Facts about Premenstrual Dysphoric Disorder (PMDD)

PMDD, or Premenstrual Dysphoric Disorder, is a more severe form of PMS characterized by significant premenstrual mood disturbance, often accompanied by mood reactivity and irritability. PMDD may occur 1-2 weeks before menstruation; however, these mood disturbances usually resolve when a woman begins to menstruate. The literature reports that women who have untreated PMDD are likely to experience a loss of three years during their lifetime resulting from premenstrual symptoms.6 

PMDD affects 3-8% of women of reproductive age, with symptoms usually occurring when a woman is in her twenties.6 Symptoms of PMDD may intensify with age, particularly as a woman enters menopause.7 Several factors can cause PMDD, including a history of an anxiety or mood disorder, a family history of premenstrual mood dysregulation, and heightened stress experienced by women aged between 20-30 years.8

Psychological symptoms may include:

• Anxiety
• Feeling overwhelmed or out of control
• Increased depressed mood
• Irritability
• Mood Swings
• Sense of feeling overwhelmed
• Sensitivity to rejection
• Social withdrawal
• Sudden sadness or tearfulness

Physical symptoms may include:

• Abdominal bloating
• Appetite disturbance (usually increased)
• Breast tenderness
• Headaches
• Lethargy or fatigue
• Muscle aches and/or joint pain
• Poor Concentration
• Sleep disturbance (usually hypersomnia)
• Swelling of extremities
• Fatigue
• Forgetfulness

PMDD should be distinguished from other medical and psychiatric conditions by a woman’s treating health professional. PMDD has features in common with chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and migraine disorder. In addition, mental illnesses such as anxiety and depression may heighten during premenstrual, mimicking PMDD.

Non-pharmacological Treatment for PMS and PMDD

Lifestyle modification

Regular aerobic exercise, especially regular, moderate-strength aerobic exercise for at least six weeks, can decrease PMS symptoms mimicking.9

• Aerobic exercise has been reported to reduce premenstrual mood symptoms and has other obvious potential health advantages.10
• Avoidance of stressful events, and adjustment of sleeping habits, are beneficial during the premenstrual period.10

Strength training conducted during the follicular phase has been shown to increase muscle strength.

• One study showed that participants that perform lumbar stabilization exercises (or strengthening your core) reduced lower back pain caused by PMS.11
•  Another study reported that 3-month regular aerobic exercise, whether moderate or intense, can improve and help reduce PMS symptoms such as negative mood, discomfort, and edema.12
• Benefits around the effects of aerobic exercise are associated with a general improvement in many premenstrual symptoms. Research indicates that participants who engage in aerobic exercise have improved psychological and physical symptoms, especially relative to premenstrual depression.13
• However, conflicting reports have also suggested that there is no evidence-based research to support exercise for the treatment of PMS and PMDD, although recommended for overall good health.14 

Women who increase their intake of complex carbohydrates may also exhibit an increase in levels of tryptophan, a serotonin precursor.10 Moreover, a study of 300 university students found that consuming fruits rich in antioxidants and non-starchy vegetables reduced PMS symptoms.15

Smoking has also been linked to increased psychological and behavioral symptoms, while consuming high-calorie, fat, sugar, and salt foods can exacerbate physical symptoms.15

Relaxation techniques and other therapies may assist with improving PMS symptoms. Cognitive-behavioral therapy (CBT) can reduce disruptive thoughts, behaviors, and emotions.16

Pharmacological Treatment

Herbal and other supplementation may also assist with alleviating PMS.  

• • Vitex agnus-castus (chasteberry)
    • This herbal medicine helps control mood swings and irritability associated with PMS and PMDD.17 
    • The extract may be associated with decreased gonadotropin, estrogen, progesterone, and prolactin levels, secondary to its role as a dopamine agonist.17 
    • In one study, participants were given forty drops of chaste berry extract for six days before the onset of menstruation for six consecutive months. Findings indicated a reduction in severe symptoms of PMS.18
  • Crocus sativus (Saffron)
    • A study reporting findings on fifty female participants administered 30 mg/d of saffron experienced reduced symptoms of PMS on the third and fourth treatment cycles.20

• • Ginkgo Biloba

• • • A study of ninety women with PMS was administered 40 mg leaf extract of G. biloba from day 16 to day 5 of their next menstrual cycle. Women reported experiencing a significant reduction in physical and psychological symptoms of PMS.21

Nutritional supplementation may also assist with alleviating PMS.  

• Magnesium
  • Magnesium and vitamin B6 can reduce PMS-related anxiety, but not the effects of stress in women with dysmenorrhea.32 
  • In terms of reducing PMS-related anxiety, magnesium and vitamin B6 are ineffective.32

• Calcium
  • Due to lower levels of calcium (lower than normal levels) in women with PMS, calcium supplementation of about 1000mg can significantly decrease the severity of PMS as it correlates with the production of serotonin and tryptophan metabolism.22–25
  • Another study showed low doses of calcium supplementation (500mg) significantly reduced PMS symptoms.26
• Fish oil
  • A randomized controlled trial involving forty-five women revealed that prolonged intake of omega-3 supplements could significantly reduce PMS symptoms.32
  • Studies have also shown that daily omega-3 supplementation can reduce PMS and PMDD symptoms.33
  • Essential fatty acids, in general, are shown to be effective in reducing PMS-related stress.32 
• Several studies have suggested an association between supplements’ administration, including vitamin D and E, thiamin, riboflavin, and decreased PMS symptoms.27–31
• Intake of non-heme iron, zinc, potassium, and copper can lower the risk of PMS .28