Is It PMS… Or Something Worse?

Saturday, September 15, 2012

GoLocalWorcester Health Team

Symptoms of PMS can be mildly irritating or severe and disruptive. If they're the latter, they may be something more serious. Photo: Ben Hussman/flickr.

Most women have endured the irritability, mood swings, cramps and bloating of premenstrual syndrome (PMS). For some, these symptoms are generally mild, reasonably tolerable and tend to improve within a day or two. But for other women, this set of symptoms can be debilitating--a warning sign of premenstrual dysphoric disorder (PMDD), a more serious condition, according to Teri Pearlstein, MD, director of Women’s Behavioral Medicine at the Women’s Medicine Collaborative.

A more severe form of PMS, PMDD affects about five percent of women and can have a significant impact on their quality of life, Pearlstein said.

PMDD: an overlooked diagnosis

“PMDD is a real clinical diagnosis that requires medical attention and treatment," said Pearlstein, "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.” The good news, she added is that PMDD is treatable. "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 (NIH), 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.

The differences between PMS and 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.

Treatment options

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,” Pearlstein said. “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.”