We often hear and know that women have mood swings during their monthly menstrual cycle, however some may experience more serious symptoms in which case it becomes a condition called ‘Premenstrual Dysphoric Disorder’ or PMDD. In this case, women experience severe depression, irritability and excessive stress 4-5 days before their menstruation cycle. The symptoms stop on, or shortly after, the first day their period begins. PMDD refers to the emotional symptoms of depression – not the wide range of physical symptoms that typically occur during a woman’s menstrual cycle which is called premenstrual syndrome (PMS). The cause of this condition is unknown, however it is often assumed that hormonal changes may play a role.
In order to be diagnosed with the condition, five or more of the following symptoms must be present:
- Loss of interest in daily activities or relationships
- Feeling overly tired and fatigued
- Feeling sad and hopeless with possible suicidal thoughts
- Anxiety and panic attacks
- Feeling out of control
- Mood swings with episodes of crying
- Getting angry and irritable for no apparent reason
- Difficulty falling asleep
- Physical symptoms such as bloating, breast tenderness, headaches, and joint or muscle pain
Women who have a higher chance of developing PMDD are those with an underlying condition of:
- Caffeine addiction
- Familial history of the disorder
- Lack of exercise
There are no physical examination or laboratory tests to diagnose PMDD. However, a thorough history, complete physical examination and psychological evaluation are done to rule out other conditions. Women should keep a journal in order to identify the time of their symptoms as well as the most troublesome symptoms. This information will enable them to handle their symptoms, and it will also help healthcare providers diagnose PMDD and determine the most appropriate treatment.
The first step to treating PMDD is to manage a healthy lifestyle including healthy foods and regular exercise. Foods with whole grains, vegetables and fruits are beneficial – it is also advisable to cut down salt, sugar, alcohol and caffeine. Exercise reduces the severity of the symptoms of PMDD. For those who experience lack of sleep, it is important to change sleeping habits before taking medications. They should adjust the height of their pillow to keep the alignment of their spine straight for a good sleep. They should also keep a journal and record:
- The day and time of the symptoms
- The type of symptoms
- The severity of the symptoms
- The duration of the symptoms
If the depression is severe then it is advisable to consult a doctor to take antidepressants. The first option is usually an antidepressant known as a selective serotonin-reuptake inhibitor (SSRI). They can take SSRIs in the second part of their cycle up until their period starts, or for the whole month. They can also consult a psychologist or psychiatrist to manage the depression with cognitive behavioral therapy (CBT) instead of taking antidepressants.
With proper diagnosis and treatment, most women with PMDD find that their symptoms reduce to tolerable levels. PMDD symptoms may be severe enough to interfere with a woman’s daily life especially in women with depression. These symptoms, predominantly suicidal thoughts, are usually worse in the second half of the cycle.
It is important to recognize PMDD and to take appropriate steps to manage it. It is a serious condition and should not be ignored by calling it usual ‘period mood swings’. Women are advised to either consult their doctor, or call 111 right away if they are having thoughts of suicide.