This severe form of premenstrual syndrome (PMS) affects 8% of women.
We know about PMS, less so about PMDD, but both have the effect of lowering women’s morale a few days before the arrival of their period. And that, every month. The difference? PMDD or premenstrual dysphoric disorder is the severe form of PMS (premenstrual syndrome). “Women who experience symptoms of premenstrual dysphoric disorder should not hesitate to talk about it” underlines Dr Joëlle Robion, medical gynecologist and member of Syngof (Union of Gynecologists and Obstetricians of France).. What are the symptoms of PMDD? What can you do to better support your cycles? What causes? The pill? Does it pass over time? Answers and advice with Dr Robion.
What is premenstrual dysphoric disorder?
Premenstrual dysphoric disorder (PMDD) is a depressive disorder that affects 3 to 8% of women in reproductive activity and which occurs during the second phase of the menstrual cycle (luteal phase). It is called “premenstrual” because it occurs before menstruation, that is to say before periods. “It is a severe form of premenstrual syndrome (PMS). Like it, its characteristic is to be limited to the luteal phase of the cycle. When women have their periods, they feel better then the disorder begins again in subsequent cycles” explains Dr Joëlle Robion.
Premenstrual dysphoric disorder is therefore an exaggerated form of PMS with a heavier impact on mood and emotions. “Women no longer complain only of breast pain, swollen stomach or fatigue but also of sadness, anxiety, panic attacks, mood changes, apathy, insomnia, sleep disorders. libido, hyperphagia or on the contrary lack of appetite” continues our interlocutor. Not every woman has all the symptoms, they often experience two, three, four or five, always with this feeling of very low morale just before their period. “They may know that it is linked to their cycle, but they cannot overcome the discomfort linked to this period.” The repetition of these symptoms over at least 2 or 3 cycles should alert you. They are distinguished from those of depression since they only exist in the 2nd part of the menstrual cycle.
What causes PMDD?
The causes of premenstrual dysphoric disorder are not clearly identified. “It is not linked to a hormonal imbalance”, announces Dr. Robion straight away. Among the avenues considered: hypersensitivity to hormones, neuroendocrine factors (disruption of serotonin and/or dopamine) or genetic factors. “We also think that women who have psychological disorders are perhaps a little more susceptible to premenstrual dysphoric disorder” adds the gynecologist.
Is the pill responsible for PMDD?
“The birth control pill is not a risk factor for this disorder. It does not improve or worsen it” replies Dr. Robion. A pill containing drospirenone is one of the treatments that can be offered to women suffering from premenstrual dysphoric disorder. A study published in 2005 showed that taking it improved symptoms but “the effects remain small” nuances the gynecologist.
What are the diagnostic criteria for PMDD in the DSM?
Diagnostic criteria appear in the DSM, the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association (APA). Premenstrual dysphoric disorder (PMDD) is classified as a depressive disorder. According to the DSM, at least 5 symptoms must be present in the last week before the start of the period, begin to improve a few days after the start of the period, and become minimal or absent in the week after the period:
- Marked emotional instability (mood swings, sudden feeling of sadness or tears, etc.)
- Irritability, anger, interpersonal conflicts
- Markedly depressed mood, feelings of hopelessness, self-deprecating thoughts
- Marked anxiety, tension and/or feeling excited or nervous
- One (or more) of the following symptoms:
- decreased interest in usual activities (work, school, etc.);
- difficulty concentrating;
- lethargy;
- change in appetite;
- hypersomnia or insomnia;
- feeling overwhelmed or out of control;
- physical symptoms such as breast tenderness or swelling;
- joint or muscle pain,
- feeling bloated or gaining weight.
These symptoms should not be attributable to the physiological effects of a substance (drugs, medications, or other treatment) or to another medical condition (for example, hyperthyroidism).
Should you consult?
Yes ! “Women who present with symptoms of premenstrual dysphoric disorder should not hesitate to talk about it. Some are in real distress. If you have a gynecologist, you go see him and if not, you go see your general practitioner” recommends Dr. Robion. You should not stay with this feeling of uneasiness just because it disappears when your period arrives. Because it repeats itself every month and has a real impact on quality of life.
Who to consult?
A doctor. Firstly, the gynecologist (when you have one) or the general practitioner. “As a gynecologist, I do not feel like prescribing antidepressants so I refer to the general practitioner or a psychiatrist” testifies Dr. Robion. The general practitioner and the psychiatrist can prescribe antidepressants, unlike the psychologist who cannot. The latter will be able to hear the patient’s complaints but that will not be enough. “There can be suicidal tendencies in some women, it’s really a disorder that can be terrible. That’s why it’s up to the psychiatrist to take over.” It is possible to consult a psychiatrist directly, without the agreement of the attending physician. He is a specialist doctor recognized as part of the care pathway and whose consultations are covered by Health Insurance.
► The first thing to do is to reassess your lifestyle habits: is physical activity regular? Is the diet varied and balanced without too much sugar, coffee or alcohol in particular? Is there any tobacco consumption? If so, it’s better to stop. Is there too much stress? If so, you need to take up yoga or meditation. In brief “take care of yourself” first advises Dr. Robion.
► “We then evaluate the patient’s contraception but it doesn’t always work” continues the specialist.
► If nothing helps, we must consider the standard treatment for premenstrual dysphoric disorder, which are antidepressants known as “selective serotonin reuptake inhibitors”. These are for example Prozac®, Zoloft® or Deroxat®.
► Next come surgical techniques such as removal of the ovaries “but it’s a bit extreme” believes Dr. Robion. Indeed, this ablation in a 40 or 45 year old woman leads to early menopause which has consequences on her quality of life.
► Hormone injections aimed at putting the ovaries to rest also exist in the treatment of premenstrual dysphoric disorder but, again, this amounts to putting the woman into menopause. “We can do it occasionally but not for 10 years in a 40-year-old woman” concludes the specialist.
Are there any natural treatments for PMDD?
“Taking calcium, magnesium and vitamin E could have an effect on improving the symptoms of premenstrual dysphoric disorder but there are no studies, warns Dr. Robion. We can still try food supplements as they are over the counter.” This intake must go hand in hand with a change in diet and physical activity if necessary. And if the symptoms do not improve, consult. Don’t wait.
Thanks to Dr Joelle Robion, medical gynecologist and member of Syngof. Source: Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD). National Library of Medicine; 2020-2022.
