An Introduction To Premenstrual Dysphoric Disorder: It’s More Than PMS

Periods are a bummer in general, and they bring along a lot more than just bleeding. Premenstrual dysphoric disorder, in particular, is a condition that can have a severe impact on your physical and mental health. Though not curable, here are some ways doctors can help manage the symptoms.

By Debashruti Banerjee
20 Sep 2021

Raise your hand if someone has told you your period “isn’t that bad” or if you’re tired of people on their period being represented as a comical, crying, bitter mess on television. Menstruation can have innumerable symptoms other than the usual bleeding and cramps?for some, even negatively impacting their personal, social and professional lives. Premenstrual disorders, a range of symptoms occurring between ovulation (release of the egg from the ovary) and the beginning of monthly menses, can affect a large number of people with physical, emotional and behavioural symptoms from their menarche (first period) to their menopause.


These symptoms, like bloating, headaches, tender breasts, irritability etc, are collectively called Premenstrual Syndrome or PMS. PMS can be manageable for many, but for others, it can take a more debilitating form known as Premenstrual Dysphoric Disorder (PMDD). Classified as a depressive disorder in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013, PMDD includes all the usual symptoms of PMS as well as a plethora of serious psychological symptoms like depression, anxiety and panic attacks.


According to Kolkata-based consultant gynaecologist Dr. Priyanka Sinha of Apollo Clinic, New Town, there is no definite cause behind PMDD, but the rise of the hormone progesterone before menstruation has a role in reducing the levels of serotonin in the brain. Serotonin is a mood-elevating neurotransmitter, reduction of which can adversely affect our mental health. PMDD symptoms occur 7 to 10 days prior to the period and start alleviating towards the end of every cycle. Though similar to PMS in the physical symptoms and treatment, PMDD can take a much more critical form if not diagnosed and treated properly. “Like Polycystic Ovary Syndrome (PCOS), PMDD is clinically diagnosed and not predictable or preventable,” says Dr. Sinha. It is not curable either, unfortunately. However, with a balanced lifestyle, prescribed supplements and proper counselling, you can cope with it better.



Symptoms of Premenstrual Dysphoric Disorder

In order to be diagnosed with PMDD, a patient must exhibit five or more of the following symptoms, as per the DSM-5 criteria:

  • Irritability
  • Anxiety and panic attacks
  • Depression and suicidal thoughts
  • Lack of focus
  • Fatigue
  • Food cravings
  • Headaches
  • Insomnia
  • Mood swings



Ways to cope with Premenstrual Dysphoric Disorder

1. Diet and exercise: A balanced and moderate lifestyle, as with anyone’s overall health, is effective in managing premenstrual symptoms as well. Proper hydration, reduction of junk food intake, eating vegetables rich in antioxidants, reducing alcohol and smoking?they’re all great places to start. Additionally, Dr. Sinha also highly suggests doing 150 to 170 minutes of moderate exercise every week. Exercise releases endorphins, a happy hormone that has similar effects on our brain as serotonin. To improve focus and calm yourself, you can also try yoga and meditation.

2. Calcium and Vitamin D: Apart from a healthy diet and active lifestyle, Dr. Sinha also prescribes some nutritional supplements to her patients like vitamin D and 1000 mg of calcium per day. “Given that calcium and vitamin D may also reduce the risk of osteoporosis and some cancers, clinicians may consider recommending these nutrients even for younger women,” reveals a 2005 study published in the JAMA Network. In fact, Vitamin D helps your body absorb calcium. Dietary sources of Vitamin D include fatty fish, egg yolks, fortified cereal, spending time in the sun etc. Calcium, on the other hand, can be found in dairy products, green vegetables and lentils.

3. Evening primrose oil: In the case of non-hormonal or herbal supplements, Dr. Sinha suggests evening primrose oil to be effective. “It contains Vitamin E, which can especially help with breast-related soreness, tenderness etc as well as reduce anxiety,” she adds. In a 2019 paper published in the Journal of Menopausal Medicine, Mohaddese Mahboubi concludes that upon long-term use, evening primrose oil can help with a variety of female ailments like “premenstrual syndrome (PMS), hot flash, mastalgia (breast pain), fibroadenomas (benign breast lumps), gestational diabetes, cervical ripening, and dilation”.

4. Oral contraceptives: Birth control pills have long been used not just to prevent unwanted pregnancies but also to regulate periods, hormone levels and premenstrual symptoms. Dr. Sinha, too, has prescribed a trial of oral contraception for 6 months to her patients. A 2012 study in the Cochrane Library revealed that “a drospirenone pill with low estrogen seems to help premenstrual symptoms in women with severe symptoms (PMDD)”.
Related story: Are You Using Birth Control Correctly?

5. Cognitive Behavioural Therapy: Since PMDD is a long-term struggle, it is imperative that you get the professional help you need as soon as possible. Apart from regular counselling, Dr. Sinha recommends Cognitive Behavioural Therapy (CBT) for patients with more severe psychological symptoms. By deconstructing and interconnecting your negative emotions, CBT can help reduce and/or eliminate them.



6. Antidepressants: Since PMDD can be triggered by lower levels of serotonin, the use of antidepressants like Selective Serotonin Reuptake Inhibitors (SSRIs) may be used in conjunction with CBT as treatment. In a trial published in the Archives of General Psychiatry, E. W. Freeman et al conclude that antidepressants “effectively reduced symptoms and improved functioning and were well tolerated by women with severe premenstrual syndrome”, even in those with a history of depression. However, these are very serious medications and should only be taken in severe cases and with a prescription.


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