Premenstrual dysphoric disorder

Premenstrual dysphoric disorder
Other namesLate luteal phase dysphoric disorder
SpecialtyPsychiatry
SymptomsSevere mood swings, depression, irritability, agitation, uneasiness, change in appetite, severe fatigue, anxiety, anger insomnia/hypersomnia, breast tenderness, decreased interest in usual social activities, reduced interest in sexual activity, difficulty in concentration
Usual onsetCan occur anytime during reproductive years
Duration6 days – 3 weeks of cycle
CausesLikely neuro-sensitivity to reproductive hormones
Risk factorsFamily history, history of violence/trauma, smoking, presence of other mental health disorders
Diagnostic methodBased on symptoms & criteria
Differential diagnosisPremenstrual syndrome, depression, anxiety disorder
TreatmentMedication, counselling, lifestyle change, surgery
MedicationSSRIs, drospirenone-containing oral contraceptives, GnRH analogs, cognitive behavioral therapy (CBT)
FrequencyUp to about 8% of menstruating women

Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptoms occur in the luteal phase (between ovulation and menstruation), improve within a few days after the onset of menses, and are minimal or absent in the week after menses.[1] PMDD has a profound impact on a woman’s quality of life and dramatically increases the risk of suicidal ideation and even suicide attempts.[2] Many women of reproductive age experience discomfort or mild mood changes prior to menstruation. However, 5–8% experience severe premenstrual syndrome causing significant distress or functional impairment.[3] Within this population of reproductive age, some will meet the criteria for PMDD.

The exact cause of PMDD is currently unknown. Ovarian hormone levels during the menstrual cycle do not differ between individuals with PMDD and the general population.[4] However, because the symptoms are only present during ovulatory cycles and resolve after menstruation, it is believed to be caused by fluctuations in gonadal sex hormones or variations in sensitivity to sex hormones.[5]

In 2017, researchers at the National Institutes of Health discovered that women with PMDD have genetic changes that make their emotional regulatory pathways more sensitive to estrogen and progesterone, as well as their chemical derivatives. The researchers believe that this increased sensitivity may be responsible for PMDD symptoms.[6]

Studies have found that those with PMDD are more at risk of developing postpartum depression after pregnancy.[7] PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013.[1] It has 11 main symptoms, and a woman has to exhibit at least five to be diagnosed with PMDD.[5] Roughly 20% of females have some symptoms of PMDD, but either have less than five or do not have functional impairment.[8]

First line treatment for PMDD is with selective serotonin reuptake inhibitors (SSRIs), which can be administered continuously throughout the menstrual cycle or intermittently, with treatment only during the symptomatic phase (approximately 14 days per cycle).[9] Hormonal therapy with oral contraceptives that contain drospirenone have demonstrated efficiency in reducing PMDD symptoms as well.[10] Cognitive behavioral therapy, whether in combination with SSRIs or alone, has shown to be effective in reducing impairment.[11] Dietary modifications and exercise may also be helpful, but studies investigating these treatments have not demonstrated efficacy in reducing PMDD symptoms.[9]

  1. ^ a b Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association. 2013. p. 625.4. Code: 625.4 (N94.3)
  2. ^ Prasad, Divya; Wollenhaupt-Aguiar, Bianca; Kidd, Katrina N.; de Azevedo Cardoso, Taiane; Frey, Benicio N. (December 2021). "Suicidal Risk in Women with Premenstrual Syndrome and Premenstrual Dysphoric Disorder: A Systematic Review and Meta-Analysis". Journal of Women's Health (2002). 30 (12): 1693–1707. doi:10.1089/jwh.2021.0185. ISSN 1931-843X. PMC 8721500. PMID 34415776.
  3. ^ Yonkers, Kimberly Ann; O'Brien, P. M. Shaughn; Eriksson, Elias (2008-04-05). "Premenstrual syndrome". Lancet. 371 (9619): 1200–1210. doi:10.1016/S0140-6736(08)60527-9. ISSN 1474-547X. PMC 3118460. PMID 18395582.
  4. ^ Hofmeister, Sabrina; Bodden, Seth (2016-08-01). "Premenstrual Syndrome and Premenstrual Dysphoric Disorder". American Family Physician. 94 (3): 236–240. ISSN 1532-0650. PMID 27479626.
  5. ^ a b Pearlstein T (April 2016). "Treatment of Premenstrual Dysphoric Disorder: Therapeutic Challenges". Expert Review of Clinical Pharmacology. 9 (4): 493–496. doi:10.1586/17512433.2016.1142371. PMID 26766596. S2CID 12172042.
  6. ^ Dubey N, Hoffman JF, Schuebel K, Yuan Q, Martinez PE, Nieman LK, et al. (August 2017). "The ESC/E(Z) complex, an effector of response to ovarian steroids, manifests an intrinsic difference in cells from women with premenstrual dysphoric disorder". Molecular Psychiatry. 22 (8): 1172–1184. doi:10.1038/mp.2016.229. PMC 5495630. PMID 28044059.
  7. ^ Yang Q, Bränn E, Bertone-Johnson ER, Sjölander A, Fang F, Oberg AS, Valdimarsdóttir UA, Lu D (March 2024). "The bidirectional association between premenstrual disorders and perinatal depression: A nationwide register-based study from Sweden". PLOS Med. 21 (3): e1004363. doi:10.1371/journal.pmed.1004363. PMC 10978009. PMID 38547436.
  8. ^ Steiner M, Macdougall M, Brown E (August 2003). "The premenstrual symptoms screening tool (PSST) for clinicians". Archives of Women's Mental Health. 6 (3): 203–9. doi:10.1007/s00737-003-0018-4. PMID 12920618. S2CID 24822881.
  9. ^ a b Rapkin AJ, Lewis EI (November 2013). "Treatment of premenstrual dysphoric disorder". Women's Health. 9 (6): 537–56. doi:10.2217/whe.13.62. PMID 24161307. S2CID 45517684.
  10. ^ Lopez, Laureen M.; Kaptein, Ad A.; Helmerhorst, Frans M. (2009-04-15). Lopez, Laureen M (ed.). "Oral contraceptives containing drospirenone for premenstrual syndrome". The Cochrane Database of Systematic Reviews (2): CD006586. doi:10.1002/14651858.CD006586.pub3. ISSN 1469-493X. PMID 19370644.
  11. ^ Kleinstäuber M, Witthöft M, Hiller W (September 2012). "Cognitive-behavioral and pharmacological interventions for premenstrual syndrome or premenstrual dysphoric disorder: a meta-analysis". Journal of Clinical Psychology in Medical Settings. 19 (3): 308–19. doi:10.1007/s10880-012-9299-y. PMID 22426857. S2CID 28720541.