Premenstrual Dysphoric Disorder (PMDD) is a rare but serious condition that can greatly impact a woman’s quality of life. It’s considered a severe form of Premenstrual Syndrome (PMS) that brings with it a host of uncomfortable symptoms during or around a woman’s period. While the two conditions share many of the same symptoms – including mood swings, cramping, cravings, headaches and fatigue – they are also distinct from each other. PMDD, specifically, includes an onslaught of more extreme behavioral and psychological symptoms, including feelings of sadness, hopelessness, or unexplainable anger or irritability. In rare cases, women with PMDD have reported experiencing suicidal thoughts or tendencies.
Although the exact cause of PMDD is unknown, research has found there are certain risk factors that increase a woman’s likelihood of suffering from this condition. Below, we discuss the suspected origin of PMDD as well as the risk factors that predispose a person to this condition.
What’s The Cause Of PMDD?
It’s important to recognize that neither PMDD nor PMS is a woman’s fault. They are naturally occurring conditions that many women may not realize they are suffering from, especially in the case of PMDD.
According to John Hopkin’s Medicine, while the exact cause of PMDD is unknown, there are theories that explain its existence. For instance, some research has suggested it is an abnormal reaction to regular hormonal changes that occur during a woman’s menstrual cycle, leading to a serotonin deficiency. Serotonin is a substance found in the brain that directly affects mood as well as other physical symptoms, thereby explaining the extreme effects that come with a PMDD diagnosis.
BabyGaga recently had the chance to speak with Jessica Ryniec, MD, a Reproductive Endocrinology & Infertility specialist for CCRM Boston. She elaborated on the cause of PMDD, explaining that it’s not the result of a hormonal imbalance, instead emphasizing how it’s an abnormal response to hormonal changes in the body related to a woman’s menstrual cycle.
“It is important to know that PMDD is NOT caused by a hormonal imbalance, but rather an abnormal response to hormonal changes (estrogen and progesterone) that normally occur during the second half of the menstrual cycle,” Dr. Ryniec explained. “Levels of serotonin and other neurotransmitters in the brain can be affected by these hormone fluctuations and lead to the mood symptoms seen with PMDD.”
Risk Factors Affecting PMDD
There are several risk factors that may increase a woman’s chances of suffering from PMDD. These may indicate whether an individual is more likely to suffer from the symptoms of PMDD. Such risk factors include:
Personal & Family History
On one hand, for instance, there seems to be a strong genetic component to the disorder. Medical News Today explains that women who either have a personal or family history of mental health problems, including but not limited to postpartum depression, mood disorders, and depression, stand a greater risk of developing PMDD. Similarly, if there is a history of PMDD or other menstrual cycle-related disorders in the family, it can also increase the likelihood, as well.
Dr. Ryniec echoes this. She explains that while there’s no proven genetic link in the presence of PMDD, there is a family history component. “There is active research into whether there is a genetic factor involved in PMDD, but right now there doesn’t appear to be anything identifiable,” Dr. Ryniec told BabyGaga. “It is more common in people with a family history of PMDD or other mental health disorders like depression or anxiety.”
Other Lifestyle Factors
John Hopkins Medicine warns that certain lifestyle factors may also contribute to PMDD. In particular, they note that women with lower education and a history of smoking are at an increased risk of developing PMDD.
Dr. Ryniec also reiterates this, saying, “Other risk factors for PMDD include lower education, cigarette smoking, a history of trauma, and history of other anxiety disorders.”
Treatment Options For PMDD
While there’s no single solution for treating PMDD, there are a wide range of things women can do to mitigate its symptoms as well as prevent them in the first place. Some of these treatment options include:
Birth Control
Dr. Ryniec acknowledges that birth control is one of the most common ways to treat PMDD. She explains how it works: Even though they are the same hormones that your body makes, they likely work for PMDD by stopping the fluctuations in hormone levels that occur in a regular cycle.” She adds, “Symptoms should be monitored as you can potentially switch to a different formulation if symptoms do not resolve or another medication can be added.”
