Premenstrual Dysphoric Disorder (PMDD)
Diagnosis and Symptoms: Premenstrual Dysphoric Disorder (PMDD) is characterized by specific symptoms that must be present in the 7 to 14 days before the onset of menses, and start to improve within a few days after menses begins. Symptoms can become minimal or absent in the week post-menses and across the majority of menstrual cycles. According to the DSM-5 criteria, at least five symptoms must be present. These symptoms must include one or more from a core set of affective symptoms: marked affective lability (e.g., mood swings, increased sensitivity to rejection), marked irritability or anger, markedly depressed mood/hopelessness, or marked anxiety/tension. The remaining symptoms can include: decreased interest in usual activities, subjective difficulty in concentration, lethargy, marked change in appetite/overeating/cravings, hypersomnia or insomnia, a sense of being overwhelmed or out of control, and physical symptoms like breast tenderness or bloating. The symptoms must also be associated with clinically significant distress or interference with life activities.
Testing and Risk: There are no lab tests to confirm PMDD symptoms. The only type of "test" involves two months of consecutive symptom collection using prospective daily ratings. PMDD occurs during the Luteal Phase (7 to 14 days before bleeding) of the menstrual cycle. Individuals assigned female at birth and of childbearing age are at risk, as well as those with a family history of PMDD, Postpartum depression, or mood disorders. PMDD is separated from PMS because PMDD is more of a behavioral disturbance, while PMS is a broader term for behavioral change.
Management: Treatment options for PMDD include both pharmacological and nonpharmacological approaches. Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment for severe symptoms of PMDD, and oral contraceptives like Yaz are also effective. Nonpharmacological ways to help include cognitive behavioral therapy (CBT), yoga, acupuncture, and supplementation with Calcium, Magnesium, or Vitamin D (based on lab work and consultation with your provider). However, there is controversy and inconsistent data regarding nonpharmacological recommendations.
