Cedars-Sinai Blog
Do I Have Premenstrual Dysphoric Disorder?
For certain women and people who were assigned female at birth, the week before their menstrual periods may be their least favorite time of the month. Individuals with premenstrual syndrome (PMS) may experience several days of unpleasant physical and mood-related symptoms. Those with premenstrual dysphoric disorder (PMDD) have more intense symptoms that interfere with their ability to function—making it difficult to work, interact with loved ones or even get out of bed.
"When you have PMS, you’re a little anxious or irritable. You can have bloating, breast tenderness or mood swings," said Caren Hoffman, MD, associate clinical chief of Gynecology at Cedars-Sinai. "The big difference with PMDD is that it’s classified as a depressive disorder. It’s a cyclic recurrence of severe mood swings, dysphoria and anxiety, usually occurring in the second half of the cycle."
"People think that we’re just here for Pap smears and babies, but we help with all aspects of women’s health, including PMDD. We work with patients to improve their quality of life."
How People Are Diagnosed With PMDD
About 75% of people who menstruate experience PMS, while only 2% to 5% experience PMDD. Symptoms of both conditions typically resolve during the first few days of the menstrual period. PMS may be bothersome, but PMDD disrupts lives.
"The rest of the month, they don’t have depression, anxiety or any other mental illness, then boom—the last few days before menstruation arrives, and they’re almost incapacitated," said Eynav Accortt, PhD, a clinical psychologist and director of Cedars-Sinai’s Reproductive Psychology Program. "They can have suicidal thoughts, feel completely overwhelmed and anxious."
The exact cause of PMDD is unclear, but experts believe that affected individuals are more sensitive to fluctuations of the hormones estrogen and progesterone throughout the menstrual cycle. PMDD arises after ovulation, when hormone levels drop.
Sometimes, people with PMDD wrongly believe that they have thyroid disorders, clinical depression or anxiety.
"Some women are misdiagnosed with a general mood or anxiety disorder, because the woman or her provider doesn’t notice the cyclical nature of the symptoms," Accortt said. "Some patients who come to me with a generalized anxiety disorder diagnosis don’t have anxiety that interferes with their functioning, except for the week before their period. No one ever thought to ask about the timing of their symptoms."
How People Are Diagnosed With PMDD
There aren’t tests to confirm the presence of PMDD. Instead, doctors rule out other conditions. They run bloodwork to check for thyroid disorders and assess whether the patient has global anxiety, depression or another mental health condition.
If doctors suspect PMDD, they ask patients to keep a menstrual calendar for two or three months.
"They’ll track when their periods happen and when they’re having mood symptoms," Hoffman said. "If it’s PMDD, symptoms should come and go with the cycle each month. If they have symptoms toward the end of the period or throughout the month, then it’s not PMDD, and they should explore that with a mental health provider."
Treatments for PMDD
Two common treatments help improve PMDD symptoms. OB-GYNs often prescribe the following:
Selective serotonin reuptake inhibitors (SSRIs)
They’re used as an antidepressant, but they may help improve PMDD symptoms. SSRIs have a rapid onset of action, so some doctors tell PMDD patients that they only need to take medication on days when they experience symptoms. Others recommend taking it daily.
"Sometimes it can confuse patients if they only need to take it certain days," Hoffman said. "I recommend taking it daily, so it isn’t hard to remember."
Continuous birth control
Taking birth control pills continuously, without the placebo pills, stops menstrual periods, and it often improves PMDD symptoms.
"Birth control works because it’s suppressing ovulation," Hoffman said. "By taking it continuously, without placebo, you’re not getting the drop in estrogen, so there’s less fluctuation in hormone levels."
If symptoms don’t respond to SSRIs or continuous birth control, other treatments are available, so stay in touch with your OB-GYN.
"An anti-inflammatory diet may help with mild-to-moderate premenstrual symptoms," Accortt said.
Cognitive behavioral therapy and dialectical behavioral therapy may also help with moderate PMDD, she added.
"People think that we’re just here for Pap smears and babies, but we help with all aspects of women’s health, including PMDD," Hoffman said, "We work with patients to improve their quality of life."
