What is PMDD?

 

Premenstrual Dysphoric Disorder (also known as Premenstrual Dysphoria, Late Luteal Phase Dysphoric Disorder, or PMDD) is a cyclical, hormone-based mood disorder with symptoms arising during the luteal phase of the menstrual cycle and lasting until the onset of menstrual flow. It affects an estimated 2-10% of women of reproductive age. While PMDD is directly connected to a woman’s menstrual cycle, it is not a hormone disorder. It is a suspected genetic disorder with symptoms often worsening over time and following reproductive events including menarche, ovulation, pregnancy, birth, miscarriage, and menopause. Women with PMDD are at an increased risk for postpartum depression and suicidal behavior. Many, but not all, women with PMDD have a history of sexual trauma or depression. 1,2,3


There is no blood or saliva test to diagnose PMDD although these tests can rule out other underlying disorders. The only way to diagnose PMDD is by tracking symptoms for at least two menstrual cycles.

Causes of PMDD

PMDD is believed to be inheritable as shown in studies on families and twins.6 These same studies showed a specific variation in the Estrogen receptor alpha (ESR1) gene in those with PMDD versus those without. Other studies suggest that those with PMDD share a different kind of emotional reaction in the brain that is not found in those without PMDD.7 Additional studies show an a-typical response to ALLO (a main progesterone metabolite) in those with PMDD versus those without. Individuals without PMDD typically respond to ALLO as they would to alcohol or anti-anxiety medication (i.e. calming). It is possible that women with PMDD have developed a tolerance to the calming effect and emotional regulation of ALLO.8,9

In 2016, researchers at the National Institutes of Health (NIH) found that women with PMDD are more sensitive to the effects of sex hormones estrogen and progesterone, due to a molecular mechanism in their genes. Researchers compared white blood cells in women with PMDD and those without, which confirmed that it impacts a woman’s cellular response to sex hormones.3.1



Further Reading - The Etiology of Premenstrual Dysphoric Disorder: 5 Interwoven Pieces by MGH Center For Women's Mental Health

Symptoms of PMDD

  • Feelings of sadness or despair or even thoughts of suicide
  • Feelings of tension or anxiety
  • Panic attacks, mood swings, or frequent crying
  • Lasting irritability or anger that affects other people
  • Lack of interest in daily activities and relationships
  • Trouble thinking or focusing
  • Tiredness or low-energy
  • Food cravings or binge eating
  • Trouble sleeping
  • Feeling out of control
  • Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain

These symptoms occur during a week or two before menstruation and go away within a few days after bleeding begins. A diagnosis of PMDD requires the presence of at least five of these symptoms.4,5


PMS & PMDD

The term "PMS" has a long history both clinical and colloquial. PMS is often used in the general population and popular culture in a way to explain or dismiss a woman's volatile mood, depression, anger, or behavior.

Clinically, Premenstrual Syndrome (PMS) is a collection of emotional and/or physical discomfort including bloating, breast tenderness, increased hunger, weepiness, and irritability. As many as 80% of women experience some form of PMS in the second half of their menstrual cycle.

PMS does not interfere with a woman's quality of life, interpersonal relationships, or ability to attend work or school. PMS symptoms are more easily managed and do not require prescription medication including antidepressants. PMS is also not classified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).

Women may experience no, mild, moderate, or severe symptoms of PMS. An estimated 2-8% of women meet the criteria for PMDD. PMDD may be borderline or mild, moderate, or severe. PMDD is the only form of premenstrual disorder currently classified in the DSM-V.

While PMS and PMDD are often used interchangeably in mainstream media and popular culture the etymology, diagnosis, and treatment widely differ. It is important to use the correct terminology when discussing PMDD so that awareness, education, and treatment may be correctly achieved.

 
 

Reviewed: October 26, 2017


1. Pagano, M.D., T. (Ed.). (2014, June 28). Sexual Health: Your Guide to Premenstrual Dysphoric Disorder. Retrieved April 23, 2015, from http://www.webmd.com/women/pms/premenstrual-dysphoric-disorder?page=2
2. Gallenberg, M.D., M. (2012, December 14). What's the difference between premenstrual dysphoric disorder and premenstrual syndrome? Retrieved April 20, 2104, from http://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/expert-answers/pmdd/faq-20058315
3. Goldberg, M.D., J. (Ed.). (2014, September 7). Depression, Thyroid Conditions, and Hormones. Retrieved April 23, 2015, from http://www.webmd.com/depression/guide/depression-the-thyroid-and-hormones
3.1."Sex Hormone-Sensitive Gene Complex Linked To Premenstrual Mood Disorder". 2017. Medicalxpress.Com. Accessed January 4 2017. http://medicalxpress.com/news/2017-01-sex-hormone-sensitive-gene-complex-linked.html
4. Diagnostic and Statistical Manual of Mental Disorders (5th ed.), (2013), American Psychiatric Association. Washington, DC.
5. PMDD Research — UNC Center for Women's Mood Disorders. (2016).Med.unc.edu. Retrieved 17 March 2016, from https://www.med.unc.edu/psych/wmd/research/pmdd
6. Huo L, Straub RE, Roca C, et al. Risk for premenstrual dysphoric disorder is associated with genetic variation in ESR1, the estrogen receptor alpha gene. Biol Psychiatry. 2007;62(8):925-933.
7. Comasco E, Hahn A, Ganger S, et al. Emotional fronto-cingulate cortex activation and brain derived neurotrophic factor polymorphism in premenstrual dysphoric disorder. Hum Brain Mapp. 2014;35(9):4450-4458.
8. Girdler SS, Straneva PA, Light KC, et al. Allopregnanolone levels and reactivity to mental stress in premenstrual dysphoric disorder. Biol Psychiatry. 2001;49(9):788-797.
9. Hantsoo L, Epperson CN. Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Current psychiatry reports. 2015;17(11):87. doi:10.1007/s11920-015-0628-3.