Many women ex­pe­ri­ence some form of emo­tion­al or phys­i­cal dis­com­fort a few days be­fore their month­ly men­stru­al cy­cle. This is known as Pre­men­stru­al syn­drome (PMS) and tends to af­fect women main­ly of child­bear­ing age. Com­mon com­plaints in­clude bloat­ing, breast ten­der­ness, headaches and mood changes and can af­fect up to 75 per cent of women.

How­ev­er, about 5 per cent of women ex­pe­ri­ence pre­men­stru­al symp­toms that are so se­vere they cause sig­nif­i­cant men­tal dis­tress and in­ter­fere with work, school or re­la­tion­ships, there­by meet­ing the cri­te­ria for Pre­men­stru­al Dys­phor­ic Dis­or­der or PMDD.

Al­though com­mon­ly dis­missed as triv­ial, PMDD can dis­rupt a woman’s life, her dai­ly ac­tiv­i­ties and re­la­tion­ships so com­plete­ly, she may de­spair that life it­self is not worth liv­ing, with al­most 15 per cent of women with PMDD con­tem­plat­ing sui­cide.

PMDD is di­ag­nosed when five or more of the fol­low­ing symp­toms oc­cur 7 to 10 days be­fore the on­set of men­stru­a­tion and then re­solve with­in a few days of the start of the men­stru­al pe­ri­od:

&emp­mar­gin;—anx­i­ety, ten­sion, ir­ri­tabil­i­ty or “edgi­ness”

&emp­mar­gin;—sad­ness, hope­less­ness, feel­ing of worth­less­ness

—sud­den mood changes

—&emp­mar­gin;loss of in­ter­est in usu­al ac­tiv­i­ties

—dif­fi­cul­ty con­cen­trat­ing

—marked anger

—fa­tigue, lack of en­er­gy

—&emp­mar­gin;change in ap­petite, food crav­ings,

—&emp­mar­gin;in­som­nia (dif­fi­cul­ty sleep­ing) or ex­ces­sive sleep­ing

—&emp­mar­gin;phys­i­cal symp­toms such as bloat­ing, breast ten­der­ness, weight gain, joint or mus­cle pain, swelling of the ex­trem­i­ties

Be­fore a doc­tor is able to make a di­ag­no­sis of PMDD, it is im­por­tant to rule out oth­er dis­or­ders that can mim­ic PMS and PMDD such as de­pres­sion, anx­i­ety dis­or­ders, bipo­lar dis­or­der, and con­di­tions such as thy­roid dis­ease, en­dometrio­sis, fi­broids, peri-menopause and oth­er hor­mon­al dis­or­ders.

Women who have a per­son­al or fam­i­ly his­to­ry of mood dis­or­ders, in­clud­ing ma­jor de­pres­sion or post­par­tum de­pres­sion are at a greater risk of de­vel­op­ing PMDD.

In ad­di­tion, obe­si­ty, stress and a his­to­ry of trau­ma or sex­u­al abuse can in­crease the like­li­hood of PMDD.

There is no sin­gle test that can di­ag­nose PMS or PMDD. The main chal­lenge in de­tect­ing PMDD is the abil­i­ty to dif­fer­en­ti­ate be­tween PMS symp­toms which may be dis­tress­ing and an­noy­ing but not dis­abling and those com­plaints that are se­vere enough to in­ter­fere with ac­tiv­i­ties, work, school or re­la­tion­ships.

A doc­tor may al­so re­quest that a woman care­ful­ly record her symp­toms on a dai­ly ba­sis for two to three full men­stru­al cy­cles.

There is cur­rent­ly a poor un­der­stand­ing of the ex­act cause of these pre­men­stru­al dis­or­ders. Many re­searchers be­lieve that they are brought about by the ris­ing and falling hor­mone lev­els that oc­cur dur­ing a men­stru­al cy­cle.

Women with PMDD are thought to be very sen­si­tive to these fluc­tu­at­ing lev­els that oc­cur just be­fore and dur­ing the men­stru­al pe­ri­od.

Re­cent stud­ies have al­so shown a con­nec­tion be­tween PMDD and al­tered lev­els of sero­tonin, which is a chem­i­cal in the brain that helps with trans­mis­sion of nerve sig­nals.

This can there­fore ex­plain why a type of an­ti­de­pres­sant med­ica­tion that can slow the re­up­take of this chem­i­cal sero­tonin has been shown to be ef­fec­tive for many women with PMDD.

These are called se­lec­tive sero­tonin re­up­take in­hibitors (SS­RIs) and are con­sid­ered to be first-line treat­ment for PMDD as well as se­vere symp­toms of PMS.

Stud­ies have con­firmed that these SS­RIs an­ti­de­pres­sant meds sig­nif­i­cant­ly re­duce the symp­toms of PMDD when com­pared with a place­bo, with 60 to 90% re­spond­ing to this treat­ment.

In ad­di­tion, these drugs were found to help even quick­er than when used for de­pres­sion which means that women may not nec­es­sar­i­ly need to take them every day but can be used on an in­ter­mit­tent ba­sis. Oth­er types of an­ti­de­pres­sants have not been shown to be ef­fec­tive.

Hor­mon­al treat­ment such as use of the birth con­trol pill may help with PMS but has not been shown to be of ma­jor ben­e­fit in PMDD.

Lifestyle changes such as di­etary changes (avoid­ing caf­feine, al­co­hol, sug­ar and eat­ing small­er and less fre­quent meals), ex­er­cise and vi­t­a­min sup­ple­ments have had con­flict­ing re­sults and their ben­e­fit is not con­firmed.

The use of cog­ni­tive be­hav­iour ther­a­py has shown some mod­est im­prove­ment in PMDD but does need fur­ther re­search.

This in­volves the use of a form of psy­chother­a­py in which neg­a­tive thoughts about your­self and the world are chal­lenged in or­der to al­ter un­want­ed be­hav­iour pat­terns or treat mood dis­or­ders.

Ul­ti­mate­ly, PMDD is a chron­ic con­di­tion that can have a se­ri­ous im­pact on a women’s qual­i­ty of life. It can oc­cur ir­re­spec­tive of any so­cioe­co­nom­ic, cul­tur­al or eth­nic back­ground. For­tu­nate­ly, once di­ag­nosed, a va­ri­ety of treat­ment and self-care mea­sures can ef­fec­tive­ly con­trol the symp­toms in most women.

If you are af­fect­ed by any of these symp­toms men­tioned here, please con­tact your doc­tor.