Premenstrual Dysphoric Disorder: Hidden Cause For Depression

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Around the time of their period, many women in their reproductive years experience brief shifts in their physical and mental well-being In reality, at least 90% of women with regular menstrual cycles report experiencing unpleasant physical or emotional symptoms prior to their periods. These symptoms tend to be moderate and bearable for the majority of women. But for a certain set of women, these symptoms can be incapacitating and lead to serious disruptions in their life.

Premenstrual syndrome, or PMS, is an all-encompassing phrase that often describes a general pattern of physical, mental, and behavioural symptoms that appear one to two weeks before menstruation and subside at that time. Although clinically severe PMS symptoms have only been documented in 3–8% of patients, PMS is a widespread condition that affects between 30 and 80 percent of women of reproductive age.

Premenstrual dysphoric disorder (PMDD) is an endocrine illness that arises as a result of a change in the hormone level with severe symptoms of PMS. PMDD, however, is distinct. Similar to PMS, it generates emotional and physical symptoms, but women with PMDD find their symptoms exhausting. Your regular activities, such as work, school, social life, and romantic relationships may be hampered by your PMDD symptoms.

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What Are The Symptoms Of PMDD?

PMDD symptoms include:

  1. Feelings of despair, anxiety, impatience or even fury that appear out of nowhere and are referred to as being moody.
  2. Excessive weeping or sobbing without cause
  3. Intense sensitivity to rejection: thinking that everyone is upset or angry with you, Feeling overburdened or that you are barely getting by
  4. difficulty staying focused / having trouble staying on task
  5. Change or decrease in one’s appetite
  6. Exhaustion, bloating, cramps, headaches, sore breasts, and body pains are some physical discomforts.

Typically, symptoms appear 5-8 days before your periods, although they might appear sooner. Once your period starts, the symptoms stop. PMDD can begin at any point following puberty.

What Is The Cause Of PMDD?

Researchers think that PMDD is brought on by a high sensitivity to changes in hormone levels, though the exact causes are still unknown. According to recent research, an increase in sensitivity to the typical hormonal changes that take place during your monthly menstrual cycle may be linked to PMDD.

Among these potential elements are:

Genetics. According to some studies, heightened sensitivity to changes in hormone levels may be brought on by genetic variations.
Reduced estrogen and progesterone levels after ovulation and prior to menstruation may cause symptoms. Serotonin, a brain chemical that controls mood, appetite, and sleep, might also be important. Like hormones, serotonin levels fluctuate during your menstrual cycle.
Smoking. According to some research, the sensitivity of your hormones may be impacted by smoking.
Anxiety and trauma. Other studies have revealed that traumatic and stressful past experiences, such as emotional or physical abuse, may be connected to PMDD in some circumstances. Your PMDD symptoms could get worse because of stress.

Is PMDD A Mental Health Problem?

As an endocrine illness, PMDD is often referred to as a disorder associated with hormones. A variety of distinct mental health symptoms, such as sadness, suicidal thoughts, and anxiety, are also experienced by patients with PMDD in addition to physical symptoms.

For these reasons, it is recognized as a mental health condition in the DSM-5, one of the primary manuals used by physicians to classify and identify mental health conditions. In the end, it is important to remember that it is entirely up to you how you interpret your symptoms and experiences. Getting the assistance you need and deserve to handle PMDD’s effects on your life is crucial.

Difference between PMDD and PMS

Around their periods, approximately 75% of women and girls report emotional and physical discomfort, but PMS typically has a minor effect on their lives. The signs of PMDD are much more severe, and they frequently lead to issues that last long after the tampon box has been put back in the cabinet. For instance:

  • A girl experiencing PMS might feel worn out or a little off. A girl with PMDD might have trouble getting out of bed or focusing on even easy tasks.
  • A girl experiencing PMS may feel irritable or frustrated. A girl with PMDD may experience irrational rage, unexpected arguments with family members, or friendships or romantic relationships that are already in trouble.
  • A woman with PMS may be more sensitive and cry easily at things like depressing commercials. A girl with PMDD may feel more like she is going through a major depressive episode, with feelings like worthlessness, misery, and even suicidal thoughts.

PMDD is brought on by an increased sensitivity to the hormones progesterone and estrogen, which peak the week before a period.

How Is PMDD Diagnosed?

There are very few diagnostic procedures besides a thorough medical history, physical examination, and pelvic examination. Your healthcare provider might want you to be assessed for mental health issues because you have mental health symptoms. In addition, your doctor might instruct you to document your symptoms in a journal or diary for a few months. The following symptoms must be present for PMDD to be diagnosed:

Five or more of the following signs must be present each month for most of the menstrual cycles over a year:

  • Feeling Low
  • Angry Or Irritable Mood
  • Difficulty In Concentrating
  • Absence Of Interest In Once-Enjoyed Activities
  • Moodiness
  • Higher Appetite
  • The Desire For More Sleep Or Insomnia
  • Feeling Overburdened Or In Charge
  • Other Physical Signs, The Most Typical Of Which Are Headache, Bloating In The Abdomen, And Tenderness In The Breasts

Symptoms make it difficult for you to function in social, professional, or other contexts. Symptoms that are not associated with another medical condition or that are exacerbated by it.

What are the treatments for PMDD?

