What is premenstrual dysmorphic disorder (PMDD)?

DEAR DOCTOR K:

I always assumed my premenstrual mood swings were normal. But then I talked to some friends whose emotional symptoms are much less severe than mine. A quick Internet search turned up “PMDD.” Can you tell me more about this?

DEAR READER:

The physical symptoms of premenstrual dysmorphic disorder (PMDD) and premenstrual syndrome (PMS) are the same. They include fatigue, swollen breasts, backache, headache, food cravings, bloating, constipation and diarrhea. But the emotional symptoms of PMDD, compared to PMS, are much more severe.

PMDD is characterized by extreme moodiness, irritability, depression and anxiety. These symptoms appear the week before a woman gets her period and go away a few days after it starts. A woman with PMDD may experience severe depression and feelings of hopelessness. In especially severe cases, women may even feel suicidal. For these reasons, PMDD is an official psychiatric diagnosis.

How can you tell if you have PMDD or PMS? For a cycle or two, keep track of the dates of your period. Note when your symptoms occur and how severe they are. Your doctor can review the pattern and severity of your symptoms.

PMDD can be treated, but finding the right treatment can take time, as well as trial and error. I spoke to Dr. Hope Ricciotti, my Harvard Medical School colleague and editor-in-chief of the Harvard Women’s Health Watch, about the options.

For women with PMDD who also desire contraception, the birth control pill can be very effective. Several studies suggest the best birth control pills for controlling PMDD symptoms contain the hormone drospirenone. Birth control pills with drospirenone are slightly more likely to cause blood clots than other pills; however, the risk is still relatively low. In women who are over 35 and are smokers, however, the risk is higher.

If this doesn’t adequately improve your symptoms, increasing the amount of estrogen in your birth control pill can help. If you still have troublesome symptoms, your doctor may recommend the “continuous method.” In this method, you take active birth control pills every day. Women who follow the continuous method will stop having periods.

Another treatment option is the class of antidepressants called selective serotonin reuptake inhibitors (SSRIs). There are many SSRIs to choose from, and studies suggest that they are equally effective. If the first one you try doesn’t work, your doctor can change the dose, or have you try a different SSRI to see if you get a better response.

The women I’ve treated for PMDD have often had their symptoms for years before seeking help. For women who haven’t experienced it, or for people who have not seen it in family and friends, it can be hard to appreciate how disruptive PMDD can be. For around 10 to 15 days each month, a person with PMDD can really have trouble at home and at work. Their moodiness and irritability can affect their relationships with family or co-workers.

I’m glad you asked about PMDD, and also glad that there are effective treatments for it.