Premenstrual dysphoric disorder (PMDD) is a severe form of Premenstrual Syndrome (PMS). It is a mood disorder associated with the luteal phase of the menstrual cycle. PMDD is premenstrual syndrome that is so severe it can be debilitating due to either physical, mental or emotional symptoms. PMDD considered being a very severe form of PMS that affects about 5% of menstruating women. Both PMDD and PMS share symptoms in common that include depression, anxiety, tension, irritability and moodiness. What sets PMDD apart is its severity. Women with PMDD find that it has a very disruptive effect on their lives.
Treatment is recommended because PMDD interferes with the sufferer's ability to function in her social or occupational life. All symptoms of PMDD are appearing after ovulation, between ovulation and menstruation (period), and disappearing within a few days after the period. Anxiety, anger, and depression may also occur.

What causes PMDD?

The exact cause of PMDD is not known. Changes in hormones related to your period may cause PMDD. Stressful life events and a family history of PMS or PMDD may increase your chances of getting PMDD. Major depression is common in women who have PMDD. However, not all women who have PMDD have major depression.

Most researchers, however, believe PMDD is brought about by the hormonal changes related to the menstrual cycle. Recent studies have shown a connection between PMDD and low levels of serotonin, a chemical in the brain that helps transmit nerve signals. Certain brain cells that use serotonin as a messenger are involved in controlling mood, attention, sleep and pain. Therefore, chronic changes in serotonin levels can lead to PMDD symptoms.

PMDD Symptoms

The main symptoms of PMDD include:

	Feelings of deep sadness or despair, possible suicide ideation
	Feelings of tension or anxiety
	Panic attacks
	Diarrhea
	Mood swings, crying
	Depressed mood or feelings of hopelessness
	Decreased interest in usual activities
	Sleep problems
	Lasting irritability or anger, increased interpersonal conflicts
	Apathy or disinterest in daily activities and relationships
	Difficulty concentrating
	Fatigue
	Change in appetite, Food cravings or binge eating
	Insomnia or hypersomnia
	Feeling "out of control"
	Increase or decrease in sex drive
	Increased need for emotional closeness
	Physical symptoms: bloating, heart palpitations, breast tenderness, headaches, joint or muscle pain

Five or more of these symptoms may indicate PMDD. Symptoms occur during the week before the menstrual cycle and disappear within a few days after the onset of the bleeding.

PMDD Treatment

Many of the same strategies used to treat PMS may also be helpful in relieving symptoms of PMDD. In general the following treatment strategies are recommended:

Good nutrition. Many health experts recommend that women with PMDD limit their intake of salt, caffeine, refined sugar and alcohol. Supplements, such as calcium, vitamin B6, vitamin E and magnesium may be recommended.

Exercises. Regular aerobic exercise such as walking or swimming appears to improve premenstrual symptoms.

Medications. Several antidepressants may be used to treat PMDD. There are three medications recommende for the treatment of PMDD: Sarafem, Paxil CR, and Zoloft. These antidepressants can relieve the symptoms of PMDD. Other antidepressants have also been effective in relieving symptoms of PMDD. These medicines can be taken continuously or intermittently, just during the 14-day premenstrual period. Taking them intermittently may decreases the side effects of these drugs.
Some over-the-counter pain relievers such as aspirin, ibuprofen (Motrin) and naproxen (Aleve) may help some symptoms such as headache, breast tenderness, backache and cramping. Diuretics, or water pills can help with fluid retention and bloating.
If anxiety is a component of the symptoms, an anti-anxiety medication may be recommended.
Hormones can be used to treat PMDD. Ovulation can be stopped either using medication or surgically (as a last resort). Medicines used to stop ovulation include birth control pills, Danazol, Zoladex, Synarel and Lupron. The second hormonal approach to treat PMDD is the use of progesterone or estrogen to relieve symptoms.

Counseling. Therapy to help women with PMDD develop effective coping strategies may help some with PMDD. Relaxation therapy, meditation, reflexology and yoga may also help, but these approaches have not been widely studied.