PMS & PMDD

Most women get some symptoms during the premenstrual two weeks phase. Around 20-30% of women will get significant PMS symptoms and the prevalence of PMDD is estimated to be 5-8% in menstruating women.

Common symptoms of PMDD include:

• Mood swings with feelings of extreme anxiety, sadness and increased irritability
• Depression with feeling of hopelessness
• Aggressive angry feelings
• Decreased performance in work and sports
• Lack of concentration and inability to perform to usual standards
• Poor quality of sleep
• Physical symptoms including abdominal cramps, headaches, breast tenderness and hot flushes

PMDD is the most severe form of PMS and is characterised by significant mood symptoms. The feeling of anxiety and depression is more intense and some women may even feel suicidal. Behavioural changes with PMDD may affect your work and relationship to a significant degree.

PMDD symptoms occur up to two weeks before the period. Symptoms start with onset of ovulation and improve with menstruation. Keeping a symptoms-diary and demonstrating the cyclical nature of symptoms with respect to periods is an important part of diagnosis.

PMDD is thought to be caused by hormonal changes caused by ovarian function affecting the neuroregulators (particularly serotonin) in the brain. With ovulation, the ovaries produce increasing levels of progesterone and oestrogen levels go down. This is thought to affect the serotonergic pathway in the brain leading to mood related symptoms.

Risk factors for PMDD include:

• Stressful lifestyle
• History of depression and anxiety
• Obesity with BMI more than 30
• Smoking
• Age: Women between 20 to 35 years have stronger ovulation and have more symptoms
• Genetic risk factors

Reducing stress through lifestyle changes is helpful. Mindfulness, yoga and meditation are also known to help. Avoiding caffeine, sugar, smoking and alcohol can also help. Getting 8 hours of sleep with regular exercise and balanced diet is very important. Managing physical symptoms through painkillers can also help the severity of psychological symptoms. Taking B-6 Pyridoxine vitamin and Evening Primrose Oil tablets (both available over the counter) during this two week window can be helpful.

If the symptoms are affecting your well-being, quality of life, work or relationship, it is important to see your GP or your gynaecologist. It is helpful to keep a diary of symptoms which will help the doctor assess the severity and cyclical nature of your symptoms.

Doctors may suggest going on the contraceptive pill which evens out the hormonal levels by blocking ovulation. Sometimes, interventions such as CBT (Cognitive Behavioural Therapy) may be helpful. For severe mood-related symptoms, your doctor may suggest SSRI (selective serotonin re-uptake inhibitor) medication which also works as an anti-depressant.