Premenstrual Dysphoric Disorder

Somewhere between 20%-50% of women aged 30-40 who have regular periods suffer from premenstrual syndrome (PMS) every month without fail. But in some women (3%-5%) PMS is more severe and with a larger set of symptoms. This condition is called premenstrual dysphoric disorder (PMDD).

Breakthrough Symptoms

Women who suffer from PMDD have an increased risk for developing postpartum depression while women on successful treatment for antidepressants may require a small increase in dosage in the days before menstruation to avoid breakthrough depression symptoms.

PMDD causes a variety of unpleasant symptoms including:

*Crying spells with no apparent reason

*Tantrums

*Verbal outbursts

*Depression

*Tension

*Anger

*Irritability

Serious Deterioration

Women with PMS may also have some of these symptoms but in those with PMDD the symptoms are so severe that the sufferer's quality of life undergoes a serious deterioration. Some women may also experience the following complaints:

*Sleep disturbance

*Lethargy

*Short attention span

*Breast tenderness

*Bloating

*Weight gain

*Joint pain

*Muscle pain

*Headaches

Daily Functioning

Symptoms tend to come on a week or so before menstruation and disappear within the first three days after bleeding begins. The PMDD sufferer's daily functioning on those days is in marked contrast to her functioning on the other days of her cycle.

While doctors still aren't sure what causes PMDD, several ideas have been offered. One idea is that of an abnormal response to the normal hormonal fluctuations that come with every menstrual cycle. Changing levels of estrogen and progesterone may result in a deficiency of serotonin. Serotonin is a vasoconstrictor (it narrows the vessels). More research is needed to prove this theory and understand the full implications of the idea.

An accurate diagnosis is important, since the symptoms of PMDD may mimic other conditions such as anxiety disorder, depression, or a thyroid condition. Yet few diagnostic procedures exist for this purpose. After taking your history, your physician may refer you to a psychiatrist to rule out other conditions. He may also ask you to record your symptoms over the course of several months to get an idea of when the symptoms occur, how severe they are, and how long they last.

Evaluating Symptoms

To pronounce a diagnosis of PMDD, your doctor will evaluate whether you experience five or more of the following symptoms for a year, on most months:

*Depression

*Irritability or anger

*Difficulty concentrating

*Disinterest in activities you used to enjoy

*Mood swings

*Increase in appetite

*Inability to sleep or sleeping too much

*Feeling out of control or overwhelmed

*Other noticeable, regular symptoms

*Symptoms that disturb your ability to interact, work, or otherwise function

*Symptoms unrelated to or exacerbated by a coexisting medical condition

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