PMDS / PMDD – Pre Menstrual Dysphoric Syndrome/Disorder
About 5% of women in fertile age has a worse variant of PMS, namely PMDS. PMDS is a syndrome with the PMS symptoms that are already familiar, plus psychological instability just before the cycle starts. These symptoms are in such a way that they hinder the functioning of work, school, daily activities, relationships, social activities. PMDS for now falls under a sort of depression. You can see it as a temporary depression around the period when the period is going to come. It starts mostly 2 to 1 week before the period starts. The PMDS can be hereditary.
At least around 75% of women experience sometimes PMS symptoms. This can be mood swings, and physical complaints like lower back pain, stomach pain, uterus pain, ovary pain, swollen and hurtful breasts. However these complaints normally don’t intervene with daily life that much as is the case with people who have PMDS.
The Diagnosis for PMDS can be made when you have a diary and you keep it for at least 2 following menstrual cycles. You write every day in your diary, and not skip a day. After the following menstrual cycles the symptoms can be clear through the diary, which are for example: depressive mood, anxiety to fear, disinterest in activities. These episodes happen during the luteal phase (after the egg release out of the ovary), the second phase of the menstrual cycle. With a normal cycle it would be around the second 2 weeks before your period starts. The heaviest it can be around 1 week before the period starts.
Some women also have complaints around the ovulation, and are normally only one week free of complaints. After a few days that the menstrual period starts the complaints are gone, and they are complaint free the week after the menstruation. This is a huge difference between PMDS and regular depression or anxiety disorder.
Sometimes women with PMDS also have a history of other mood disorders and anxiety disorders. Hallucinations and delusions can happen in rare cases in the late luteal phase of the menstrual cycle.
The PMS symptoms when not treated can also result later in PMDS symptoms, depending on the disbalance of the body, but mostly there are connections to mental instability in an earlier stage.
The following symptoms are characteristic for PMDS, they have to be there during the last week of the luteal phase of the menstrual cycle during the past year. They also must disappear in within a few days after the period started till the beginning of the folliculair phase (when the egg is released) and one week after the period has been finished. One of the four symptoms can be one of the next ones:
-Sadness, hopelessness and feeling of mocking themselves
-Anxious, fearful feeling of being on the edge
-Labile mood, crying, heightened sensitivity of rejection
-Staying annoyance, anger, adding up to interpersonal conflicts
-Disinterest in daily activities, that can be also related to disinterest in social activities (school, work, relationships, friends, hobbies)
-Subjective feeling of concentration problems
-Feeling tired, lack of energy
-Change in food habits, lack or extra food cravings or certain food cravings
-Hypersomnia (extreme need for sleep) or insominia (sleeplessness)
-Subjective feeling of being overwhelmed or loss of control
-Physical complaints like: swollen, sensitive or painful breasts, headache, feeling bloated, gaining weight when clothes/shoes/rings fit tight. Also pain of joints or muscles.
Also there can be mood swings, depression, intense anger and conflict with other people, tension, anxiety, irritability, difficulty concentrating, fatigue, change in appetite, feeling out of control, sleep problems, cramps and bloating, headache, hot flashes.
The symptoms can come together with suicidal thoughts. Also the PMDS can cause symptoms that can make another disorder worse, but it is not a cause of another disorder and it can not be interchanged or confused with another disorder because the PMDS happens in a certain time span depending on the menstrual cycle.
The causes can be an abnormal reaction to hormone changes related to the menstrual cycle. There has been shown a relationship between low levels of serotonin in the brain, that helps transmit nerve signals. Certain brain cells that use serotonin control also mood, attention, sleep and pain. Hormonal changes may cause a decrease in serotonin, leading to PMDS symptoms.