping
  • Upset stomach, constipation, or diarrhea
  • Bloating
  • Cramping
  • Headache or back pain
  • Appetite changes or cravings
  • Trouble concentrating
  • Tension, irritability, mood swings
  • Anxiety or depression

In general, a lot of people tend to just chalk up a woman's occasional crankiness and cravings to PMS. But for a small number of women, the symptoms are much more troubling than that.

Between 2 and 10 percent of women experience a much more severe form of PMS, known as PMDD: premenstrual dysphoric disorder. PMDD symptoms are similar to PMS symptoms, but they are so intense that they can interfere with a woman's work, social life, and relationships. Most women who seek treatment for severe PMS or PMDD have at least two or three symptoms, and probably have a combination of emotional and physical symptoms.

Many questions about PMDD remain unanswered, like what causes it and how symptoms can be alleviated. The good news is, researchers are currently studying treatments for PMDD, such as serotonin reuptake inhibitors, or SSRI, antidepressants, and oral contraceptives to regulate hormones.

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15 How Is PMDD Different From PMS?

PMDD is more than just a little bloating and cramping before a woman gets her period. It is a condition that is classified as a disorder in the Diagnostic and Statistical Manual of Mental Disorders. PMDD usually gets more severe as menstruation nears, causing the woman to feel very strong emotions like tension, anxiety, anger, depression.

If a woman's PMS symptoms are so severe and are beginning to affect her mentally and emotionally, some doctors will consider a PMDD diagnosis. While PMS symptoms may be uncomfortable and unpleasant, PMDD can cause severely debilitating symptoms that interfere with a woman's ability to concentrate, do work, and interact with others.

A recent study showed a strong correlation between a woman's symptoms and interference in all aspects of her life. Women who have PMDD reported significantly more interference in relationships with their husbands and families than women who have PMS.

14 What Causes PMDD?

It is unclear what causes PMDD. Depression and anxiety are common in both PMS and PMDD. Doctors think it's possible that the hormonal changes during the menstrual cycle can worsen the symptoms of existing mood disorders.

Recent studies have found a possible connection between PMDD and low levels of serotonin, a brain chemical that helps transmit nerve signals. Brain cells that use serotonin as a messenger control your attention span, sleep, and feelings of pain. It is thought that changes in serotonin levels are what can lead to PMDD symptoms.

13 What Are the Symptoms of PMDD?

Like PMS, PMDD symptoms usually start to appear a week or two before your period starts. Symptoms can continue for the first few days that you have your period. PMDD can cause a lot of symptoms that are commonly associated with PMS, like bloating, breast tenderness, fatigue, and changes in sleep and eating habits.

However, with PMDD, extreme emotional/behavioral symptoms can also appear, such as sadness or depression, anxiety, moodiness, irritability, and anger.

For a diagnosis of PMDD to be made, a woman will usually be asked to keep a diary to record her symptoms for at least two menstrual cycles. These symptoms must cause an impairment in functioning. A woman must have at least five PMDD symptoms from a list of 11 symptoms.

The symptoms must occur during the period of a woman's menstrual cycle after ovulation and before menstruation. If a woman doesn't have the required number of symptoms to meet the criteria for a PMDD diagnosis, that doesn't mean she doesn't have anything; she still has severe PMS and may need to seek treatment to help with unpleasant symptoms.

12 How Is PMDD Diagnosed?

Before a doctor makes a diagnosis of PMDD, he or she will rule out other emotional problems, such as a depression or panic disorder. In addition, a physical exam will rule out medical conditions like endometriosis, fibroids, menopause, or hormonal imbalances that could also be causing symptoms.

For a PMDD diagnosis, doctors require the patient to have at least five of the following symptoms:

PMDD is diagnosed when at least five of the above symptoms occur after ovulation. Prior to the onset of menstruation, the symptoms usually intensify to the point of being overwhelming. During the first or the second day of menstruation, the symptoms subside, and the patient begins to feel normal again.

The patient can feel normal and symptom-free for up to 10 days before the PMDD cycle starts again. If the patient's symptoms are present every day and linger after menstruation begins, they are probably not due to PMDD.

11 Ruling out Other Disorders

It is important for doctors to rule out other possible conditions before arriving at a PMDD diagnosis. Medical illnesses such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and migraines can have symptoms that are very similar to those of PMDD. Also, depression and anxiety disorders can be exacerbated during the premenstrual period and may imitate PMDD symptoms.

