Know Your Diagnosis

PMDD: Ladies, have you ever been so irritable that your mood seems to swing? Suddenly you are crying for no reason and then yelling at the top of your lungs. You are boiling with anger; how could people be so insensitive? Can't they understand that today is not your day? Besides the fact that you feel emotional, you seem to be anxious for apparent reasons. What in the world is going on? Your usual fun activities are no longer satisfying; you're tired and craving chocolate. Your mood is all over the place; now you realize your boobs hurt, and that cute shirt seems to fit a little snugly today. You cannot work, definitely not finishing your project, and reading for class is out. Just as soon as you are sure the end of the world must be happening, as you have been "moody" for several days, things get worse when your menses start. Great. This sucks. You're miserable; people avoid you because you're hostile and feel like crap. Luckily you know day 3 of your cycle is coming with the balancing forces of mother nature, and all have been restored. So what's the problem?

 

You may be experiencing Premenstrual Dysphoric Disorder, which includes some of the symptoms mentioned above. PMDD can affect up to 2% of all women. The diagnosis is made in females who experience these symptoms during most menstrual cycles, starting at least one week before menses and usually ending a few days after their period has started. Most women experience physical and emotional changes during their menstrual cycle; however, for a few women, these symptoms are devastating, causing interference in their daily lives. Some women can be so disturbed by their emotions, causing clinically significant depression and suicidal ideations. Unfortunately, these symptoms can be present throughout a woman's reproductive years.

 

How would you know you have PMDD if all women have menses symptoms? For one, you could start keeping a menstrual log of your symptoms, dates, and exact relationship to your cycle for at least two months. If you are taking OCP (oral contraception pills), you need to think back before starting the hormones, which could be helping to alleviate your symptoms. PMDD should not be confused with PMS, a premenstrual symptom of lesser severity. Otherwise, you will need to follow up with your PCP, GYN, and/or psychiatrist. If you would like an evaluation, please get in touch with our office. Remember from previous discussions that PMDD is listed under depressive disorders.

 

Treatment options: Those ladies with mild symptoms may help introduce exercise and stress reduction techniques. As we know, exercise has been proven to improve mood, helping alleviate some of your symptoms. Another natural remedy is Castleberry which seems to enhance mood stability. As with any natural remedy, you should consult a physician before starting and adding to your medications. For those ladies with moderate to severe PMDD, it is helpful to prescribe SSRIs that are used to treat depression. The effect on serotonin, the neurotransmitter in your brain that regulates emotions, will be enhanced, which could stabilize your mood. Other medication therapies, such as gonadotropin-releasing hormone agonist therapy, are usually reserved for individuals who cannot tolerate SSRIs or have had no response to such treatment. Besides medication treatment, one may want to try cognitive behavioral therapy, which has been proven to relieve both depressive and anxiety symptoms. In sporadic cases, a woman could undergo surgery to remove her ovaries to alleviate her symptoms.

 

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