What are the symptoms like?

Many symptoms of PMDD are similar to those of depression. PMDD is distinguished from depression by the cyclical pattern and the typical physical symptoms. The core symptoms of PMDD that are similar to depression include:

• intense feelings of unhappiness.
• being unable to see a positive future.
• feelings of worthlessness - feeling useless at everything.
• increased sensitivity to rejection or criticism.
• feeling suddenly sad or tearful.
• crying a lot for no particular reason.
• marked anxiety or tension - a feeling of being keyed up or on edge.
• persistent and marked anger, irritability or an increase in conflicts with other people.
• finding it hard to be with people.
• losing interest in usual activities (eg work, school, friends, hobbies).
• difficulty concentrating.
• feeling tired all the time, or having less energy than usual.
• increases in appetite, binge or comfort eating - especially of salty or sweet foods.
• sleeping more than usual, or (in a smaller group of sufferers) being unable to sleep.
• feelings of being overwhelmed or out of control.

Other symptoms that are common and more specific to PMDD include:

• physical symptoms such as breast tenderness or swelling, headaches, joint or muscle pain.
• an altered view of one's body - a sensation of 'bloating', feeling fat or actual weight gain.

When do these symptoms occur?

Women's menstrual cycles are not all the same length. Typically, a cycle lasts from 24 to 35 days. However, in some women the cycle can be as short as 21 days or as long as 42 days. Because of this, the timing of the symptoms varies slightly from woman to woman.

In all cases of PMDD the pattern is:

• the symptoms occur during the week before menstruation.
• the symptoms decrease during the menstrual bleed.
• the week following menstruation is symptom-free, but in women with longer cycles this symptom-free time can be longer.

Who is most at risk of developing PMDD?

• Women with a history of depression or anxiety disorder
• Women with a close family member with a history of depression or anxiety disorder.
• Women with a history of postnatal depression.

Symptoms are most likely to emerge in a woman between her teenage years and her late 20s.

What causes PMDD?

The cause of PMDD is unknown. However, the hormonal changes that occur during the menstrual cycle appear to be important in causing symptoms. The premenstrual fall in the sex hormones oestrogen and progesterone may also be significant. Another cause may be the changes in brain chemicals such as serotonin, dopamine and cortisol that occur with the menstrual cycle.

Is there a treatment?

The aim of treatment is to help reduce symptoms and allow women with PMDD to carry on with normal life.

Drug treatments

• Some women are helped by antidepressants notably fluoxetine (Prozac). Other antidepressants, including setraline (Lustral) and paroxetine (Seroxat) have been found to be helpful.
• These antidepressants are called selective serotonin reuptake inhibitors (SSRIs) and affect a brain chemical called serotonin.
• This might be why women with PMDD crave foods such as chocolate or other carbohydrate rich foods that are naturally high in serotonin.
• The oral contraceptive pill helps some women, but not others. The reasons for this are not absolutely clear. Different brands of the Pill differ in their constituent hormones. Recent research has suggested that the combined oral contraceptive pill, which contains oestrogen and progesterone, can help some sufferers. However, progesterone-only pills can actually make PMDD symptoms worse.¹

Other treatments

• Support from doctors, nurses, friends and family is invaluable.
• Studies have shown that changes to diet can help. Increasing intake of foods rich in complex carbohydrates (such as pasta and rice) and cutting down on dietary fat and caffeine may help some women.

I think I have PMDD. What should I do?

Visit your GP to talk about your concerns. He or she should be able to arrange appropriate help. Keeping a diary of your menstrual cycles, and noting down how you feel - emotionally and physically - may help.

Someone close to me has PMDD. What should I do?

• It is important to be supportive and understanding.
• Encourage her to seek help from a GP, before the symptoms prevent her carrying out normal, day-to-day activities.
• Take care of yourself: if necessary, seek help and support for yourself so you can continue helping the person close to you.