Is it PMS or Something More?

Posted Wednesday, September 12, 2012

Experts from the Women’s Medicine Collaborative describe the difference between PMS and a more serious condition known as PMDD

Irritability, mood swings, cramps and bloating. For many women, these are the unwelcome signs of premenstrual syndrome (PMS), a group of physical and emotional symptoms related to a woman’s monthly menstrual cycle. While they can be bothersome, PMS symptoms are generally mild, tolerable and tend to improve within a day or two after a woman’s period begins, according to experts at the Women’s Medicine Collaborative.

But for some women, these symptoms can be debilitating, interfering with their ability to function at home, work or school, and could indicate a more serious condition known as premenstrual dysphoric disorder (PMDD). A more severe form of PMS, PMDD affects about five percent of women and can have a significant impact on their quality of life, says Teri Pearlstein, MD, director of Women’s Behavioral Medicine at the Women’s Medicine Collaborative.

“PMDD is a real clinical diagnosis that requires medical attention and treatment, yet some women chalk up their symptoms to having a ‘bad case’ of PMS, while others don’t seek help for fear they won’t be taken seriously. Many of these women suffer silently each month with everything from extreme mood swings to anxiety to lethargy,” she says. “But the good news is that PMDD is treatable, so there is a lot we can do to help women cope with this very real condition once they are diagnosed.”

The exact cause of PMS, which can affect up to 75 percent of women during their childbearing years, according to the National Institutes of Health, and PMDD is unknown, although it is assumed that women with PMDD have a sensitivity to the normal hormonal fluctuations of the menstrual cycle. Experts also believe the neurotransmitter serotonin, a chemical in the brain that helps transmit nerve signals, is involved in the development of PMDD. PMS and PMDD have nearly identical symptoms that present one to two weeks before a woman’s period begins. What distinguishes PMDD is the degree or severity to which symptoms interfere with daily activities. Pearlstein says typical PMDD signs include irritability, mood swings, lack of patience, feeling overwhelmed or out of control, fatigue, increased appetite (often with food cravings for specific foods), breast tenderness and abdominal bloating.

Women are typically diagnosed with PMDD when they have five or more of these symptoms during the week before their period. However, because some PMS and PMDD symptoms can mimic other conditions, such as irritable bowel syndrome, thyroid disease, anxiety or depression, Pearlstein adds that it’s important that women also have a thorough exam to rule out any of these other medical problems.

Although there is no cure, treatments that suppress ovulation and menstrual cycle hormonal fluctuations, such as oral contraceptives, are effective in treating PMDD. Antidepressants that enhance serotonin (including Prozac, Zoloft and Paxil) can also be used to treat PMDD when used daily throughout the cycle or during premenstrual weeks only. Pearlstein says some women prefer to take a medication during the symptomatic phase only. Other treatment options include calcium supplements, the herb chasteberry, dietary changes, exercise and cognitive behavior therapy.

“It can be confusing for women to tell whether they have PMS or PMDD, so one thing to remember with PMS is that while your symptoms may be annoying or a nuisance, you’re able to deal with them and go about your everyday life,” says Pearlstein. “However, if you find these symptoms are debilitating to the point where they’re disrupting your work and damaging your relationships, you may want to discuss your symptoms with a medical professional.”

The Women’s Behavioral Medicine team at the Women’s Medicine Collaborative includes board-certified psychiatrists and social workers offering specialized, personal help for a wide range of behavioral health issues exclusive to women, including mood and anxiety disorders during pregnancy and postpartum; pregnancy loss; infertility; and mood and anxiety disorders related to the menstrual cycle, the menopausal transition and chronic medical disease.

Filed under: Women's Medicine Collaborative,