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When it’s more than PMS

At one time or another, most menstruating women have experienced some form of premenstrual syndrome (PMS), a collection of mild to moderate symptoms that includes mood swings, breast tenderness, bloating, food cravings, fatigue and irritability. But for 3 percent to 9 percent of women, these symptoms become extreme and disabling, a condition called premenstrual dysphoric disorder (PMDD). Like PMS in overdrive, PMDD brings severe depression, sleep problems and moodiness that profoundly affect one’s ability to manage daily routines and relationships.

Your doctor may diagnose PMDD if you suffer at least five or more of the following symptoms during the week before your period and have for most of your cycles in the past year:

  • depression or hopelessness
  • anxiety, feeling keyed up or on edge
  • severe mood swings
  • anger or irritability
  • decreased interest in usual activities
  • difficulty concentrating
  • fatigue and low energy
  • overeating or cravings for certain foods
  • sleep problems (insomnia, waking too early or oversleeping)
  • feeling overwhelmed or out of control
  • physical symptoms (bloating, breast tenderness or headaches)

But first, your doctor will need to rule out other possibilities such as thyroid problems, lupus, depression or an anxiety disorder—conditions that can worsen before menstruation. Your doctor may have you keep a journal to record your moods and symptoms for at least two months.

If you suffer from PMDD, you should get regular exercise and adequate rest. Eat a better diet, too—increase your whole grains, vegetables and fruit and reduce salt, sugar, alcohol and caffeine. Your doctor may suggest nutritional supplements such as vitamin B6, calcium and magnesium; aspirin or ibuprofen for headache, backache and cramping; and a diuretic to reduce bloating.

Women with PMDD may benefit from a type of antidepressant called a selective serotonin-reuptake inhibitor (SSRI), such as Prozac, Zoloft or Paxil. You may get adequate relief by taking the SSRI part time (for only the 14 days before your period).