PMS and PMDD: Real Conditions That Require Real Treatment

Are you suffering from Premenstrual Syndrome (PMS) or Premenstrual Mood Dysphoric Disorder (PMDD)?  No matter what you call it, it is still a very disturbing and real condition. PMDD is as unique as the individual it effects. It can present with a wide array of symptoms including physical (bloating, cramping, headaches), emotional (mood swings, irritability, depression) or mental (fatigue, forgetfulness). Thus, treatment must be individualized and can be quite complex.

PMDD, in short, is truly “hormonal”, as it is directly related to the hormone Progesterone, and its effects on the body and neurotransmitters in the brain. Neurotransmitters are the messengers that send signals between brain cells, the one most commonly linked to PMDD is called Serotonin. Progesterone is made by the ovary from the cyst left behind after ovulation (release of the egg) has occurred. This occurs usually midway between subsequent menstrual flows. Progesterone is produced for 2 weeks, levels peaking just prior to the menstrual flow. Unless the ovary receives a signal from a developing pregnancy (which instructs the ovary to keep making progesterone to support the pregnancy until it can support itself), after 2 weeks progesterone production stops, the levels drop, and the period begins. Thus, women suffering from PMDD are usually symptom free the 2 weeks after a period begins, and the symptoms progressively worsen until the next menstrual flow.

PMDD can sometimes be difficult to distinguish between other disorders, such as underlying anxiety and depressive disorders that show worsening symptoms during the progesterone phase. Therefore, a detailed history of symptoms, usually involving a symptom diary, is needed as well as testing to assess for these and other conditions (thyroid function, diabetes) that can mimic PMDD symptoms. Your doctor will explain the work-up to you.

Once the diagnosis is made, treatment options will be discussed. These will be varied, depending upon the type and severity of the individual’s symptoms. Treatment can vary from:

• Supportive measures, e.g. diet, vitamins and supplements, exercise (which releases natural endorphins that counteract the progesterone effects on Serotonin)
• Hormone therapy aimed at preventing ovulation and progesterone production and
• Pharmacologic, using medicines aimed at decreasing the Serotonin response.

PMDD is a complicated disorder. The diagnosis can be sometimes difficult to pinpoint. The treatment options are varied and must be individualized. However, PMDD can be treated through collaberation and teamwork; our team of gynecologists are ready and able to assist you.