Strictly speaking, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are not psychological disorders but has been included here as disorders because of their disabling effects on emotions and mood as well as their prevalence.
Premenstrual syndrome and premenstrual dysphoric disorder can be seen as parts of a spectrum of disorders that are related to the menstrual cycle. The similarities between them are the predictable nature of their symptoms which usually appear in the last week before monthly menstruation and subside after it begins, and the physical discomfort and mood swings that so frequently trouble women during their childbearing years. The differences between the two disorderslies in the severity of those symptoms and the degree to which they can disrupt women’s lives.
There are more than a few myths about premenstrual syndrome. The most prevalent of these myths is that PMS has no basis in biology; that it is not a disease caused by bodily malfunction but is rather caused by emotional instability. In actuality, PMS is completely biological.
Premenstrual syndrome includes such a broad and varied range of symptoms that confusion may be understandable. Some are purely physical: headaches, pain in the pelvic area, tenderness of the breasts, fluid retention and bloating. Others are emotional; a woman can experience mood swings, feel irritable, or even sudden bursts of crying.
Milder forms of these symptoms can befelt by nearly all women at some point in their menstrual cycle and are not indications of PMS. However, if symptoms appear during the last week or ten days prior to the onset of menstruation and are severe enough to prevent normal function, women are diagnosed with premenstrual syndrome. For those women, PMS represents a monthly disruption of normal activities that lasts until menstrual flow begins, pregnancy, or complete menopause.
Risk factors are age (between the late 20’s and early 40’s), giving birth to at least one child, a family history of depression, and a medical history of a mood disorder or postpartum depression.
How prevalent is premenstrual syndrome?
In the United States, it has been estimated that up to 85% of women regularly experience at least one symptom of PMS. This percentage is a bit higher in Europe, Asia and Australia, standing at 90%.
What causes premenstrual syndrome?
A definitive cause of PMS has not yet been determined. However, because the abundance of evidence pointing to effect of hormonal changes on mood, most experts agree that abnormally high ratios of estrogen to progesterone that occur just prior to menses produce the symptoms of PMS.
What treatments are available?
For mild caseds of PMS, lifestyle changes can help alleviate symptoms:
- Get plenty of regularly scheduled exercise, and include both aerobic and strength-building activities in your routine.
- Maintain a healthy diet, with plenty of fruits, vegetables and whole grains.
- Avoid salt, sugar, alcohol and caffeine; this is particularly important if you having symptoms of PMS.
- Get an adequate amount of sleep and don’t smoke.
- Dietary supplements such as folic acid, calcium (with vitamin D), magnesium and vitamins B-6 and E may alleviate some of the symptoms of PMS.
If symptoms are more severe, your physician may prescribe birth control medications. By stopping or limiting ovulation, birth control medications have reduced both physical and emotional symptoms for many women.
Where can I find help with PMS?
Massachusetts General Hospital maintains a website devoted to women’s mental health. Their section on PMS can be accessed at www.womensmentalhealth.org/specialty-clinics/pms-and-pmdd/?gclid=CLyc8v_szKoCFahdTAodEQ9ONg. You can also reach them by phone at 800-994-9662 (TDD: 888-220-5446).
What is premenstrual dysphoric disorder (PMDD)?
Premenstrual dysphoric disorder (PMDD) is far more severe than PMS. While it causes many of the same symptoms, the symptoms are intensified and disabling. The depression that can occur with PMS can reach the point at which thoughts of suicide occur, anxiety can become panic attacks, and irritability turns into anger. There are problems with concentration, severe fatigue, insomnia, and the feeling that life is spiraling out of control. To be diagnosed with PMDD, you must be experiencing five or more of these symptoms.
What causes premenstrual dysphoric disorder?
Unlike PMS, hormonal imbalances do not seem to be the direct cause of PMDD. In fact, when estrogen and progesterone are measured, women with and without PMDD are found to have the same hormonal levels. However, monthly hormonal fluctuations seem to influence brain chemistry and activity, specifically in the case of serotonin. This theory is supported by the fact that medications that work on serotonin reduce or eliminate symptoms of PMDD.
In addition to the risk factors similar to PMS, there is evidence of a genetic predisposition to PMDD; if a woman’s mother had PMDD, the chances of her developing the disorder are greatly increased.
How prevalent is PMDD?
An estimated 3 to 8 percent of women are diagnosed with premenstrual dysphoric disorder.
What treatments are available?
Prevention and treatment is very similar to that of PMS: including lifestyle changes such as a healthy diet and getting adequate sleep. However, women with the far more serious symptoms of PMDD are also prescribed serotonin reuptake inhibitors (SSRIs).
Where can I find help with PMDD?
Massachusetts General Hospital maintains a website devoted to women’s mental health. Their section on PMS and PMDD can be accessed at www.womensmentalhealth.org/specialty-clinics/pms-and-pmdd/?gclid=CLyc8v_szKoCFahdTAodEQ9ONg. You can also reach them by phone at 800-994-9662 (TDD: 888-220-5446).
Kaplan, H.I., &Sadoc, B.J. (1996). Concise Textbook of Clinical Psychiatry. Baltimore, MD: Williams & Wilkins.
(n.a.) (n.d.). Premenstrual Syndrome. Retrieved from www.womensmentalhealth.org/specialty-clinics/pms-and-pmdd/
Steiner, M., Peralstein, T., Cohen, L.S., Endicott, J., Kornstein, S.G., Roberts, C. . . . Yonkers, K. (2006). Expert guidelines for the treatment of severe PMS, PMDD, and Comorbidities: The role of SSRIs. Journal of Women’s Health, 15 (1), 57-69. doi:10.1089/jwh.2006.15.57