PMDD is a severe, ongoing condition that requires medical attention. The severity of PMDD symptoms may be lessened or relieved by several of the following treatment modalities:

Natural and Alternative treatment of PMDD

  • Aromatherapy: Chamomile, lavender, neroli, rose and geranium are used as drops in the bath or as an oil diffuser. It relieves pain in the PMDD and also reduces stress and sleep problems.
  • Warm bath: Warm baths might help you unwind and promote sleep. Menstrual cramps are also relieved by warm water. Before going to bed, take a 20-minute bath to ease PMDD symptoms.
  • Cognitive-behavioural Therapy or Psychotherapy: A non-pharmacologic approach is also provided by psychotherapy and cognitive-behavioural therapy (CBT) to treat PMS and PMDD. In treating women with PMDD, a recent study found that cognitive-behavioural therapy (CBT) was just as effective as fluoxetine (20 mg daily). 17 Other small studies indicate that cognitive strategies may help ease premenstrual symptoms.
  • Inhibitors of selective serotonin reuptake (SSRI): For the treatment of PMDD symptoms, selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacological agents. A sizable body of research, including numerous double-blind, randomized studies, supports the efficacy of SSRIs in reducing PMS and PMDD symptoms, both physically and emotionally. Women typically respond to low doses of SSRIs, and this response to treatment happens quickly, frequently within a few days. Evidence supports the use of other antidepressants with serotonergic activity, such as duloxetine, venlafaxine (Effexor), and the tricyclic antidepressant clomipramine, in the treatment of premenstrual symptoms (Cymbalta).
  • Increased protein and carbohydrate intake while reducing sugar, salt, caffeine, and alcohol.
  • Vitamins are added (such as vitamin B6, calcium, and magnesium).
  • Chakra: PMDD is caused by an imbalance of energy in the sacral chakra, which is situated in the lower abdomen, related to the colour orange, and affects the hormones that control reproduction. The body’s natural ability to repair itself is started by chakra-cleansing exercises.
  • Routine exercise and Yoga: Regular aerobic exercise has been shown to positively affect PMDD symptoms that are both emotional and physical.
  • Stress reduction: It has been demonstrated that the benzodiazepine alprazolam (Xanax) is effective in reducing premenstrual symptomatology, particularly premenstrual anxiety. However, this medication should only be prescribed under strict supervision due to the risk of abuse and dependence.

These methods have shown benefits in reducing the pain and giving relief but there is a need to be cautious as yoga, medicines and take of nutrients should be done by consulting the specialist or trainer.

Last line of treatment

Hormonal treatment: The idea behind hormonal treatments for PMDD is that stopping ovulation will eliminate premenstrual symptoms. There have been conflicting results from studies using oral contraceptives (OCPs) to treat PMS and PMDD. The addition of the novel progestin, drospirenone, may be responsible for oral contraceptives working more effectively. Drospirenone differs from the progestins found in other oral contraceptives and shares chemical similarities with spironolactone; a diuretic occasionally used to treat fluid retention in premenstrual symptoms in female patients.

Leuprolide acetate and goserelin acetate are examples of gonadotropin-releasing hormone (GnRH) agonists, a class of medication that causes the ovaries to stop producing estrogen and progesterone. This results in brief menopause and lessens the physical signs of PMS and PMDD, such as bloating and irritability. However, the drug causes incredibly low estrogen levels, leading to severe hot flashes and bone loss. To stop hot flashes and bone loss, women are treated with low doses of estrogen and progesterone in addition to the GnRH agonist. Although very efficient, this treatment is expensive and complicated and is only used when other options have failed.

To stop hot flashes and bone loss, women are treated with low doses of estrogen and progesterone in addition to the GnRH agonist. Although very efficient, this treatment is expensive and complicated and is only used when other options have failed.
Some women experience symptoms that worsen over time and persist through menopause. A woman might require prolonged treatment as a result. Throughout treatment, medication dosage may change.

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Will aging make my PMDD symptoms better?

Most likely not until you go through menopause. Some women’s PMDD symptoms get worse with time and stress. Even hysterectomized women can develop PMDD if at least one functional ovary is still present after the hysterectomy. When you reach menopause, your PMDD symptoms will disappear along with your period.

Does PMDD lead to heavy bleeding?

No, PMDD doesn’t lead to heavy bleeding. A brain malfunction known as PMDD results in an abnormally negative response to the normal fluctuations in hormone levels.
However, heavy periods may accompany additional symptoms, such as pelvic pain or painful periods, which could exacerbate the PMDD-related mood symptoms. Both heavy or irregular periods and mood symptoms could be signs of underlying medical conditions (such as thyroid disorders).

An underlying hormonal issue, such as irregular ovulation, an imbalance of hormones, or abnormal growth in your uterus, could also be indicated by heavy periods (such as polyps, fibroids, or a tumour).

Once you reach menopause and stop having periods, PMDD usually goes away. Additionally, you might observe that your symptoms change over time, occasionally for the better. By keeping track of your symptoms, you can better understand how your symptoms change over time and which treatments are most effective.

Remember that you might need to try a few different treatments before you find one that works for you. Do not be afraid to get in touch with people in your community or online, as this process can be frustrating. Connecting with others can help the process go a little more smoothly, whether you’re doing it to let out your frustrations or to discuss a potential treatment option.


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