Is It More Than PMS? By Jill Ross, HealthAtoZ contributing writer It's that time of the month and you're cranky, weepy, moody and even the dog hides when he sees you. You may think you've got PMS, but it may be PMDD. PMDD? Yes, PMDD. PMDD symptoms typically go well beyond what are considered manageable or normal premenstrual symptoms. They occur the week before and get in the way of living a normal life. Then they disappear a few days after the onset of menstruation, medical experts say. Those premenstrual days, though, can be agonizing. With both conditions, women can feel irritable, tense, emotional, sad and tired while experiencing roller-coaster mood swings. They also may have physical symptoms, such as bloating and breast tenderness. However, chances are with PMDD, you will have more severe mood swings and have trouble functioning at home or at the office. "Women (who have PMDD) mostly find that they are pretty irritable and out of control," says Diane Dell, a gynecologist, obstetrician and psychiatrist at Duke University Medical Center in Durham, N.C., and a former president of the American Medical Women's Association. Unless they have physical symptoms, most women with PMDD go to work even though they feel overwhelmed, Dell says. Even in the office, they may find it difficult keeping it all together. They are prone to angry outbursts and clashes with co-workers or family members. Who has PMDD? At least half of menstruating women experience PMS as opposed to 3 percent to 5 percent who experience PMDD, according to the American Psychiatric Association. While most women have heard of PMS, a national survey of 500 women found that 84 percent were unaware of PMDD. The survey was commissioned by the Society for Women's Health Research. Though the majority of women surveyed reported experiencing premenstrual symptoms in the previous year, 45 percent said they had never discussed PMS with their doctors. Even among women with strong or severe symptoms, 27 percent never talked with their physicians about the problem, despite the fact that their symptoms interfered with daily activities. Some women wait for years to ask a doctor about premenstrual problems, says Jean Endicott, Ph.D., director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center. "They fear becoming the target of jokes or that seeking help is a sign of weakness," she says. Keeping a diary If you think you may have PMS or PMDD, speak with your health care provider and keep a diary of your symptoms, Dell says. "A diary allows both the physician and a patient to make sure the symptoms are occurring just in premenstrum and not during other times in the menstrual cycle," Dell says. In that way, it can help a physician diagnose whether you have PMS, PMDD, or depression or another condition. For some women, premenstrual symptoms can actually mask symptoms of depression. If the severe mood symptoms do not go away within a few days of menstruation, be sure to tell your health care provider. Also, if you already have a psychiatric disorder such as depression or even a medical disorder such as diabetes or asthma, you should know that PMS or PMDD could make it worse. "Whatever you have, it's going to get worse premenstrually," Dell says. Researchers aren't exactly sure what causes PMS or PMDD. One theory is that they are related to hormonal changes because of the menstrual cycle. Recent research has shown a connection between premenstrual symptoms and low levels of serotonin, a neurotransmitter in the brain. What works for PMS and PMDD? Making some lifestyle changes by getting regular aerobic exercise, reducing stress and cutting back on caffeine and carbohydrates may be helpful with PMS but don't really help much with PMDD, according to Dell. If you have PMDD, she suggests talking to your health care provider about drug therapy. Treatment guidelines published by the American College of Obstetricians and Gynecologists recommend antidepressants known as selective serotonin reuptake inhibitors (SSRIs) as the initial drug of choice for the treatment of severe mood and physical premenstrual symptoms. SSRIs approved by the Food and Drug Administration (FDA) to treat PMDD include Sarafem® (fluoxetine), Paxil CR® (paroxetine controlled-release) and Zoloft® (sertraline). Sarafem has the same active ingredient as Prozac®. However, these are not your only choices. Your doctor may prescribe anti-anxiety drugs or other SSRIs, which can be just as effective.  Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns with a doctor.
Paxil may increase the risk for birth defects, particularly heart defects, when women take it during the first three months of pregnancy, according to a 2005 advisory from the FDA. The FDA is waiting for the results of recent studies to better understand the higher risk. Discuss with your doctor about the health risks of Paxil if you plan to become pregnant or are in the first three months of pregnancy. You may want to consider taking a different antidepressant. Do not stop taking the drug without first talking to your doctor. Antidepressants can take a few weeks to take effect. Most doctors recommend taking it daily throughout the menstrual cycle for several months if it is working. Your PMDD checklist Think about how you feel the week before your menstrual period. If you answer "yes" to some of the following questions, discuss your answers with your doctor to see if you have PMDD. Symptoms can vary from cycle to cycle, which is why it is a good idea to keep a daily record of both your mood and physical symptoms for two or three menstrual cycles to aid in discussions with your doctor. Are you bothered by intense:
- Irritability
- Fatigue
- Tension
- Bloating
- Sensitivity
- Food cravings
- Sadness
- Breast tenderness
- Feelings of being overwhelmed
- Sudden mood changes for no reason
Do these symptoms cause problems with your:
- Work
- Social activities
- School
- Relationships (family, friends, etc.)
Do these problems go away soon after your period starts? Sources: American College of Obstetricians and Gynecologists Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center Duke University Medical Center American Psychiatric Association The Food and Drug Administration
This article was reviewed and updated June 2007.
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