When this occurs, the term PME, or premenstrual exacerbation, is used to refer to the worsening of the patient's mood before the onset of a menstrual period. It is estimated that 40 percent of women who seek treatment for PMDD actually end up having a PME of a pre-existing mood disorder.

PMDD can be identified primarily by the cyclical, repetitive nature of the symptoms. PMDD mood symptoms are only present for a specific period of time leading up to menstruation, while other mood disorders are variable or constant over time. The best way to distinguish PMDD from an existing mood disorder is to track symptoms daily over a period of time.

10 Treatment: a Healthier Lifestyle

By making some lifestyle changes, it is possible to alleviate some of the physical (and maybe even a few of the mental) symptoms of PMS and PMDD. Making positive lifestyle changes may also help the depression, seasonal affective disorder and bipolar disorder that often occur with PMDD.

Regular exercise can help reduce premenstrual symptoms. It's unclear whether or not it can help with PMDD symptoms, but is often suggested for its other health benefits. Many doctors suggest that women with PMDD limit their intake of salt, caffeine, sugar, and alcohol, and quit smoking. Obesity, smoking, and poor diet can further complicate PMDD.

A recent study of 10 years of health data from more than 3,000 women showed that those who smoked were more than twice as likely to develop moderate to severe PMS symptoms than non-smoking women. It's also a good idea to try to limit stress. Yoga, meditation, and relaxation exercises can help alleviate some of the anxiety and tension that may accompany other PMDD symptoms.

9 Treatment: Nutritional Supplements

While their effectiveness hasn't been well studied, your doctor may suggest that you start taking nutritional supplements to help with your PMS/PMDD symptoms. Certain nutritional supplements have been shown to improve PMS symptoms, calcium being one of the most popular.

A large trial found that getting 1200 mg calcium a day significantly reduced both the physical and emotional symptoms of PMS. To maintain healthy amounts of calcium in your body, you shouldn't drink more than three cups of coffee or one soda per day; these caffeinated beverages contain acids that can rob your body of calcium.

Other studies have shown that vitamin B6, magnesium, and vitamin E can also improve symptoms in some women. These supplements, as well as many herbal remedies, have all been studied for use in PMDD treatment, but as of yet, there is no consistent or overwhelming evidence to guarantee their effectiveness in relieving moderate to severe symptoms.

8 Treatment: Medication

Many women attempt to treat physical PMS symptoms themselves. Some over-the-counter pain relievers such as aspirin, ibuprofen, and naproxen may help with physical symptoms such as headaches, breast tenderness, back aches, and cramping. Diuretics or water pills can help with fluid retention and bloating.

Because of the possible link between hormones and serotonin levels, many doctors believe that selective serotonin reuptake inhibitor, or SSRI, antidepressants should be recommended first. There are several antidepressants which may be used to treat PMDD. The three drugs that are approved by the FDA for treating PMDD symptoms are Sarafem, Paxil, and Zoloft. These may help with emotional symptoms, fatigue, food cravings, and sleep problems.

If anxiety is a present symptom, an anti-anxiety drug may be recommended. However, none is currently approved to treat PMDD. These drugs are also typically limited to being taken a few days at a time during each cycle to deter dependence.

7 Treatment: Herbal Remedies

Some herbal remedies, like the chasteberry, wild yam, dandelion, and bupleurum, can help with hormonal imbalances. A lot of these herbal remedies can be used to treat symptoms of PMS and even menopause.

These herbs are said to help alleviate bloating, weight gain, cramps, irritability, depression, and headaches caused by hormonal changes during a woman's menstrual cycle. Some women also report improvement of PMS symptoms when using herbs such as black cohosh, ginger, raspberry leaf, St. John's Wort, and evening primrose oil.

Because the FDA doesn't regulate herbs and herbal supplements, it's best to seek your doctor's advice before trying any. Some herbal remedies can have adverse interactions with other medicines you are taking, or can make them less effective.

For example, St. John's Wort may diminish the effectiveness of blood pressure medications. Like St. John's wort, black cohosh, which is often used to treat symptoms of menopause and PMS, can also cause problems with heart medications, and even possibly cause liver damage!

6 Treatment: Hormones

Hormones can be used to treat PMDD. Many women prefer to take birth control pills as a way to stop ovulation. Oral contraceptives are sometimes given for PMDD, but because there are so many different forms of birth control pills, there have not been a lot of studies to demonstrate how effective they are in treating PMDD symptoms.

New studies suggest some new formulations may be beneficial, possibly because of the levels of progestin and estrogen they use, but the results of these studies are still a little unclear.

