Premenstrual Dysphoric Disorder (PMDD) is a severe form of Premenstrual Syndrome (PMS), marked by intense physical and emotional symptoms that begin about a week before menstruation and subside soon after. This condition, which goes beyond classic PMS in its intensity, considerably disrupts daily life, affecting daily activities and relationships.

Main symptoms include marked irritability, mood swings, anger, tension, depressive feelings, fatigue and concentration problems. PMDD requires special attention to improve the well-being of affected women.

This article aims to provide an in-depth understanding of PMDD, its causes, diagnosis, available treatments, as well as management strategies to support women in their daily lives.

What is premenstrual dysphoric disorder (PMDD)?

Definition of TDPM

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS). It is characterized by intense emotional, cognitive and physical symptoms, leading to significant distress or impairment of well-being in women. PMDD is recognized as a severe mood disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

This disorder typically manifests itself during the luteal phase of the menstrual cycle, i.e. the period between ovulation and the onset of menstruation, with symptoms resolving a few days after the onset of menstruation.

The symptoms of PMDD are often comparable to those of depression, but are specifically linked to the menstrual cycle.

Prevalence of PMDD

PMDD affects a significant proportion of women of childbearing age, with an estimated 3-8% of women affected. This prevalence suggests that the disorder is more widespread than initially thought, particularly among women aged 25 to 35.

However, PMDD can develop at any time during the childbearing years.

Premenstrual dysphoric disorder symptoms

Symptoms of PMDD vary in intensity from one woman to the next, mainly including increased irritability, mood fluctuations, severe depression, anxiety and marked nervousness.

Other symptoms include reduced interest in usual activities, difficulty concentrating, fatigue, changes in appetite, sleep disorders, and physical symptoms such as breast tenderness and headaches.

It is essential that these symptoms are severe enough to disrupt daily activities and functioning, and in some cases can even lead to suicidal thoughts, hence the importance of proper diagnosis and treatment.

Possible causes of premenstrual dysphoric disorder (PMDD)

Hormone and neurotransmitter imbalances

Premenstrual Dysphoric Disorder (PMDD) is influenced by complex factors, among which hormonal imbalances and variations in neurotransmitter levels are key. Symptoms generally appear during the luteal phase of the menstrual cycle, suggesting a predominant role for fluctuations in sex hormones, particularly estrogen and progesterone.

Interestingly, hormone levels in women with PMDD do not necessarily differ from those of unaffected women. Rather, it is thought that women with PMDD react more sensitively to the usual hormonal fluctuations, leading to specific biochemical reactions in the nervous system and premenstrual symptoms.

With regard to serotonin, a key neurotransmitter in mood regulation, a drop in its levels or an alteration in its metabolism is often linked to PMDD symptoms. Selective serotonin reuptake inhibitors (SSRIs), by increasing serotonin levels in the brain, are sometimes found to be effective in alleviating these symptoms, supporting this hypothesis.

Genetic and biological factors

Heritability plays a significant role in the onset of PMDD, with studies of twins and families revealing an estimated genetic predisposition of around 56%. This percentage suggests that some women are genetically predisposed to developing this disorder. In addition, research has identified genetic changes influencing sensitivity to estrogen and progesterone, and their effects.

The role of environmental and lifestyle factors

Environmental and lifestyle factors also contribute to the development and severity of PMDD. Environmental stress and past trauma are significant risk factors, which can amplify symptoms or make women more susceptible to the disorder. On the other hand, a balanced diet, regular physical activity and quality sleep can reduce the severity of symptoms, while a stressful, unbalanced lifestyle can aggravate them.

Diagnosis and differentiation of PMDD

Diagnostic criteria for premenstrual dysphoric disorder (PMDD)

Premenstrual Dysphoric Disorder (PMDD) is identified according to precise criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). For a diagnosis of PMDD to be made, the patient must manifest at least five specific symptoms during the majority of her menstrual cycles over the past year.

It is essential that these symptoms include at least one of the following manifestations:

• Mood swings, such as sudden feelings of sadness
• Intenseirritability or anger, or an increase in interpersonal conflicts
• pronounced depressive mood, feelings of hopelessness or self-deprecation
• Increasedanxiety and tension, or a feeling of nervousness

In addition, the patient must suffer from at least one of the following symptoms:

• Reduced interest in usual activities
• Concentration difficulties
• Fatigue
• Significant changes in appetite, overeating, or specific food cravings
• Insomnia or hypersomnia
• Feeling overwhelmed or out of control
• Physical symptoms associated with premenstrual syndrome, such as breast pain or swelling

These symptoms must be severe enough to interfere with daily functioning and occur mainly during the luteal phase of the cycle, i.e. the week before menstruation, and disappear once menstruation has begun.

Diagnostic tools

The diagnosis of PMDD is often based on a daily symptom diary kept by the patient for at least two consecutive cycles. This allows us to verify the regularity and severity of symptoms, as well as their impact on daily life.

In addition, depression inventories can be used to identify depressive symptoms and differentiate PMDD from other mood disorders. However, it is important to note that symptoms reported retrospectively are not always reliable for establishing a definitive diagnosis.

