What is PMS/PMDD?

Many women know without even looking at the calendar that their menstrual period is about to begin. Common signals are breast tenderness, a feeling of bloatedness or weight gain, feeling tired or "down" or more irritable. These changes are entirely normal.

But a small proportion of women experience emotional and behavioral symptoms that are more than minor. In such cases, job performance, relationships, or self-image are affected. Affected women often experience conflicts with their partners, missed work days, and fears of losing control – particularly with their children. It is not "normal" when premenstrual symptoms interfere with women's lives in a distressing and disruptive manner. For these women, appropriate treatment may bring relief.

PMS stands for Premenstrual Syndrome. PMS is a cluster of emotional, behavioral and physical symptoms that have a cyclic pattern related to the menstrual cycle. The symptoms become severe in the week or two preceding menses and abate with menstruation.

PMDD, or Premenstrual Dysphoric Disorder, is a severe, disabling form of PMS. It is a clinical diagnosis characterized by intense mood and behavioral changes, and frequently, uncomfortable physical symptoms in the week or two prior to menstruation. These symptoms lead to significantly impaired functioning in interpersonal relationships and in carrying out day-to-day activities.

Symptoms of PMS/PMDD

Clinically significant PMS is likely to include several of the following symptoms, which can vary from one woman to another. A diagnosis of PMDD requires that at least five of the following symptoms, including at least one starred (*) symptom, be experienced at least at a moderate-to-severe level premenstrually and remit after the menstrual period:

  • irritability or persistent anger *
  • tension, anxiety, feeling “on edge” *
  • feeling depressed, blue, hopeless, worthless or guilty *
  • mood swings *
  • feeling out of control
  • decreased interest in usual activities
  • difficulty concentrating·
  • food cravings or changes in appetite
  • fatigue, lack of energy
  • sleep problems
  • physical symptoms such as breast tenderness, swelling, aches
How Common is PMS/PMDD?

Estimates of the percentage of women affected by PMS vary widely. The research of Dr. Jean Endicott at Columbia University showed that about one-quarter of cycling women have no premenstrual symptoms. About one-third have mild or moderate symptoms that are noticeable to them but do not interfere with their usual activities. Another third experience worsening of symptoms that are related to an underlying physical or mental health problem. The remaining ten percent or less experience severe premenstrual symptoms that interfere with job performance, relationships, and usual activities and are not an exacerbation of another health problem. This is consistent with other findings indicating that, using PMDD specific diagnostic criteria, approximately 3-8% of cycling women can be diagnosed with the disorder.

PMS appears to be a chronic condition which is most severe among women in their twenties and thirties. However, many women who are in their thirties when they obtain medical treatment for PMS report that their symptoms started years earlier and gradually worsened. The years of the thirties are filled with simultaneous stresses for many women, such as caring for children, developing a career, and maintaining a household. These same years may be the time when stress-responsive hormones reach their peak sensitivity in women.

What Causes PMS/PMDD?

The causes of PMS/PMDD are still not known. Physiologically, it is thought to be a consequence of complex interactions between ovarian steroid production and central neurotransmitters.

There is considerable evidence to suggest that PMS has a physiologic basis. Symptom reports recorded daily by thousands of women in research studies clearly show a pattern related to the menstrual cycle in the women who suffer PMS. Although no hormonal abnormality has been clearly identified, the symptoms appear to be related to the shifts in the female reproductive hormones that occur during the menstrual cycle. It is possible that some women are vulnerable to these hormonal shifts. They may have either greater shifts in their reproductive hormone levels or a greater susceptibility to the normal hormonal shifts that occur in every menstrual cycle.

Agents that suppress ovulation, such as Lupron, a GnRH agonist, reduce PMS symptoms. Clinical trials investigating certain oral contraceptive (OC) formulations have shown some efficacy in PMDD symptom reduction, but more information is needed about the efficacy of OCs for PMDD.

The neurotransmitter serotonin appears to be involved in the symptoms of PMS/PMDD. Research has shown that antidepressants called selective serotonin reuptake inhibitors (SSRIs) can help many women with severe PMS or PMDD.