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Premenstrual Syndrome and Premenstrual Dysphoric Disorder

January 24, 2022

Most women of reproductive age are well aware of premenstrual symptoms. Premenstrual syndrome, also known as PMS, includes changes in mood as well as physical signs that occur in the days to two weeks before a woman's menstrual period starts. Symptoms typically go away shortly after the period begins. 

Premenstrual dysphoric disorder, also known as PMDD, is a more severe form of PMS, affecting about 3–6% of women. PMDD can interfere with daily life and make it hard for a woman to maintain relationships. Women who have had major depression are more likely than others to have PMDD. 

Endocrine Connection 

Disorders that mimic PMS and PMDD:

  • Mood and anxiety disorders 
  • Menopausal transition 
  • Thyroid disorders 
  • Substance abuse 
  • Some medical disorders can worsen before menses (migraines, irritable bowel syndrome, ME-CFS)

Doctors are still searching for the exact cause of premenstrual syndrome or PMDD. Hormone levels are the same in women with or without PMS/PMDD. But it is thought that women with PMS/PMDD have a greater response to the fall in hormones that occurs in the days before a period. There may also be changes in neurotransmitters in the brain. Some women have a genetic risk factor for PMDD. Undiagnosed depression or anxiety can also lead to problems. 

PMDD and PMS symptoms are the same, but the severity is different. Physical signs can include fatigue and problems with sleep. Women may also experience joint and muscle pain, headaches and breast tenderness. Temporary weight gain and bloating, changes in appetite and constipation or changes in bowel function can also affect women with premenstrual syndrome. 

Premenstrual symptoms can also include tension, anxiety, depression, anger, irritability and feelings of hopelessness. Women may experience crying spells and mood swings, have trouble concentrating or face a desire to withdraw from family and friends. Women with PMDD may feel depressed, extremely anxious, have high levels of irritability, and feel overwhelmed or out of control. Suicidal thoughts may occur with severe depression.

Lifestyle changes and medication can both be used to treat these conditions, and often a combination of these is needed. Women may be able to lessen their symptoms by eating small, frequent meals that are low in salt but high in fruits, vegetables, and whole grains. 

Exercise can lessen the symptoms of the syndrome. Aim for a healthy average of 30 minutes a day, five days a week. Stress reduction techniques, healthy sleep habits, and decreased caffeine and alcohol use can also help.  

Some women report improvement in symptoms with calcium as well as vitamin D, vitamin E, vitamin B6, and magnesium supplements but there are limited data on the utility of these supplements for PMS and PMDD. 

Medications for PMS symptoms include SSRIs, a type of antidepressant that is thought to be the most effective treatment for PMS/PMDD. Some women take the medication every day. It can also be given less frequently, by starting on day 14 of the cycle until day 1 of the period, or by starting on the first day that symptoms develop until the onset of the period.  Anti-inflammatory medications such as ibuprofen and naproxen can decrease pain. Birth control pills help regulate hormone levels by blocking ovulation and may make PMS less intense.  

PMS is part of life for most women. While the symptoms can be uncomfortable, they should not be life-altering. If you are experiencing PMS symptoms that are affecting your daily life, talk to your doctor to discuss the possibility that you might have PMDD and need treatment. 

  • What is my diagnosis? 
  • What are my treatment options? 
  • What are the advantages and disadvantages of each of my treatment options? 
  • Should I see an endocrinologist for my condition? 


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