Premenstrual dysphoric disorder (PMDD): When there is more than the PMS

Most women have at least a little familiar with the miseries of premenstrual syndrome (PMS). Nearly 75% of women suffer from PMS symptoms during the two weeks before menstruation. Premenstrual dysphoric disorder (PMDD) is PMS with a twist.

Although both the physical symptoms of PMDD and PMS are similar - tiredness, breast swelling, back pain, headaches, food cravings, bloating, constipation, diarrhea - TDP includes emotional symptoms much more severe than the mood swings associated with PMS. It is characterized by extreme mood swings, irritability, depression and anxiety appear the week before a woman has her period and disappears a few days after its launch. They can produce depression and feelings of severe despair. In particularly serious cases, women may even feel suicidal. For these reasons, the TDP is a formal psychiatric diagnosis.

How to know if you have PMS or premenstrual dysphoric disorder? A diary of symptoms can help. Keep track of the dates of his term, and note when symptoms occur and how severe they are. (Start with your next period. - Do not try to hide the symptoms of your last cycle) The next step is to meet with your doctor. He or she will examine the reason for their symptoms and try to rule out other causes for them. The good news is that you can treat PMDD. But there is no one size fits all. It may take time and trial and error to find an effective cure.

The use of the "pill" for PMS and PMDD 
My first recommendation for soft SPM techniques is to promote regular exercise and relaxation. Some women find that reducing sodium reduces swelling and inflammation. For women with premenstrual syndrome or premenstrual dysphoric also want contraception, birth control pills and shortening or eliminating the "bye" Typical (where you get your period) can be very effective.

Several studies suggest the best birth control pills to control the symptoms of PMS or PMDD are those containing drospirenone hormone. When I command one of these drugs for a woman who wants to control their PMS or PMDD, I usually start with a dosing schedule that includes only a four-day interval, the "free time". If symptoms persist, I recommend a different pill with a higher dose of estrogen. If symptoms do not improve, I have next to the woman taking pills with active hormones every day, by completely omitting any "free time". (It is also called the continuous method.)

Women who stop taking birth control pills still have periods, but may have occasional irregular bleeding. Many people find the compromise is worth it to relieve symptoms of premenstrual syndrome and premenstrual dysphoric disorder. Keep in mind that birth control pills containing drospirenone are slightly more likely to cause blood clots than pills with other types and quantities of hormones. However, the risk is still very low in healthy women.

Doctors used to prescribe progesterone alone for PMS and PMDD. The most recent studies suggest that it does not help you. Although there is still a lot of attention to the use of progesterone, I do not recommend it.

SSRIs: Another option for symptom relief 

A class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) is another excellent option for treating PMS and PMDD. In fact, most doctors now consider them first-line therapy for these conditions. There are many SSRIs to choose from, and studies suggest that they are equally effective. There are two ways to take an SSRI for PMS/PMDD.

The first is to simply take it every day throughout your cycle. Another way is to take it only after ovulation (which usually occurs about 14 days before your period) and to stop when menstruation starts. This is called luteal-phase-only treatment.

The results of a recent study suggest that some women may benefit from taking an SSRI only when they are experiencing PMS/PMDD symptoms. Of course, any woman who continues to have symptoms during her period would benefit more from taking the SSRI throughout her period instead.

It may take several cycles before you see improvement. If the initial dose does not work, your doctor may increase it and give the new dose a few cycles to see if it helps. If you don’t find relief from the first SSRI you try, ask your doctor about trying a different one. Some women who do not respond to one SSRI may do better with a different one. Side effects of SSRIs are common and may include nausea, jitteriness, and headache. These drugs can also decrease sexual interest and interfere with the ability to have an orgasm. Taking them only in the luteal phase may ease side effects.

Whether you have PMS or experience the extreme emotional symptoms of PMDD, don’t suffer in silence. Pay close attention to the pattern of your symptoms and ask your doctor for help.
By: Hope Ricciotti, MD,