When it’s More than PMS
If mood changes at that time of the month are more than you can bear, you’re not alone.
Reviewed by: D. Jeffrey Newport, MD, MS
Written by: Lauren Schneider
The days leading up to your menstrual period can be tumultuous, and many people experience an array of physical and emotional changes. If your mood-related symptoms take a heavy toll on your quality of life, this may be a sign of premenstrual dysphoric disorder (PMDD), says psychiatrist D. Jeffrey Newport, MD.
As Director of Women’s Reproductive Mental Health of Texas within UT Health Austin’s Mulva Clinic for the Neurosciences, Dr. Newport prepares people with a history of mental illness or trauma for pregnancy and sees patients with psychological conditions related to menstruation, pregnancy, and childbirth. Here, he shares his expertise regarding PMDD symptoms as well as how the condition can be diagnosed and treated.
What is PMDD?
PMDD is defined as serious mood-related symptoms that recur in the days leading up to one’s menstrual period. These symptoms can include the following:
- Panic attacks
- Attention or sleeping difficulties
While many people experience mood shifts associated with premenstrual syndrome (PMS), Dr. Newport says the extent to which symptoms disrupt daily functioning sets PMDD apart. “Even though the symptoms are intermittent, the dysfunction that that is attributable to PMDD rivals that of major depression.”
What causes PMDD?
According to Dr. Newport, scientists are “just scratching the surface” of the link between the menstrual cycle and mental health. Genetics, stress, and the way one’s nervous system reacts to hormonal fluctuations may all contribute to PMDD onset.
Dr. Newport adds that a history of sexual trauma could increase one’s likelihood of developing PMDD. He draws a parallel to postpartum depression, which is more common in individuals who experience some form of distress related to childbirth.
How is PMDD diagnosed?
To diagnose PMDD, clinicians must assess whether a patient’s symptoms are truly brought on by their period or whether symptoms of another mental health condition happened to coincide with the patient’s period. Dr. Newport says the “gold standard” for diagnosis is to have a patient track their mood over the course of two menstrual cycles to confirm that the symptoms present only in the premenstrual period and subside afterwards. He notes that because this is time and labor intensive, other diagnostic strategies have emerged in recent years using patient recall.
Women’s Reproductive Mental Health offers this printout for people looking to track their symptoms across their menstrual cycle. For those who would prefer a digital option, Dr. Newport recommends the PMDD Tracker app.
How is PMDD treated?
PMDD is usually treated with a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs), which allow your brain to use the serotonin it produces more effectively. Serotonin is a chemical with important mood-related functions which are thought to be disrupted in PMDD.
SSRIs can relieve PMDD symptoms within a few hours, rather than the weeks needed for patients with depression to experience the full effects of the medication. Dr. Newport attributes this to the direct role serotonin likely has on PMDD, while depression treatment requires structural changes to brain circuitry that are gradually put into motion by increasing serotonin activity.
Because SSRIs work so quickly for PMDD, patients have the option of taking the medication only on the days leading up to their period. This allows them to limit common side effects of the medication, which can include weight gain and sexual dysfunction.
Suppression of ovulation
Oral contraceptives can be used to avoid ovulation. If these do not provide symptom relief, ovulation can be blocked entirely with medication or, in rare instances, surgery.
Who should seek help for PMDD?
Dr. Newport says that anyone whose regular functioning is severely impacted by mood changes in the days leading up to their menstrual cycle should reach out to a healthcare provider.
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