PMDD

PMS has become a household word and the brunt of many jokes. According to a recent survey, many women remain unaware of its more severe form, premenstrual dysphoric disorder or PMDD.  Among 500 women recently surveyed, 8 out of 10 did not know that severe premenstrual problems have been officially classified as PMDD, nor did they know that such problems can be diagnosed and treated.  Even more disturbing is that the one in 4 respondents who described their premenstrual symptoms as strong or severe were among those unaware of PMDD.

 "We've got to educate women that they do not have to tolerate debilitating premenstrual symptoms," said Phyllis Greenberger, MSW, Executive Director of the Society for Women's Health Research, which commissioned the Yankelovich Partners survey (sponsored by a grant from Eli Lilly, manufacturers of Prozac).  "Women have a right to know if what they are experiencing month to month is actually PMDD, and how to get help."

PMDD stands for Premenstrual Dysphoric Disorder. It is the acronym for the more severe form of PMS (Premenstrual Syndrome). Like PMS, PMDD occurs the week before the onset of menstruation and disappears a few days after. PMDD is characterized by severe monthly mood swings and physical symptoms that interfere with everyday life, especially a woman's relationships with her family and friends. PMDD symptoms go far beyond what are considered manageable or normal premenstrual symptoms. 

PMDD is a combination of symptoms that may include irritability, depressed mood, anxiety, sleep disturbance, difficulty concentrating, angry outbursts, breast tenderness and bloating. The diagnostic criteria emphasize symptoms of depressed mood, anxiety, mood swings or irritability. The condition affects up to one in 20 American women who have regular menstrual periods.

The physical symptom list is identical for PMS and PMDD; while the emotional symptoms are similar, they are significantly more serious with PMDD. In PMDD, the criteria focus on the mood rather than the physical symptoms. With PMS, sadness or mild depression is not uncommon.  With PMDD, however, significant depression and hopelessness may occur; in extreme cases, women may feel like killing themselves or others. Attributing suicidal or homicidal feelings to "it's just PMS" is inappropriate; these feelings must be taken as seriously as they are in anyone else and should be promptly brought to the attention of mental health professionals.

Women who have a history of depression are at increased risk for PMDD. Similarly, women who have had PMDD are at increased risk for depression after menopause. In simplest terms, the difference between PMS and PMDD can be likened to the difference between a mild headache and a migraine.

While nearly all of the women in the survey reported experiencing premenstrual symptoms in the last 12 months, nearly half (45 percent) have never discussed PMS with their doctors. Even among women with strong or severe symptoms, more than one out of four (27 percent) had never talked with their doctors about PMS, despite the fact that most in this group reported that the symptoms interfere with their daily activities.

When asked about their reluctance to seek medical treatment even if they thought they had PMDD, nine of every 10 respondents who would not seek treatment said that they could cope with their problems on their own, and about one of every four felt their doctors would not take their complaints seriously if they did bring it up.

PMDD has recently been listed as an official psychiatric diagnosis. The fear of this stigma may contribute to women's reluctance to discuss it with their doctors. "I frequently work with patients who have waited years to ask a doctor about premenstrual problems or have been turned away by their health care provider when they tried to discuss symptoms," said Jean Endicott, Ph.D., Director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center. "They fear becoming the target of jokes or that seeking help is a sign of weakness. Informing women and providers about diagnosing and treating PMDD helps clear the way to effective medical care."

Survey respondents reporting strong or severe symptoms revealed the classic PMDD features of impaired social functioning and predominant mood symptoms.  Two out of three women (67 percent) with moderate, strong or severe symptoms reported interference with their daily activities. One third of these women said they find their mood changes, not their physical symptoms, to be most bothersome.

The survey also found that women with strong or severe premenstrual symptoms were five times as likely as those with moderate symptoms (26 percent vs. 5 percent) to experience these symptoms every month. A key part of the PMDD diagnosis is determining whether symptoms have occurred during most cycles of the past year and are clearly documented for at least two consecutive menstrual cycles.

When asked what they would do if they thought they had PMDD, two out of three women (66 percent) in the survey said they would most likely get information from their obstetrician or gynecologist, as opposed to consulting friends or using Internet resources. This is encouraging, according to Dr. Endicott, because the American College of Obstetricians and Gynecologists (ACOG) issued treatment guidelines for premenstrual symptoms earlier this year. It recommended the newer form of anti-depressant medications called "SSRIs" (selective serotonin reuptake inhibitors) as the preferred method for treating symptoms associated with PMDD.