What is premenstrual dysphoric disorder?

Many women are familiar with premenstrual syndrome (PMS) and experience it every month before their periods. But there's another, much less well-known condition: premenstrual dysphoric disorder (PMDD). Up to 8% of menstruating women suffer from major symptoms of this disorder every month. Women over 30 are the most affected. Yet these women bear another burden: ignorance and misunderstanding of PMDD. Let's demystify it!

PMDD typically starts a few days before the onset of menstruation (during the luteal phase, i.e. from ovulation to menstruation), and symptoms gradually subside once bleeding begins. It profoundly affects women’s daily lives—particularly their mental health. Many report a loss of self-esteem and even suicidal thoughts. The people around them no longer recognize their personalities. They may even be absent from school or work. They feel stigmatized by this invisible evil they can't put a name to.

While the exact cause of PMDD remains a mystery, several hypotheses have been put forward, one of which seems more plausible: the hormonal pathway. Since PMDD occurs before menstruation, hormonal fluctuations associated with menstrual cycles could be the cause. Some women may be more sensitive to these fluctuations, triggering PMDD. But more research is needed...

Isn't it the same as premenstrual syndrome?

PMS and PMDD are two distinct entities, but they have some similarities. PMS manifests itself mainly through physical symptoms, such as sore breasts, abdominal pain and cramps, headaches and so on. Mental afflictions are also possible—but will be of lesser intensity than with PMDD. The two conditions are very similar and are frequently confused. It is believed, however, that the cause may be the same, namely changes in hormone levels. However, PMS is much more common, affecting up to 90% of women before menopause. In sum, PMDD is a severe form of PMS. It's also important to note that PMDD is not a mental illness.

That sounds like me. What are the symptoms?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), to be diagnosed with PMDD, you must meet several criteria of varying complexity:

At least two menstrual cycles must be affected by at least 5 of the following symptoms, starting approximately one week before menstruation and fading thereafter:

• Rapid and significant mood swings
• Intensified anger or sensitivity
• Sadness or depression
• Anxiety or nervousness
• Loss of interest in usual leisure activities
• Lack of concentration
• Severe fatigue
• Changes in appetite
• Sleep problems: insomnia or, on the contrary, increased sleepiness
• The feeling of losing control
• Physical manifestations: menstrual or muscular pain, tender breasts, and bloating

The person's daily life must be affected or distressed. These symptoms cannot be explained by any other cause, such as medication or a medical condition.

Important! This information is provided for information purposes only and does not constitute a diagnosis. Only a healthcare professional with the appropriate training can diagnose PMDD.

And then what? Can it be cured?

Cognitive-behavioural therapy (CBT) has been shown to be beneficial in PMS, so it is likely to be helpful in PMDD as well, in addition to other therapies. CBT is a type of psychotherapy used for many types of pathology. Several treatments can be tried to alleviate symptoms, which do not always work perfectly depending on the individual:  

• A category of antidepressants known as serotonin reuptake inhibitors (SSRIs) appears to be showing promising results. They can be taken every day or started about ten days before menstruation.
• Hormones are another possible aid. For example, oral contraceptives, particularly those containing drospirenone (a type of progesterone) and a low dose of estrogen, may be effective. The idea? Limit hormonal fluctuations as much as possible by taking the medication continuously. 

If nothing works, other more drastic treatments are being studied:

• Injecting a drug creates a kind of medicated menopause, with many undesirable side effects
• Surgery as a last resort

These treatments have numerous contraindications and are not suitable for everyone, so it's essential to consult a healthcare professional to decide on a treatment that's right for you.