- With Mayo Clinic internist
Sandhya Pruthi, M.D.
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Sandhya Pruthi, M.D.
Sandhya Pruthi, M.D.
Dr. Sandhya Pruthi, certified by the American Board of Family Practice, has been practicing medicine at Mayo Clinic since 1995 with special interests in breast diseases and women's health.
She is a consultant in the Department of Internal Medicine, Division of General Internal Medicine, and the Breast Diagnostic Clinic. She is an assistant professor of medicine at Mayo Clinic College of Medicine in Rochester, Minn.
The Winnipeg, Manitoba, native stresses education and patient-related research and has been active in both areas since joining Mayo Clinic. She is the primary investigator at Mayo Clinic of several clinical trials evaluating new agents for the prevention of breast cancer and identification of biomarkers for early detection of breast cancer. Her other research and clinical interests include managing the health of women who are at increased risk of breast cancer, breast pain and hot flashes, and developing patient education decision-making tools for breast-related concerns. She is director of the Breast Diagnostic Clinic and is a member of the Women's Health Executive Committee. Dr. Pruthi has been newly elected as a member to the board of directors for the American Society of Breast Disease. She has assisted with a variety of articles for MayoClinic.com.
"Having an opportunity to share information with my patients in the way that will help them to understand and be able to make educated decisions about their own health is very important to me," she says.
"The Web has become a major information site for people, and I want them to get the best and accurate information to be able to make informed choices for themselves, their family members and friends."
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Question
Premenstrual dysphoric disorder (PMDD): A severe form of PMS
What is premenstrual dysphoric disorder (PMDD)? How is it treated?
Answer
from Sandhya Pruthi, M.D.
About 75 percent of menstruating women experience mild to moderate premenstrual symptoms. But up to 10 percent of menstruating women have premenstrual dysphoric disorder (PMDD) — a severe, sometimes disabling form of premenstrual syndrome (PMS).
Premenstrual dysphoric disorder is distinguished from PMS by the severity of its symptoms and its impact on relationships and daily activities. Symptoms of PMDD — which occur in the last week of the menstrual cycle and usually improve within a few days after menstruation begins — include:
- Persistent sadness or depression
- Marked anxiety, feelings of being "keyed up"or "on edge"
- Mood swings often marked by periods of teariness
- Persistent or marked anger or irritability
- Decreased interest in usual activities
- Fatigue or lethargy
- A feeling of being overwhelmed or out of control
- Flu-like symptoms, including muscle aches, headaches and joint pain
- Breast tenderness
- Changes in sleep patterns — problems falling and staying asleep or sleeping too much
- Changes in appetite — overeating, lack of appetite or specific food cravings
The cause of PMDD isn't clear. Major depression is very common with PMDD. But PMDD can also occur in women who do not have a history of major depression.
Treatment of PMDD is directed at preventing or minimizing symptoms and may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
- Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) reduce symptoms such as fatigue, food cravings and sleep problems.
- Oral contraceptives. Oral contraceptives stop ovulation and stabilize hormone fluctuations, which reduces mood swings.
- Nutritional supplements. Consuming 1,000 milligrams of dietary and supplemental calcium daily may reduce the physical and emotional symptoms of PMDD. Vitamin B-6 and magnesium also may help.
- Herbal remedies. Clinical trials suggest that L-tryptophan and chasteberry may reduce irritability, mood swings, anger and headaches associated with PMDD.
- Diet and lifestyle changes. Regular exercise often reduces premenstrual symptoms. Decreasing 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.
