A week before your period, is it the real depression? And it starts again every month? You may be suffering from premenstrual dysphoric disorder or PMDD, which affects 3 to 8% of women. It is a severe form of the better known Pre-Menstrual Syndrome (PMS). Advice to overcome this malaise.
We know the MPSminus the HRDT but both have the consequence of lowering the morale of women a few days before the arrival of their period. And that every month. There difference ? The TDPM or premenstrual dysphoric disorder is the severe form of PMS (premenstrual syndrome). “Women who have symptoms of PMDD shouldn’t be shy about talking about it” emphasizes Dr. Joëlle Robion, medical gynecologist and member of Syngof (Union of Gynecologists and Obstetricians of France).. What are the symptoms of the TDPM? What to do to better support its cycles? What causes ? There pill ? Does it pass over time ? Answers and advice with Dr. Robion.
What is premenstrual dysphoric disorder?
Premenstrual dysphoric disorder (HRDT) is a depressive disorder which affects 3 to 8% of women in genital activity and which occurs during the second phase of the menstrual cycle (luteal phase). It is called “premenstrual” because it occurs before menstruation that is to say before menstruation. “It’s a severe form of premenstrual syndrome (PMS). Like him, its characteristic is to be limited to the luteal phase of the cycle. When women have their period, they feel better then the disorder starts again in the following cycles” explains Dr. Joëlle Robion.
Premenstrual dysphoric disorder is therefore an exaggerated form of PMS with a heavier impact on mood and emotions. “Women no longer just complain about breast pain, swollen belly or fatigue but also sadness, anxiety, panic attacks, mood swings, listlessness, insomnia, libido disorders, hyperphagia or, on the contrary, lack of appetite” continues our interlocutor. Not every woman has all the symptoms, they often experience them two, three, four or five always with this feeling of very low morale just before their period. “They may know that it is linked to their cycle, they cannot overcome the discomfort linked to this period”. There repetition of these symptoms for at least 2 or 3 cycles must alert. They differ from those of a depression since they only exist in the 2nd part of the menstrual cycle.
What causes PMDD?
The causes of premenstrual dysphoric disorder are not clearly identified. “It’s not related to a hormonal imbalance”, immediately announces Dr. Robion. Among the avenues considered: hypersensitivity to hormones, neuro-endocrine factors (disruption of serotonin and/or dopamine) or genetics. “It is also thought that women who have mental disorders may be a little more susceptible to PMDD” adds the gynecologist.
Is the pill responsible for PMDD?
“The birth control pill is not a risk factor for this disorder. It does not improve or worsen it” replies Dr. Robion. A pill made from drospirenone is one of the treatments that can be offered to women suffering from premenstrual dysphoric disorder. A study published in 2005 showed that taking it improved symptoms but “the effects remain small” nuance the gynecologist.
“Women who have symptoms of PMDD shouldn’t be shy about talking about it”
What are the diagnostic criteria for PMDD in the DSM?
Diagnostic criteria are found in the DSM, the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association (APA). Premenstrual Dysphoric Disorder (PMDD) is classified as a depressive disorder. According to the DSM, at least 5 symptoms must be present in the last week before menstruation begins, begin to improve a few days after menstruation begins and become minimal or absent in the week after menstruation:
- Marked affective instability (mood swings, sudden feeling of sadness or tears…)
- Irritability, anger, interpersonal conflicts
- Markedly depressed mood, feeling hopeless, self-deprecating thoughts
- Marked anxiety, tension and/or feeling excited or jittery
- One (or more) of the following symptoms:
- decreased interest in usual activities (work, school, etc.);
- difficulty concentrating;
- lethargy;
- change in appetite;
- hypersomnia or insomnia;
- feeling overwhelmed or out of control;
- physical symptoms such as breast tenderness or swelling;
- joint or muscle pain,
- bloating or weight gain.
These symptoms must not be attributable to the physiological effects of a substance (drugs, medications, or other treatment) or to another medical condition (eg, hyperthyroidism).
Should you consult?
Yes ! “Women who show symptoms of premenstrual dysphoric disorder should not hesitate to talk about it. Some are in real distress. If we have a gynecologist, we will see him and if not, we will see his general practitioner” recommends Dr. Robion. We must not stay with this feeling of unease on the pretext that it disappears when the rules arrive. Because it is repeated every month and has a real impact on the quality of life.
Who to consult?
Doctor. First, the gynecologist (when you have one) or the general practitioner. “As a gynecologist, I don’t feel like prescribing antidepressants so I re-address to the general practitioner or a psychiatrist” testifies Dr. Robion. The general practitioner and the psychiatrist can prescribe antidepressants unlike the psychologist who cannot. The latter will be able to hear the patient’s complaints, but that will not be enough. “There can be suicidal tendencies in some women, it really is a disorder that can be dreadful. That’s why it’s up to the psychiatrist to take over.” It is possible to consult a psychiatrist directly, without the agreement of the attending physician. He is a specialist doctor recognized as part of the care pathway and whose consultations are covered by health insurance.
► The first thing to do is to re-evaluate your lifestyle : is physical activity regular? Is the diet varied and balanced without too much sugar, coffee or alcohol in particular? Is there tobacco consumption? If so, it is better to stop. Is there too much stress? If so, you should take up yoga or meditation. In short “take care of yourself” first advises Dr. Robion.
► “We then evaluate contraception of the patient but it does not always work” continues the specialist.
► If nothing helps, consider the reference treatment for premenstrual dysphoric disorder, which are antidepressants known as “selective serotonin reuptake inhibitors”. These are for example the Prozac®, Zoloft® or even Deroxat®.
► Next come surgical techniques such as the removal of the ovaries “but that’s a bit extreme” says Dr. Robion. Indeed, this ablation in a woman of 40 or 45 years leads to a early menopause not without consequences on his quality of life.
► hormone injections aiming to put the ovaries to rest also exist in the management of premenstrual dysphoric disorder but, here again, this amounts to putting the woman in menopause. “We can do it occasionally but not for 10 years in a 40-year-old woman” concludes the specialist.
Are there any natural treatments for PMDD?
“The taking of calcium, magnesium and vitamin E may have an effect on improving symptoms of PMDD but there are no studies, warns Dr. Robion. We can still try in food supplements as it is over the counter. This intake must go hand in hand with a change in diet and physical activity if necessary. And if the symptoms don’t improve, consult. Do not wait.
Thanks to Dr. Joelle Robion, medical gynecologist and member of the Syngoff. Source: Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD). National Library of Medicine; 2020-2022.