PMDD

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome that affects a minority of people who menstruate. It is characterized by recurrent, disabling emotional, cognitive, and physical symptoms that arise in the luteal phase of the cycle and resolve after the onset of menstruation.

Core mood symptoms include depressed mood, anxiety, irritability, anger, or conflict with others, along with physical symptoms such as breast tenderness, bloating, headaches, sleep disturbance, and fatigue. Symptoms must be present in most cycles for at least two consecutive cycles and cause marked distress or impairment.

Timing is a key feature: symptoms typically begin in the week before menses, peak just before menstruation, and improve within a few days after bleeding starts. They should not be present in the week following menses. PMDD is diagnosed in reproductive-age people after evaluation to exclude other causes of mood disturbance and physical symptoms.

Etiology involves sensitivity to normal hormonal fluctuations, particularly progesterone metabolites that affect GABA activity and serotonin systems. Genetic and environmental factors may contribute. The disorder is distinct from non-premenstrual mood changes and from milder premenstrual syndrome.

Treatment includes pharmacologic and psychosocial approaches. First-line medications are selective serotonin reuptake inhibitors, which can be taken daily or only during the luteal phase. Hormonal options include continuous combined oral contraceptives. Other treatments include mood stabilizers, GnRH agonists with add-back for severe cases, and psychotherapy, such as cognitive-behavioral therapy.

Prognosis varies; many individuals benefit from treatment, and symptoms often lessen with age or menopause. PMDD can significantly affect work, relationships, and quality of life, but with appropriate management, functioning can improve.