Confusion with other disorders

PMDD can be confused with other disorders, such as major depression and anxiety disorders. It is therefore essential to distinguish PMDD from these conditions on the basis of the duration and timing of symptoms. Unlike major depression or anxiety disorders, PMDD symptoms generally disappear after the onset of menstruation.

Prospective follow-up of symptoms is often necessary to differentiate PMDD from major depression, showing that PMDD symptoms are specifically related to the luteal phase and disappear after menstruation. This distinction is vital to ensure appropriate, targeted treatment.

Treatment options for PMDD

Medical approaches

Treatment of premenstrual dysphoric disorder (PMDD) encompasses a variety of options aimed at relieving emotional, cognitive and physical symptoms. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, paroxetine, citalopram and escitalopram, are often preferred as first-line treatments. They have proven effective in reducing symptoms of depression, irritability, anxiety and mood swings.

Complementary hormone therapy is another effective strategy. Oral contraceptives, particularly those based on drospirenone, have been specifically approved for PMDD. They help alleviate symptoms by blocking ovulation and balancing hormone levels. For more severe cases, gonadotropin-releasing hormone (GnRH) agonists may be considered, although they are generally regarded as a last resort.

Complementary therapies

Cognitive-behavioural therapy (CBT) is particularly beneficial in the management of PMDD, helping women to recognize and modify negative thought patterns and behaviours. Other approaches such as biofeedback, guided imagery, as well as relaxation and meditation techniques, can also reduce the stress and tension associated with PMDD.

Adopting soothing routines, such as taking warm baths with essential oils or listening to soft music, can relieve physical and emotional symptoms. Regular physical activity, including yoga, is recommended to alleviate bloating, irritability, anxiety and sleep disturbances.

The role of nutrition and food supplements

Adopting a balanced diet, rich in complex carbohydrates, fiber and essential nutrients, is important in the management of PMDD. Consumption of dietary supplements rich in magnesium helps reduce premenstrual symptoms.

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An additional calcium intake of 1,000 to 1,300 mg per day is recommended to reduce symptoms of depression and anxiety. However, it’s important to note that the effectiveness of supplements may vary from a diet naturally rich in these nutrients.

Long-term management of TDPM

Adopting a balanced lifestyle

To effectively manage premenstrual dysphoric disorder (PMDD) over the long term, adopting a healthy lifestyle is essential. A diet rich in key nutrients, including complex carbohydrates, fiber, and foods containing thiamine and riboflavin, can reduce the severity of symptoms.

It is advisable to reduce caffeine, sugar, salt and fatty foods, as these substances can aggravate symptoms. Regular physical exercise, even of low impact, plays a positive role. Engaging in 30 minutes of moderate physical activity most days of the week can improve mood and overall well-being. In addition, incorporating relaxing routines such as taking hot baths with essential oils or listening to soft music can help relieve menstrual cramps and other physical symptoms of PMDD.

Strategies for anticipating PMDD symptoms

Anticipating the symptoms of PMDD is a key step towards successful management.

Keeping a symptom diary helps identify patterns and predict periods of intense symptoms, making it easier to plan management strategies in advance, such as adjusting daily activities or taking prescribed medication. Cognitive-behavioral therapies (CBT) also offer support by helping women develop techniques for managing emotions and reactions, thereby reducing the impact of PMDD on their lives.

These therapies help to change negative thinking and behavior patterns, improving the ability to manage symptoms.

Communication and support

Discussing PMDD symptoms openly with your doctor, family and friends is essential for successful management. This communication fosters the emotional and practical support needed to overcome the challenges of PMDD. Participating in support groups and online communities can also provide a space for sharing experiences and finding management strategies with others facing similar challenges.

Research and new advances

Research continues to be fundamental to understanding and treating PMDD. Recent studies have focused on the effectiveness of selective serotonin reuptake inhibitors (SSRIs) and oral contraceptives, such as those based on drospirenone, in alleviating the symptoms of PMDD.

Standardized studies and research methodologies are essential to accurately assess the efficacy of treatments, and to clearly distinguish PMDD from premenstrual syndrome (PMS). Advances in medical research offer the hope of more specific and effective treatments in the future.

Premenstrual Dysphoric Disorder (PMDD) is a complex and severe condition, profoundly affecting the lives of many women.

It’s essential to understand that PMDD is more than just an intensified premenstrual syndrome. It is an officially recognized mood disorder, listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Symptoms such as rapid mood swings, irritability, dysphoria and anxiety should be taken seriously and never underestimated.

Available treatments, including selective serotonin reuptake inhibitors (SSRIs) and some oral contraceptives, offer effective ways of controlling these symptoms.

A holistic approach is essential, involving lifestyle modifications, a balanced diet, regular exercise and emotional support.

Recognizing the impact of PMDD on quality of life, and not hesitating to seek help, is fundamental. Affected women should keep a diary of their symptoms, talk openly with their doctors and loved ones, and consider the various management options available to them.

By taking a proactive approach and seeking the right support, it is possible to live better with PMDD and significantly improve quality of life.

Sources :

https://www.sciencedirect.com/science/article/abs/pii/S1297958902000073

https://www.revmed.ch/view/858794/6848923/RMS_2387_733.pdf

https://psychaanalyse.com/pdf/SYNDROME_PREMENSTRUEL_VULNERABILITE_DES_FEMMES.pdf