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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.