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well…what? premenstrual dysphoric disorder

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Getting your period can be bloody awful, and for many women the week or so leading up to it is not much better. The changes the body goes through in this time can cause moderate to severe symptoms, known as premenstrual syndrome, or PMS. While PMS can make life difficult, about 5% of women of reproductive age have a condition known as premenstrual dysphoric disorder, or PMDD, which is a more severe premenstrual condition that is generally considered a mood disorder. PMDD can affect a woman’s relationships, her work, and her life in general, but it can be treated if diagnosed. Unfortunately, like PMS, it can often be dismissed as feminine instability or weakness, and is often misunderstood by even close friends and family.

PMDD presents through both physical and mental symptoms. To be diagnosed, five symptoms must be present each menstrual cycle, but they don’t have to be the exact same symptoms every time. PMDD may cause depression, anxiety, irritability, anger, oversensitivity, and tiredness, as well as a loss of interest in regular activities and a lack of concentration. PMDD may also cause feelings of being out of control or overwhelmed, changes in sleep patterns such as sleeping too much or not enough, and changes in appetite, including cravings, overeating, and sometimes loss of appetite. Physical symptoms, as they can occur with PMS or PMDD, are not counted as separate symptoms in diagnosis, but when premenstrual, women may have breast tenderness and swelling, muscle and joint pain, headaches, a feeling of being bloated, and they may gain weight.

Due to its relation to the menstrual cycle, many women go to their gynaecologists for treatment of PMDD. Others seek help from psychologists or other health professionals. Before diagnosis, a patient seeking treatment may be asked to keep a symptom diary to determine that her symptoms are definitely linked to her menstrual cycle, and are not just more severe premenstrually. This could take up to two months, but if the symptoms are acute, treatment will probably start sooner. Antidepressant medication, most often selective serotonin reuptake inhibitors (SSRIs), is usually prescribed to treat the emotional symptoms of PMDD. SSRIs can be taken either all month for more severe cases, or the two weeks prior to menstrual flow for moderate cases.

Along with medication there are behavioural approaches and nutritional strategies to treat PMDD. Some women need to use all three approaches to effectively treat their PMDD. Research has found that limiting alcohol, caffeine, and salt consumption may be of benefit to women with PMDD. Avoiding sugar has also been suggested to be of benefit.

While it has not been studied specifically for its effect on PMDD, regular exercise is strongly recommended in its treatment, and in studies of PMS, it has been shown to be beneficial. Some doctors and researchers suggest meditation and yoga, along with other relaxation techniques, might be helpful as well. As PMDD is a mood disorder, some women have cited psychotherapies such a cognitive-behavioural therapy, interpersonal therapy, and supportive counselling as useful in their treatment.

Treatment can take a few months to work. If after a few menstrual cycles the symptoms have not gone away, your health professional can devise a new treatment plan. It may be as simple as using a different brand of antidepressant, or taking SSRIs all month instead of half the time. PMDD can be an awful lot to deal with, but it is a manageable illness that many women treat effectively with some support from the people close to them.

For more information, always ask your health professional.

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