What is PMDD?
Premenstrual Dysphoric Disorder (also known as Premenstrual Dysphoria, Late Luteal Phase Dysphoric Disorder, or PMDD) is a cyclical, hormone-based mood disorder with symptoms arising during the luteal phase of the menstrual cycle and lasting until the onset of menstrual flow. It affects an estimated 2-10% of women of reproductive age. While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance. PMDD is a severe negative reaction to the natural rise and fall of estrogen and progesterone. It is a suspected genetic disorder with symptoms often worsening over time and around reproductive events including menarche, ovulation, pregnancy, birth, miscarriage, and menopause. Women with PMDD are at an increased risk for postpartum depression and suicidal behavior. Many, but not all, women with PMDD have a history of sexual trauma or depression. 1,2,3
Causes of PMDD
PMDD is believed to be inheritable as shown in studies on families and twins.6 These same studies showed a specific variation in the Estrogen receptor alpha (ESR1) gene in those with PMDD versus those without. Other studies suggest that those with PMDD share a different kind of emotional reaction in the brain that is not found in those without PMDD.7 Additional studies show an a-typical response to ALLO (a main progesterone metabolite) in those with PMDD versus those without. Individuals without PMDD typically respond to ALLO as they would to alcohol or anti-anxiety medication (i.e. calming). It is possible that women with PMDD have developed a tolerance to the calming effect and emotional regulation of ALLO.8,9
In 2016, researchers at the National Institutes of Health (NIH) found that women with PMDD are more sensitive to the effects of sex hormones estrogen and progesterone, due to a molecular mechanism in their genes. Researchers compared white blood cells in women with PMDD and those without, which confirmed that it impacts a woman’s cellular response to sex hormones.3.1
Symptoms of PMDD
- Feelings of sadness or despair or even thoughts of suicide
- Feelings of tension or anxiety
- Panic attacks, mood swings, or frequent crying
- Lasting irritability or anger that affects other people
- Lack of interest in daily activities and relationships
- Trouble thinking or focusing
- Tiredness or low-energy
- Food cravings or binge eating
- Trouble sleeping
- Feeling out of control
- Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
PMS & PMDD
The term "PMS" has a long history both clinical and colloquial. PMS is often used in the general population and popular culture in a way to explain or dismiss a woman's volatile mood, depression, anger, or behavior.
Clinically, Premenstrual Syndrome (PMS) is a collection of emotional and/or physical discomfort including bloating, breast tenderness, increased hunger, weepiness, and irritability. As many as 80% of women experience some form of PMS in the second half of their menstrual cycle.
PMS does not interfere with a woman's quality of life, interpersonal relationships, or ability to attend work or school. PMS symptoms are more easily managed and do not require prescription medication including antidepressants. PMS is also not classified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
Women may experience no, mild, moderate, or severe symptoms of PMS. An estimated 2-8% of women meet the criteria for PMDD. PMDD may be borderline or mild, moderate, or severe. PMDD is the only form of premenstrual disorder currently classified in the DSM-V.
While PMS and PMDD are often used interchangeably in mainstream media and popular culture the etymology, diagnosis, and treatment widely differ. It is important to use the correct terminology when discussing PMDD so that awareness, education, and treatment may be correctly achieved.