- With Mayo Clinic gynecologist and obstetrician
Mary Gallenberg, M.D.
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Mary Gallenberg, M.D.
Mary Gallenberg, M.D.
Dr. Mary Gallenberg is board certified by the American Board of Obstetrics and Gynecology and by the American Board of Internal Medicine in internal medicine and medical oncology. She is credentialed as a menopause practitioner by the North American Menopause Society.
An Antigo, Wis., native, Dr. Gallenberg is a consultant in the Department of Obstetrics & Gynecology at Mayo Clinic, Rochester, Minn., and an assistant professor at the Mayo Clinic College of Medicine.
Dr. Gallenberg has been with Mayo Clinic since 1990. She was on the Mayo Clinic Women's HealthSource editorial board and has been honored for excellence in teaching. She also won a Mayo Clinic Excellence Through Teamwork award.
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Question
Premenstrual dysphoric disorder (PMDD): Different from PMS?
What's the difference between premenstrual dysphoric disorder (PMDD) and premenstrual syndrome (PMS)? How is PMDD treated?
Answer
from Mary Gallenberg, M.D.
Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling form of premenstrual syndrome (PMS). Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships. About 30 percent of menstruating women have PMS. Up to 8 percent of women with PMS have symptoms that meet the diagnostic criteria for PMDD.
In both PMDD and PMS, symptoms occur in the last week of the menstrual cycle and usually improve within a few days after menstruation begins. Both PMDD and PMS may also cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however, the following emotional and behavioral symptoms stand out:
- Anxiety
- Feelings of being "keyed up" or "on edge"
- Persistent irritability
- Marked anger
The cause of PMDD isn't clear. Underlying depression and anxiety are common in both PMS and PMDD, so it's possible that the normal physical changes that trigger a menstrual period somehow exacerbate mood disorders.
Treatment of PMDD is directed at preventing or minimizing symptoms and may include:
- Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, others) and sertraline (Zoloft, others), reduce symptoms such as fatigue, food cravings and sleep problems. You can control PMDD by taking SSRIs all month or only in the interval between ovulation and the start of your period.
- Birth control pills. Taking birth control pills stops ovulation and stabilizes hormone fluctuations. Birth control pills containing drospirenone and packaged with a four-day placebo interval after 24 days of combination hormones may be more effective than are standard birth control pills.
- Nutritional supplements. Consuming 1,000 milligrams of dietary and supplemental calcium daily may reduce the physical and emotional symptoms of PMDD. Vitamin B-6, magnesium and L-tryptophan also may help.
- Herbal remedies. Clinical trials suggest that chasteberry may reduce irritability, mood swings, anger and headaches associated with PMDD.
- Diet and lifestyle changes. Regular exercise often reduces premenstrual symptoms. Cutting back caffeine intake can alleviate anxiety and irritability. Also, eating more carbohydrates in the week before your period may improve mood and memory.
It's important that you review your symptoms with your doctor. A thorough medical evaluation can determine if symptoms are due to PMDD or some other condition. If you are diagnosed with PMDD, your doctor can recommend specific treatments to help minimize the impact PMDD has on the days you experience symptoms.
- Casper RF, et al. Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder. http://www.uptodate.com/home/index.html. Accessed May 20, 2010.
- Casper RF, et al. Treatment of premenstrual syndrome and premenstrual dysphoric disorder. http://www.uptodate.com/home/index.html. Accessed May 20, 2010.
- Lopez LM, et al. Oral contraceptives containing drospirenone for premenstrual syndrome (Review). Cochrane Database of Systematic Reviews. 2009:CD006586.
- Chasteberry. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 16, 2010.
- Gold CE, et al. Diet and lifestyle factors associated with premenstrual symptoms in a racially diverse community sample: Study of Women's Health Across the Nation (SWAN). Journal of Women's Health. 2007;16:541.
- Sayegh R, et al. The effect of a carbohydrate-rich beverage on mood, appetite, and cognitive function in women with premenstrual syndrome. Obstetrics & Gynecology. 1995;86:520.
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