Ask Doctor K: Severe PMS may actually be PMDD

Tue., Feb. 16, 2016

Dr. Anthony L. Komaroff Universal Uclick

DEAR DOCTOR K: I always assumed my premenstrual mood swings were normal. But then I talked to some friends whose emotional symptoms are much less severe than mine. A quick Internet search turned up “PMDD.” Can you tell me more about this?

DEAR READER: The physical symptoms of premenstrual dysmorphic disorder and premenstrual syndrome are the same. They include fatigue, swollen breasts, backache, headache, food cravings, bloating, constipation and diarrhea. But the emotional symptoms of PMDD, compared to PMS, are much more severe.

PMDD is characterized by extreme moodiness, irritability, depression and anxiety. These symptoms appear the week before a woman gets her period and go away a few days after it starts. A woman with PMDD may experience severe depression and feelings of hopelessness. In especially severe cases, women may even feel suicidal.

How can you tell if you have PMDD or PMS? For a cycle or two, keep track of the dates of your period. Note when your symptoms occur and how severe they are.

PMDD can be treated, but finding the right treatment can take time.

For women with PMDD who also desire contraception, the birth control pill can be effective. Several studies suggest the best birth control pills for controlling PMDD symptoms contain the hormone drospirenone. If this doesn’t adequately improve your symptoms, increasing the amount of estrogen in your birth control pill can help.

Another treatment option is antidepressants called selective serotonin reuptake inhibitors. There are many SSRIs to choose from, and studies suggest they are equally effective.

The women I’ve treated for PMDD have often had their symptoms for years before seeking help. For around 10 to 15 days each month, a person with PMDD can have trouble at home and at work. Their irritability can affect their relationships with family or co-workers.

I’m glad you asked about PMDD, and I’m also glad there are effective treatments for it.

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