At least 75% of women with regular menstrual cycles report unpleasant physical or psychological symptoms premenstrually. For the majority of women, these symptoms are mild and tolerable. However, for a certain group of women, these symptoms can be disabling and may cause significant disruption in their lives.
We are used to the term PMS but what exactly are the symptoms and what can you do to help yourself? Read more and find out about a little less well known version, PMDD.
Psychological Symptoms of PMS
- Depression
- Anger
- Irritability
- Anxiety
- Sensitivity to rejection
- Sense of feeling overwhelmed
- Social withdrawal
Physical Symptoms of PMS
- Lethargy or fatigue
- Sleep disturbance (usually hypersomnia)
- Appetite disturbance (usually increased)
- Abdominal bloating
- Breast tenderness
- Headaches (read more about menstrual migraines)
- Muscle aches, joint pain
- Swelling of extremities
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome affecting 3-8% of women in their reproductive years. In contrast to PMS, PMDD is characterized by more significant premenstrual mood disturbance. The most common symptom is irritability; however, many women also report depressed mood, anxiety, or mood swings. These symptoms emerge one to two weeks preceding menses and resolve completely with the onset of menses. By definition, this mood disturbance results in marked social or occupational impairment, with its most prominent effects in interpersonal functioning.
Diagnosis
It is important for clinicians to distinguish between PMDD and other medical and psychiatric conditions. Medical illnesses such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and migraine disorder can have features that overlap with PMDD. Additionally, psychiatric disorders such as depression or anxiety disorders can worsen during the premenstrual period and thus may mimic PMDD.
The best way to confirm the diagnosis of PMDD is by prospective daily charting of symptoms. Women with PMDD should experience a symptom-free interval between menses and ovulation. Although there is no consensus about the best instrument by which to confirm the diagnosis of PMDD, two well-validated scales for the recording of premenstrual symptoms include the Calendar of Premenstrual Experiences (COPE) and the Prospective Record of the Severity of Menstruation (PRISM).
What Causes PMS and PMDD?
Although the etiology of PMS and PMDD remains uncertain at present, researchers now concur that these disorders represent biological phenomena rather than purely psychological events. Recent research indicates that women who are vulnerable to premenstrual mood changes do not have abnormal levels of hormones or some type of hormonal dysregulation, but rather a particular sensitivity to normal cyclical hormonal changes.
Non-Pharmacologic Treatment for PMS and PMDD
Keeping a monthly mood chart can be informative and even therapeutic for many women. In addition to helping with the diagnosis, many women feel better if they can identify the relationship between their cycles and mood changes, and also anticipate days that they may be at risk for mood worsening.
Lifestyle changes can help to ameliorate the symptoms of PMS and PMDD. For women with mild symptoms, and these interventions should be tried before pharmacological treatment. Although solid evidence is lacking, clinicians generally recommend that patients with PMS or PMDD decrease or eliminate the intake of caffeine, sugar, and sodium. Other helpful lifestyle modifications include decreasing alcohol and nicotine use and ensuring adequate sleep. Also, regular aerobic exercise has been demonstrated to have beneficial effects on both the emotional and physical symptoms of PMS/PMDD.
Certain nutritional supplements have also been shown to improve premenstrual symptomatology and herbal remedies may have some role in the treatment of premenstrual symptoms. One recent double-blind, placebo-controlled trial concluded that agnus castus fruit extract (1 tab a day), also known as chasteberry, significantly decreased premenstrual symptoms of irritability, anger, headache and breast fullness when compared to placebo.
Psychotherapy offers another non-pharmacologic approach to the treatment of PMS and PMDD. A recent study found that cognitive-behavioral therapy (CBT) was as effective as fluoxetine (20 mg daily), in the treatment of women with PMDD. Other limited studies suggest that cognitive approaches can be useful in helping to reduce premenstrual symptoms.
This article was taken in part from:
Disclaimer
All content on this website is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. Always consult your own GP if you’re in any way concerned about your health.