PREPARED BY
MARTIN SHAJI
PHARM D
Premenstrual Dysphoric
Disorder (PMDD)-
a brief medical study..

Chances are good that you’ve had some type of premenstrual
syndrome since you started your period. Doctors think as many as
three-quarters of menstruating women have some signs of PMS,
whether it’s food cravings, cramps, tender breasts, moodiness, or
fatigue.
But premenstrual dysphoric disorder (PMDD) is different. It causes
emotional and physical symptoms, like PMS, but women with PMDD
find their symptoms debilitating, and they often interfere with their
daily lives, including work, school, social life, and relationships.
Introduction

Epidemiology
Epidemiologic studies have identified approximately 20% of reproductive
age women as having moderate to severe PMS. The prevalence of PMDD
is estimated to affect 5% to 8% of menstruating women. Available data
suggest that PMS occurs across cultures at essentially comparable rates.
Although it is common to have one or a few premenstrual symptoms,
clinically significant PMS occurs in only 3 to 8 percent of women ,
while PMDD affects approximately 2 percent of women.

Causes
Researchers don’t know the exact cause of PMDD. Most, however, think
it may be an abnormal reaction to hormone changes related to your
menstrual cycle.
Studies have shown a connection between PMDD and low levels of
serotonin, a chemical in your brain that helps transmit nerve signals.
Certain brain cells that use serotonin also control mood, attention,
sleep, and pain. Hormonal changes may cause a decrease in serotonin,
leading to PMDD symptoms.

Symptoms
The symptoms of PMDD usually show up the week before you start your
period and last until a few days after it begins. Most of the time they are
severe and debilitating, and they can keep you from daily activities.
Mood swings.
Depression or feelings of hopelessness.
Intense anger and conflict with other
people.
Tension, anxiety, and irritability.
No interest in your usual activities.
Trouble concentrating.
Fatigue.
Appetite changes.

Symptoms of PMDD include:
Mood swings Depression or feelings of hopelessness Intense anger
and conflict with other people
Tension, anxiety, and irritability decreased interest in usual activities
difficulty concentrating fatigue change in appetite feeling out of
control sleep problems cramps and bloating breast tenderness
Headaches Joint or muscle pain Hot flashes
symptoms of PMDD are similar to but more severe than those
experienced in PMS

Diagnosis
If you have any of the classic symptoms of PMDD, you should see
your doctor. She will review your medical history with you and give
you a thorough exam, and will do some tests to find out how you
are feeling emotionally and mentally.

For a PMDD diagnosis to be made, a patient must experience at
least five symptoms, including at least one of the following:
feelings of sadness or hopelessness
feelings of anxiety or tension
mood changes or increased sensitivity
feelings of anger or irritability
Other symptoms of PMDD can include:
apathy to routine activities, which may be associated with social withdrawal
difficulty concentrating
fatigue
changes in appetite
sleeping problems, whether excessive sleeping (hypersomnia) or insomnia

Treatment: consists of self care
Drugs and lifestyle changes may help.
Self-care
Physical exercise and Stress management
decreasing intake of sugar, salt, caffeine, and alcohol
increasing protein and intake of complex carbohydrates

Medications
Birth control, SSRIs and Anxiolytic
The FDA has approved the birth control pill Yaz for the treatment of
PMDD. However, other oral contraceptives may also help a woman
with PMDD.
Therapies
Cognitive behavioral therapy

Possible alternative remedies that have been tried for PMS and may
help with PMDD include:
yoga
qi therapy
saffron therapy
guided imagery
photic stimulation
acupuncture