Menstruation can be stopped completely using medicines such as Danazol, Zoladex, Synarel, and Lupron. These drugs suppress estrogen production, basically causing the body to mimic menopause. Another way of using hormones to treat PMDD is by the use of progesterone for symptom relief. Progesterone can come in suppositories, vaginal gels, and creams or lotions that are applied to the skin.

5 Treatment: Counseling

Some PMDD sufferers may benefit from therapy or counseling. In individual or group therapy, women can learn strategies to help them cope with the emotional symptoms of PMDD. Relaxation techniques, meditation, and reflexology may also help with symptoms.

Women can also learn to deal with depression and anxiety by finding a support group, whether online or in real life. Sometimes, just knowing you're not the only one struggling with your feelings or with these symptoms can help you feel much better.

For information on how to find PMDD support groups, check out the National Association for PMDD. The NAPMDD site gives you lots of information on symptoms (including a printable symptom tracker), diagnosis, treatment, and may help you find a healthcare provider in your area who specializes in PMDD. You can also send an e-mail or chat with a peer support volunteer or find links to several online support groups.

4 Can PMDD Affect Your Fertility?

Many women experience problems with their periods, and women who are having trouble conceiving may wonder if some sort of menstrual disorder is the cause. Some menstrual disorders that interfere with ovulation may decrease your fertility and your chances of becoming pregnant. However, because PMDD does not interfere with the biological process of ovulation, it should not affect your chances of conceiving.

In fact, some doctors believe that PMS symptoms are a sign that your menstrual cycle is working as it should. If you become pregnant, the egg is fertilized before your PMS symptoms would normally begin. If the egg is not fertilized, the presence of PMS symptoms is a signal that your period will soon start and that your cycle is working correctly.

It's also thought that if you become pregnant, your PMDD symptoms will temporarily subside, as your body is no longer going through the menstrual cycle--the same for menopause!

3 Complications From PMDD

PMDD symptoms are far more severe than PMS. The symptoms are so severe, that if left untreated, they can seriously interfere with a woman's daily life. Mood changes and depression that may accompany PMDD can be associated with suicidal thoughts and behavior.

Although the symptoms of PMDD can negatively impact a woman's quality of life, getting a diagnosis is vital because there are several treatment options available that are effective in controlling symptoms.

Several PMDD sufferers are concerned that they are bipolar; many suffer from debilitating anxiety and depression. Sadly, almost 15 percent of sufferers have reported attempting suicide. Many women who have undergone different treatment options have claimed what works for a while sometimes eventually wears off; they are left to find an alternative treatment.

Some women, even young women in their 20s and 30s, are so desperate to find a solution that they even consider undergoing a hysterectomy and/or oophorectomy to remove the uterus and/or the ovaries to remove the cause of PMDD altogether.

2 Overcoming the Stigma of Menstruation

There is often a stigma attached to any condition that is associated with the menstrual cycle. For years, many women have just lived with their symptoms and attempted to treat them at home with over the counter medicines.

According to a survey by the Society for Women's Health Research, not many women are aware of PMDD; Surprisingly, 84 percent of survey respondents, even those who indicated they had severe PMS/PMDD symptoms, responded they had never even heard of PMDD. Many women just assume that these symptoms are a part of life and don't bother to seek help.

The same survey also showed interesting results related to the respondents and their doctors: 45 percent of those surveyed indicated they have never discussed PMS or their symptoms with their doctors. Of the women surveyed who described their symptoms as strong or severe, 24 percent felt their doctors wouldn't take their complaints seriously, even if they did attempt to seek help.

1 See Your Doctor

If you are experiencing severe PMS-like symptoms and are concerned you might have PMDD, you should start keeping a symptom journal. Keep track of your symptoms--when they occur and how long they last. If you have any of the previously mentioned PMDD symptoms, you should definitely see your doctor.

It will be helpful to go to your appointment with a list of the symptoms that you are experiencing. Your doctor will most likely review your symptoms and should give you a thorough medical exam, including a blood test, to rule out other conditions. Your doctor may also feel that a psychiatric evaluation would be helpful and/or necessary.

Talk to your doctor before taking any nutritional or herbal supplements, as it is possible that supplements can interfere with other medications you may be taking. Your doctor may suggest different lifestyle changes, medications, therapies, or a combination of those to help you take control of your symptoms.

Sources: WebMD, Mayo Clinic, U.S. National Library of Medicine, Medicine Net

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