Premenstrual dysphoria disorder: It’s biology, not a behavior choice – Harvard Health (blog)

Home Harvard Health Blog Premenstrual dysphoria disorder: Its biology, not a behavior choice - Harvard Health Blog Posted May 26, 2017, 10:30 am

Almost all women have some mild premenstrual symptoms that signal the imminent arrival of their period every month. These symptoms are typically just an annoyance and dont cause any distress.

But for some women, these symptoms are much more significant. About 20% of menstruating women suffer from premenstrual syndrome, or PMS. Women with PMS have mostly physical symptoms and some minor mood disturbances caused by the changing hormone levels in the second half (or luteal phase) of the menstrual cycle. These hormone-induced symptoms can cause significant physical distress in the days leading up to menstruation.

Sometimes in about 5% to 8% of menstruating women debilitating mood changes accompany these premenstrual physical symptoms. Globally this is often referred to as severe PMS, but in the United States this combination of physical symptoms and mood disturbances is called premenstrual dysphoria disorder, or PMDD.

Unfortunately, women with PMDD are often misdiagnosed. Sometimes they go undiagnosed, being told they are just hormonal and need to get over it. And sometimes they are overdiagnosed. Unfortunately, it is all too common for women with PMDD to be incorrectly diagnosed with bipolar disorder.

Broadly speaking, if you have PMDD, you have an increased sensitivity to your reproductive hormones during the two weeks before your period starts. This sensitivity leads to alterations in the brain chemicals and neurologic pathways that control your mood and your general sense of well-being. Exactly what that sensitivity is and what causes it has not been well understood. And treatment options have been limited.

Fortunately, progress is being made with some exciting new discoveries. Researchers at the National Institutes of Health (NIH) have found that women with PMDD have an altered gene complex that processes the bodys response to hormones and stressors. This is a very important discovery, as it establishes a biological basis for the mood disturbances of PMDD. Not only is this validation for women who live with PMDD, but it also has tremendous implications for new and improved treatment options.

And more recently, Dr. Peter Schmidt, one of the lead researchers on the NIH study, published data that support the working theory that it is the changes in hormone levels, not just the hormones themselves, that trigger the symptoms of PMDD.

There are no tests to diagnose PMDD. The diagnosis is made entirely on the type and timing of symptoms.

To make the diagnosis of PMDD, symptoms must be present only in the week or two before your period, and they must subside within a few days of starting your period as quickly as they come on. The type of symptoms are also important. Specifically, to meet the criteria for PMDD you must experience at least one of the following:

In addition to these four core mood symptoms, any one of the following symptoms (to make a total of five) are needed to confirm PMDD:

If you experience any of these symptoms apart from the two weeks before your period, you dont have PMDD. Instead, it is likely that you have another underlying mood disorder. With the other mood disorders like major depression, bipolar disorder, and generalized anxiety disorder, you may have good days and bad days with your symptoms but they are not predictable. Your symptoms will occur randomly throughout the month, not just in the two weeks before your period. You may, however, notice an increase in symptoms before your period. This is known as a premenstrual exacerbation. It is very important to get the diagnosis right because the treatments are often very different for PMDD from the other mood disorders.

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Premenstrual dysphoria disorder: It's biology, not a behavior choice - Harvard Health (blog)