What's the difference between premenstrual dysphoric disorder and premenstrual syndrome?
Answers from Mary M. Gallenberg, M.D.
Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling extension of premenstrual syndrome (PMS). Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships.
In both PMDD and PMS, symptoms usually begin seven to 10 days before your period starts and continue for the first few days that you have your period. Both PMDD and PMS may also cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however, at least one of these emotional and behavioral symptoms stands out:
- Sadness or hopelessness
- Anxiety or tension
- Extreme moodiness
- Marked irritability or anger
The cause of PMDD isn't clear. Underlying depression and anxiety are common in both PMS and PMDD, so it's possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders.
Treatment of PMDD is directed at preventing or minimizing symptoms and may include:
- Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, Sarafem, others) and sertraline (Zoloft) may reduce emotional symptoms and other symptoms, such as fatigue, food cravings and sleep problems. You can reduce symptoms of PMDD by taking SSRIs all month or only in the interval between ovulation and the start of your period.
- Birth control pills. Taking birth control pills stops ovulation and stabilizes hormonal ups and downs, reducing PMS and PMDD symptoms for some women.
- Nutritional supplements. Consuming 1,200 milligrams of dietary and supplemental calcium daily may possibly reduce symptoms of PMS and PMDD. Vitamin B-6, magnesium and L-tryptophan also may help, but talk with your doctor for advice before taking any supplements.
- Herbal remedies. Some studies suggest that chasteberry may possibly reduce irritability, mood swings, anger and headaches associated with PMDD, but more research is needed. The Food and Drug Administration doesn't regulate herbal supplements, so talk with your doctor before trying them.
- Diet and lifestyle changes. Regular exercise often reduces premenstrual symptoms. Cutting back caffeine can help reduce anxiety and irritability. Eating carbohydrates — in small, more frequent meals — may help reduce the severity of mood symptoms. Also, try to avoid emotional triggers, such as arguments over financial issues or relationship problems, if possible.
Review your symptoms with your doctor. A thorough medical evaluation may determine if symptoms are due to PMDD or some other condition. If you're diagnosed with PMDD, your doctor can recommend specific treatments to help minimize symptoms.
Dec. 14, 2012
- Yonkers KA, et al. Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder. http://www.uptodate.com/index. Accessed Nov. 26, 2012.
- Casper RF, et al. Treatment of premenstrual syndrome and premenstrual dysphoric disorder. http://www.uptodate.com/index. Accessed Nov. 26, 2012.
- Lopez LM, et al. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006586.pub4/abstract. Accessed Nov. 26, 2012.
- Vitex agnus-castus. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed Nov. 26, 2012.
- Gold EB, et al. Diet and lifestyle factors associated with premenstrual symptoms in a racially diverse community sample: Study of Women's Health Across the Nation (SWAN). Journal of Women's Health. 2007;16:641.
- Lentz GM, et al. Comprehensive Gynecology. 6th ed. Philadelphia, Pa.: Mosby Elsevier; 2012. http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-0-323-06986-1&eid=4-u1.0-B978-0-323-06986-1..C2009-0-48752-X--TOP. Accessed Nov. 26, 2012.
- Vigod SN, et al. Understanding and treating premenstrual dysphoric disorder: An update for the women's health practitioner. Obstetrics & Gynecology Clinics of North America. 2009;36:907.
- Kastner TM (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 5, 2012.