Twenty to fifty percent of women between the ages of 30 to 40 with regular menstrual cycles experience premenstrual syndrome (PMS) as a regular physiological occurrence every month. In more severe cases, affecting three to five percent of menstruating women, this syndrome is labeled as premenstrual dysphoric disorder (PMDD) . Patients with severe PMDD are at risk for developing postpartum depression. Furthermore, women successfully treated with antidepressants often show breakthrough symptoms of depression in the premenstrual phase of their menstrual cycle. All that is needed is a small increase in the dosage of the antidepressant premenstrually.

PMDD Symptoms

Women with PMDD complain of irritability, anger, tension, marked depressed mood, and mood lability (crying spells for no reason, verbal outbursts, or tantrums ) to such a severity that quality of life is seriously compromised. In addition to these symptoms, some women complain of lethargy, sleep disturbance, limited concentration and a host of physical symptoms such as breast tenderness, headaches, joint and muscle pain, bloating and weight gain.

The primary symptoms that distinguish premenstrual dysphoric disorder from other mood disorders (i.e., major depression) or menstrual conditions is the onset and duration of PMDD symptoms -- with symptoms appearing during the week or so before and disappearing within a few days after the onset of menses -- and the level by which these symptoms disrupt daily living tasks. (This diminished level of functioning is generally in great contrast with the same woman's interactions and abilities at other times during the month.)

The symptoms of PMDD may resemble other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Consult a physician for diagnosis.

What Causes PMDD

Although the exact cause of PMDD is not known, several theories have been proposed. One theory states that women who experience PMDD may have abnormal reactions to normal hormone changes that occur with each menstrual cycle. This may include the fluctuation of estrogen and progesterone levels that normally occur with menstruation causing a serotonin deficiency, in some women (Serotonin is a substance found naturally in the brain and intestines that acts as a vessel-narrowing substance, or vasoconstrictor). Additional research is necessary.

How is Premenstrual Dysphoric Disorder Diagnosed?

Aside from a complete medical history and physical and pelvic examination, diagnostic procedures for PMDD are currently very limited. Your physician may consider recommending a psychiatric evaluation to, more or less, provide a differential diagnosis (to rule out other possible conditions). In addition, he/she may ask that you keep a journal or diary of your symptoms for several months, to better assess the timing, severity, onset, and duration of symptoms. In general, in order for a PMDD diagnosis to be made, the following symptoms must be present:

• over the course of a year, during most menstrual cycles, five or more of the following symptoms must be present:
  • depressed mood
  • anger or irritability
  • difficulty in concentrating
  • lack of interest in activities once enjoyed
  • moodiness
  • increased appetite
  • insomnia or hypersomnia
  • feeling overwhelmed or out of control
  • other physical symptoms

• symptoms that disturb social, occupational, or physical functioning

• symptoms that are not related to, or exaggerated by, another medical condition