Premenstrual Dysphoric Disorder (PMDD)

Do you happen to know any female around you that is experiencing both physical and emotional lability symptoms that can be disruptive at certain times of the month? They may be suffering from PMDD, read on to find out more about this debilitating disorder.

What is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS).

In PMDD, the symptoms occur in cycles, only during the second half of the menstrual cycle and may last until the first few days after your period begins. 
Contrary to PMS, PMDD is associated with a debilitating interference of normal routine life and personal relationship with others.

What are the symptoms of PMDD?

Women with PMDD may experience the following symptoms: 

• Lethargy
• Change of sleeping pattern or eating habits
• Hot flashes
• Digestive symptoms such as bloating, indigestion, nausea or vomiting, constipation
• Breast tenderness
• Fluid retention symptoms such as weight gain, swelling of the hands and feet
• Neurological symptoms such as dizziness, headache, fainting spells, muscle cramps
• Emotional or behavioural symptoms such as, 
  

• Irritability, agitation
• Anger
• Anxiety
• Sadness or crying episodes
• Depression 
• Nervousness
• Concentration impairment, forgetfulness
• Insomnia
• Mood swings

When do symptoms of PMDD begin?

PMDD symptoms tend to begin 7-10 days before you start your period and may continue for the first few days after your period commences.

What causes PMDD?

The actual reason for a woman to develop PMDD remains unknown. However, there are several factors that have been linked to the development of PMDD, such as: 

• Genetics: family history of PMDD can make you more prone to developing it yourself. 

• Underlying endocrine abnormalities: fluctuation of oestrogen and progesterone, possible increase in aldosterone, antidiuretic hormone (ADH), can all lead to the development of PMDD.
• Low serotonin levels: serotonin is responsible for regulating mood, sleep, digestion, nausea, and others. Low serotonin levels can contribute to the development of PMDD.
• Low microminerals: low levels of microminerals such as magnesium and calcium can contribute to the development of PMDD.

How common is PMDD?

Studies have shown that while PMS is fairly common, affecting 75% of women with a regular menstrual cycle, PMDD is uncommon and affects only 3-8% of women who are already affected by PMS.  

Who is at risk of developing PMDD in Singapore?

You are more predisposed to PMDD if you have the following factors:

• Family history: a family history of PMS or PMDD increases your risk of developing PMDD.
• Mental health: a history or family history of psychiatric disorders such as depression, anxiety, or other mood disorders increases your risk of developing PMDD.
• Smoking: smoking or a history of smoking can increase your risk of developing PMDD.

How does PMDD affect a woman’s life?

PMDD is extremely disruptive, affecting not only a woman’s day-to-day life but also affecting and disrupting her relationship with others. PMDD causes detrimental physical and emotional symptoms which go on to cause tensions and problems in all aspects of a woman’s life.

When should I see doctor if I suspect have PMDD?

PMDD can be treated so if you notice that you have cyclical symptoms suggestive of PMDD, and you are experiencing daily functional impairment with possible relationship breakdowns, make an appointment with us and we can help you through your symptoms.

How is PMDD diagnosed?

PMDD is diagnosed in the following ways:

• Medical history: PMDD is associated with mental health symptoms hence, this can identify any triggers or cause for PMDD.
• Physical examination: includes a pelvic examination to identify areas of tenderness with regards to your menstrual cycle.
• Blood tests: help identify any organic conditions such as thyroid disease or underlying micromineral deficiency to aid in the diagnosis of PMDD. 

What are the treatment options for PMDD in Singapore?

The management and treatment of PMDD are not easy as there is no single solution to the condition. Treatment usually requires a partnership discussion with your doctor, via motivation, patience, and trial and error. 

Treatment for PMDD usually involves a combination of various options that include both medical and non-medical approaches. 

Non-medical treatment options include:

• Inculcate good sleep habits to help improve your mood.

• Exercise can be beneficial in improving mental health as exercise releases endorphin and serotonin (also known as happy hormones). Furthermore, physical activities improve fluid retention symptoms.
• Healthy dietary intake with more protein, high fibre, less complex carbohydrates, and low sugar is important. Your doctor may also recommend dietary supplements such as calcium, magnesium, vitamin B6, and vitamin E. Do check with your doctor on the doses of the supplement to avoid overdosing of microminerals.
• Psychotherapy, cognitive behavioral therapy, relaxation techniques may also be offered to challenge your thought process and allow you to cope better when symptoms occur. 

Medical treatment options include: 

• Birth control pills: hormonal pills with synthetic oestrogen and progesterone can be useful in managing hormonal levels and hence allow for better control of PMDD symptoms. Your doctor will obtain your medical history and counsel you on the risk and side effects of hormonal medications prior to prescribing.
• Mood tablets: Selective serotonin release inhibitors (SSRI) has been shown to be clinically effective in improving mood/behavioral symptoms. Some physical symptoms including breasts tenderness and change in appetite can be alleviated with the use of SSRI. SSRI can be taken continuously or only when symptoms of PMDD occur. Like most medications, SSRI comes with a list of side effects. Discuss with your doctor to educate yourself about the benefits and disadvantages of SSRI.
• Nonsteroidal anti-inflammatory drugs (NSAIDS): useful in relieving physical symptoms such as migraines, aches, and menstrual cramps.

Your doctor wilL work together with you to come up with an individualised management plan for your symptoms and follow-up with you over the course of weeks to months to see your response to the treatment plan.

Is PMDD a psychiatric condition?

PMDD is a medical condition that can be associated with both physical symptoms and a range of mental health symptoms including depression, anxiety, irritability, or suicidal feelings. PMDD can coexist or be misdiagnosed with concurrent mood disorders. 

You are advised to speak to your doctor if you notice persistent, chronic abnormal mood symptoms or if you have feedback from your loved ones on possible mood issues.

What is the difference between PMDD and PMS?

PMDD is an extension of and a more severe form of PMS. In addition to the usual physical symptoms of PMS, PMDD has a negative effect on a person’s social aspect with debilitating interference of daily routine and interpersonal relationship. 

Is there a test for PMDD?

Unfortunately, there is no diagnostic test for PMDD. PMDD is diagnosed based on a detailed medical history and a clinical evaluation of your symptoms. Occasionally, your doctor may offer you blood tests to screen for other possible medical conditions (such as endocrine disorders) that may confound your symptoms. 

Frequently asked questions

At what age does PMDD usually begin?

PMDD can occur anytime as long as a woman is reproductively healthy, however, the average age of PMDD onset is 26 years.

Is PMDD the same as bipolar?

Both PMDD and bipolar disorder are cyclic disorders, and they may often present together at the same time. However, they are not the same as each other.

When is PMDD at its peak?

Symptoms of PMDD usually begin approximately 6 days before your period begins and are at its peak 2 days before your period starts.

Can PMDD be cured?

PMDD is treatable through a non-medical treatment, medical treatment, or a combination of both. Speak to your doctor who can help personalise a treatment plan for you.