Resembling clinical depression, premenstrual dysphoric disorder (PMDD) is not PMS, although both occur in the days before menstruation. In PMDD, emotional symptoms become debilitating a week or two before a woman’s period begins and cascade into other mood and physical disorders. The symptoms abate once menstruation starts.
Eleven symptoms mark PMDD, including depressed mood, mood swings, irritability, lack of interest in previously enjoyed activities, difficulty concentrating, no energy, appetite changes, insomnia or constant sleeping, feeling overwhelmed, bloating, breast soreness and tension. Women who consistently experience any five or more of these symptoms meet the criteria for a PMDD diagnosis.
As with PMS, there is no lab test for PMDD. Certain disorders—thyroid problems, chronic fatigue syndrome, lupus, even depression itself—mimic PMDD and should be ruled out before PMDD is diagnosed. Once established, however, PMDD should be treated with lifestyle changes and antidepressants. If you believe you may have PMDD, talk to your doctor about it.
Women endure it, doctors empathize with it and sitcoms make light of it, but if you’re female there’s little chance of avoiding it: premenstrual syndrome, or PMS.
You probably know the signs of PMS: Seven to 10 days before your period, you notice you’re retaining fluids, your breasts are sore, you suddenly crave chocolate and you may even need a good cry. In fact, doctors say more than 150 symptoms—physical, emotional or mental—can be attributed to PMS. Then, at the onset of your period, the symptoms retreat for another month.
Seventy-five percent of menstruating women say they experience premenstrual discomfort, while 30 percent to 40 percent are affected by PMS. And unfortunately, an estimated 5 percent to 7 percent of menstruating women suffer a type of PMS so severe it affects their daily function. This type of PMS has its own medical term: premenstrual dysphoric disorder, or PMDD.Most PMS is treatable
As of yet, no tests can help doctors diagnose PMS. In addition, the severity of symptoms varies among women and can be different in the same woman from month to month. PMS usually sets in after age 20, and once it occurs, it becomes a regular episode until menopause.
Doctors believe PMS is somehow linked to the interaction of the brain and the ovaries. Beyond that, little else has been established. However, you can make some lifestyle changes to find relief from PMS, such as:
- eating foods rich in complex carbohydrates, such as leafy vegetables, whole grains and fruit
- exercising several times each week for better moods, more self-esteem and greater physical resistance to symptoms
- using less salt to minimize bloating and swelling
- decreasing caffeine and alcohol consumption to reduce irritability
- practicing relaxation through yoga, deep breathing or meditation
- taking supplements of chewable calcium (1,200 mg/day) and magnesium (200 mg/day), which have been shown to reduce bloating, moodiness and breast soreness by as much as 50 percent
- getting sufficient sleep to reduce stress and restore yourself
Several medications can also treat PMS effectively. Nonsteroidal anti-inflammatory drugs—or NSAIDs—relieve cramps and breast pain, although their long-term use may cause stomach problems. Low doses of selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft and Paxil have reduced PMS symptoms in up to 70 percent of patients. What’s more, they can be taken a week before PMS usually arrives, then discontinued until the following month.
You might also ask your doctor if diuretics to relieve fluid retention are appropriate for you. Likewise, consult your physician before trying complementary therapies such as black cohosh or chaste berry, an herbal remedy recently shown to relieve PMS-associated mood swings, breast soreness and headaches. (Note: Lactating women should avoid chaste berry.)
One treatment that doesn’t work is vitamin B6. Several studies failed to show any relief from PMS in patients who took it in high doses. Further, megadoses of vitamin B6 are believed to cause nerve damage, so it’s best to avoid this therapy.