Premenstrual dysphoric disorder. What is it? How to treat it?

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Premenstrual dysphoric disorder “PMDD”, aka “PMS.”  The strict criteria of this disorder affects up to 12% of women, although 80% of women report at least one physical (or psychiatric) symptom during the luteal phase (last 2 weeks of their “month”).  Most women do not report significant impairment of their lives.

The symptoms fluctuate, meaning if one year they are severe monthly, the next year they may feel fine.  Women who gained weight or had a stressful event in the past year are much more likely to have symptoms of premenstrual syndrome compared to those who did not.

Why does this happen?  Every month a woman’s hormone levels change.  The cyclical changes in estrogen and progesterone levels may trigger the symptoms.

What are the symptoms?

  • Angry outbursts
  • Confusion.  Depression
  • Social withdrawal.
  • Breast tenderness.
  • Headache.
  • Swelling of hands or feet.
  • Weight gain.
  • Abdominal bloating.
  • Anxiety.
  • Irritability.

Treatment focuses on relieving the psychiatric and physical symptoms.  Options include…

  • Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for PMS and PMDD    These medications can be taken continually or can be taken just during the luteal phase monthly.
  • Serotonin aSNRIs can also be used, although this is “off-label” meaning that the FDA has not specifically approved these medications for this medical indication.
  •  Oral contraceptives “The Pill” works best when it is used “continuously” meaning treat with active birth control pills for 112 days at a time.
  • Other medications like calcium  or Vitamin D supplementation or herbal preparations (like saffron, ginkgo, peppermint, angelica root, turmeric, tangerine leaf, bitter orange, St. John’s wort) were not found to help symptoms.

I hope this helps.

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About drlesliegreenberg

I have been practicing as a family physician for over 20 years--as both an educator of physicians and clinician. From infancy to the elderly, I perform obstetrics and general medicine. I love my career and am passionate about my field of knowledge and my patients. Follow me on Facebook at Leslie Md Greenberg Medical Disclaimer The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
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