A condition more severe than PMS?

PEOPLE often argue that attaching emotions to hormonal changes in women screams of sexism. However, a sensitive and practical approach is at times necessary to alleviate any mental suffering women may experience due to hormonal imbalances and cyclical changes.

Many of us are familiar with the term premenstrual syndrome (PMS) and even use it loosely when our significant other is being “difficult” as well as during arguments that we as men may not be winning. However, not many of us may be aware of premenstrual dysphoric disorder (PMDD), which is a more severe form of PMS.

Both PMS and PMDD begin about seven to 10 days prior to the start of the menstrual cycle; however, the latter is characterised by more severe symptoms that disrupt daily social and occupational functioning.

Symptoms

PMDD is characterised by, but may not be limited to, the following:

• Severe mood instability;

• Marked irritability and anger;

• Difficulty concentrating;

• Fatigue;

• Feelings of “losing control”;

• Depressed mood;

• Anxiety and tension.

Physical symptoms include: Abdominal bloating, breast tenderness, headaches, and generalised body aches.

Cause

The exact cause of PMDD is still an area for research as it is a fairly new diagnosis in the realm of psychiatry. However, biological, psychological and social factors are intertwined and cause significant distress. Hormonal changes during menstruation involving oestrogen and progesterone play a central role.

There are reports of premenstrual symptoms being more common in families, even though a specific gene responsible has not been identified.

Environmental stress and lack of sleep have also been implicated in some studies.

Treatment

Because PMDD can often be more debilitating than PMS, antidepressants may be needed to control and manage symptoms. This often causes controversy as medicating symptoms originating from hormonal changes in a particular sex raises many eyebrows.

However, its worthwhile to consider that treatment is also needed for other psychological disorders, specifically in women not limited to postpartum depression and psychosis, which can lead to significant risk of harm to both mother and baby if left untreated.

Also, emotional symptoms during times of menopause for both men and women are frowned upon less and have been used as staple for marketing strategies for supplement makers.

Antidepressants of the selective serotonin reuptake inhibitors class have shown good efficacy in treating symptoms of PMDD. You can reduce symptoms by either taking antidepressants throughout the month or only in the interval between ovulation and the start of menstruation.

Cognitive behavioural therapy, — in while the premise is that a person’s perception of an event can cause emotional and physical symptoms is treated with targeted interventions to alter the way people perceive and process events and thoughts, has been effective, and is important in providing a medication-free option for some patients

Other modalities of treatment for which further research is needed include herbal supplements, such as primrose oil, oral contraceptives with pill-free intervals, and diet and lifestyle changes, such as eating more fruits and vegetables, regular exercise and a structured sleep schedule.

The take-home message is that premenstrual dysphoric disorder is a more severe form of premenstrual syndrome and we need to adopt an open-minded, non-sexist approach towards better mental health care for our women.

Dr Ashish Sarangi MBBS is a resident in psychiatry at the University Hospital of the West Indies. He may be contacted via email at aks_sarangi@hotmail.com