Anti-Depressants
According to Harvard Health, antidepressants work to help improve PMDD by slowing the reuptake of serotonin. Specifically, the publication says that 60-90% of women who take anti-depressants for PMDD respond positively.
There are a wide variety of anti-depressants on the market, including selective serotonin reuptake inhibitors (SSRIs) like Celexa and Prozac. Women with PMDD may also be prescribed serotonin and norepinephrine reuptake inhibitor (SNRI) venlafaxine (Effexor) or a tricyclic antidepressant such as Anafranil. Speak with your doctor if you believe this is the right course of action for you.
Vitamins & Supplements
Incorporating certain vitamins and supplements into your diet can help mitigate the symptoms of PMDD. Harvard Health specifically encourages women with this condition to consider taking vitamin B6, calcium, magnesium supplements, as well as herbal remedies. The do, however, warn that “there is no consistent or compelling evidence leading to consensus about their efficacy,” so speak to your doctor to see if this could be beneficial to you.
“Many vitamins and dietary supplements have been studied without consistent effects when compared with placebo, although chasteberry (vitex) may have some small benefit,” Dr. Ryniec explained.
GnRH agonists
A gonadotropin-releasing hormone agonist (GnRH) is a form of medication that targets gonadotropins and sex hormones. They are used to low sex hormone levels and have been effective in treating a wide range of conditions, including cancer, gynecological disorders, and early on-set puberty. GnRH is used in a variety of fertility treatments and also in transgender hormone therapy. Dr. Ryniec explains that, in some cases, it’s also been effective in combatting the symptoms of PMDD, saying “[They] effectively shut down the ovarian cycle so that there are no hormonal fluctuations to lead to symptoms.”
Cognitive Behavioural Therapy & Acupuncture
Cognitive behavioural therapy is a type of psycho-social intervention that aims to improve a person’s overall mental health. CBT emphasizes emotional regulation and providing the individual with coping strategies, amongst other things. Acupuncture, on the other hand, is a type of physical treatment that involves inserting tiny needles at specific pressure points on the body. It’s typically used to relieve pain, but has been associated with other positive effects, including improving mental health.
Dr. Ryniec says that both of these treatments have had positive results on PMDD when used alongside other treatment options: “Cognitive behavioral therapy and acupuncture also show some benefits as alternative treatment options, but likely best in conjunction with one of the above options.”
Surgical Therapy
“As a last resort surgical therapy may be considered in very rare, refractory, and extreme debilitating cases but a number of considerations would need to be taken into account prior to reaching this option,” Dr. Ryniec shared.
As Dr. Ryniec emphasied, this is a rare and last-resort option in treating PMDD that requires careful considering. The surgical management of PMDD may include “a hysterectomy and bilateral salpingo-oophorectomy—that is, removal of your uterus, ovaries, and fallopian tubes,” as Very Well Health explains.
Lifestyle Changes
Diet. Harvard Health warns that the typical recommendations made to women to mitigate premenstrual symptoms may not work in the case of PMDD, such as decreasing caffeine, sugar, and alcohol intake and consuming smaller meals. Rather, the publication suggests that women with PMDD consume more high-protein foods and complex carbohydrates. This, in turn, can help raise levels of tryptophan, which is a precursor for serotonin and other neurotransmitters.
Exercise. Getting an adequate level of exercise is important for all individuals, even those not suffering from PMDD. But Harvard Health cites research that has found aerobic physical activities, like walking, swimming, and biking, can mitigate the symptoms of PMDD by improving mood and energy levels.
PMDD is a serious condition that requires a diagnosis from a doctor. Similarly, the majority of its treatment options require a doctor’s recommendation or prescription. If you believe you’re suffering from this condition or want to learn more about your treatment options, we strongly encourage you to consult your health care practitioner with your queries.
Source: John Hopkins Medicine, Medical News Today, Harvard Health, Very Well Health,