Premenstrual Dysphoric Disorder (PMDD) & PMS

Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a collection of symptoms that many women experience during the one to two weeks before a menstrual period. These symptoms may be physical, psychological and emotional. They disappear soon after the start of menstrual bleeding. While researchers are not certain what causes PMS, some popular explanations include that symptoms are related to cyclic changes in female sex hormones, pituitary hormones, prostaglandins, and neurotransmitters. The symptoms of PMS are both physical and psychological and can include:

PHYSICAL: Bloating, breast tenderness, swelling of feet and ankles, fluid retention and weight gain, painful uterine cramps just before and during the first few days of menstruation, headaches, food cravings (especially for salty or sweet foods), acne breakout, low energy or fatigue, palpitations, dizziness, backaches or muscle pain

PSYCHOLOGICAL: Fatigue, mood swings, irritability, depression, aggressiveness or hostility, crying spells, difficulty concentrating, increased appetite, forgetfulness, changes in sexual desire

While psychotherapy cannot change the biological process that produces the symptoms of PMS, mindfulness and stress reduction techniques can help women to be more aware of their cycles and to make lifestyle changes that can reduce the negative impact PMS has on their lives.

Premenstrual Dysphoric Disorder (PMDD)

While up to 75% of women report some discomfort related to their menstrual cycle, only 5% of women experience premenstrual symptoms that are so severe they cause significant mental distress and interfere with work, school, or relationships. PMDD can be devastating for women but is often not taken seriously by medical providers. About 15% of women with PMDD attempt suicide. Treatments for PMDD include antidepressants and hormone therapies which should be prescribed and managed by a physician or other qualified health provider. In addition to medication, lifestyle changes may be effective in relieving symptoms.

Symptoms of PMDD include: 

  • Depression
  • Anxiety or tension
  • Sudden mood changes
  • Irritability
  • Loss of interest in daily activities
  • Difficulty concentrating
  • Decreased energy
  • Food cravings and appetite changes
  • Insomnia or sleepiness
  • Physical symptoms, such as breast tenderness or bloating

Risk Factors of PMDD include:

  • Family history of PMDD
  • Stress
  • Being overweight or obese
  • Past history of trauma or sexual abuse

Further research is needed on the effectiveness of psychotherapy for treating PMDD but some studies do suggest the Mindfulness-based cognitive therapy can be helpful for many women in recognizing symptoms and taking actions to reduce their severity.

Therapy for PMDD in my practice includes thorough assessment to determine if PMDD is the primary diagnosis and referral to a qualified medical provider for proper treatment. I utilize mindfulness-based cognitive therapy and psycho-education to help women feel empowered to understand their bodies and to work with their cycles and embrace radical self-care.

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