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PMDD (premenstrual dysphoric disorder)

You’ve all heard of PMS, premenstrual syndrome. This involves physical/mental symptoms that occur the week or two before a period starts, and resolves a day or two into the bleed (in your natural cycle, not on birth control pills).


Symptoms include:


Headache

Bloating

Moodiness

Irritability

Fatigue

Cravings


How is PMDD different? PMDD, premenstrual dysphoric disorder, has extreme mood symptoms associated with the luteal phase. It’s not just irritability or moodiness. It involves severe depressive symptoms, intense sadness, anger, tension, or even suicidal thoughts. The severity of these mood symptoms typically interfere with normal functioning during the week or two prior to a period.


We think the cause is the steady drop in estrogen and progesterone in the 2nd half, or luteal phase, of the cycle. Though this happens premenstrually in all cycles (triggered by no pregnancy that month) some women are more sensitive to those drops than others. Stress, genetics, and history of other mood disorders may also increase the risk of PMDD.


So what can we do?

First, identify it. This is a medical diagnosis, not just an eye roll inducing “female problem”. These symptoms should be taken seriously. Keep a calendar and record mood symptoms along with cycle timing to better see if it correlates with the luteal or premenstrual phase.


Second, treatment.

There are options:


1️⃣therapy can help develop coping mechanisms to deal with the emotional changes each month.


2️⃣birth control methods that have both estrogen and progesterone override the normal cycle hormone fluctuations that are likely causing the symptoms. Yes, there is a hormone level drop (or withdrawal) that induces the period bleed on a pill, but it is much less of a drop than your usual cycle. Continuous pills may also help.


3️⃣Antidepressants. The SSRI class is helpful for this and some women will take it daily or only during the luteal phase. Other antidepressants can also be effective as well. Discuss side effects of these medications with your doctor before starting them so you know what to expect.


If you think you may have PMDD, let your doctor know and ask how you can be helped. There is no need to suffer.


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