What is Premenstrual Disphoric Disorder (PMDD)?

PMDD is a severe form of Premenstrual Syndrome (PMS).  Both PMS and PMDD are characterised by adverse physical and psychological conditions.  However, the defining characteristic between the two conditions is that the symptoms that are experienced in PMDD are more severe.

Diagnosis of PMDD

Diagnosis requires at least five of the following symptoms:

• Depressed mood
  
  
• Anxiety
  
  
• Irritability
  
  
• Poor concentration
  
  
• Lack of energy
  
  
• Food cravings and possibly an increase in appetite
  
  
• Insomnia or hypersomnia

It also includes physical symptoms such as:

• Breast tenderness
  
  
• Bloating
  
  
• Headache
  
  
• Joint Pain
  
  
• Muscle Pain

Cause of PMDD

Although the core cause of PMDD is unknown, it is believed that it may be the interaction of cyclical changes of the hormones with the changes in the brain neurotransmitters.  Whilst stress is associated with PMDD, it is not considered the cause.

Clinical Criteria

The timing of symptoms in PMDD can be confirmed by charting.  This record can be kept by the person for at least 2 cycles.  The most common time for the appearance of symptoms seems to be the late luteal phase of the menstrual cycle and then disappearing with the onset of the menses or by the end of the full flow of the menses.

Treatment

Exercise

Regular moderate aerobic exercise has been shown to lessen the symptoms of PMDD.  It is suggested that a sedentary person begin with 30 minutes a day of brisk walking 5 days per week. Exercise also increased endorphins and lowers cortisol.  Exercise may therefore have a positive effect on those who undergo negative moods and mood swings during the luteal phase.

Nutrition and Diet

There is a definite correlation between diet and the severity of the symptoms of PMDD.  Caffeine, sugar and salt have been shown to increase the symptoms.

• Caffeine - Although there is no specific data to prove this, women who consume the highest caffeine intake also report the most PMDD symptoms;
  
  
• Sugar - Sugar impairs estrogen metabolism.  PMDD symptoms are found to be more common in women with a high sugar intake;
  
  
• Salt – Excessive salt and decreased potassium stress the kidney’s ability to maintain fluid volume.

Furthermore, the following suggestions are recommended:

• Reduce fat intake;
  
  
• Increase plant foods;
  
  
• Reduce saturated fat and cholesterol (animal products) intake;
  
  
• Increase fibre intake such as fruits, vegetables, grains, legumes.

Supplements

It is imperative that, when considering supplements, a naturopath or nutritionist is consulted in order to be advised on the most suitable brands and dosages for the particular symptoms being experienced. The following supplements have been shown to improve the severity of symptoms:

• Magnesium has been shown to improve physical symptoms associated with PMDD;
  
  
• Calcium has been shown to improve altered hormonal patterns;
  
  
• Zinc;
  
  
• Vitamin E has been shown to reduce breast tenderness, headaches, nervous tension associated with PMDD;
  
  
• Essential Fatty Acids;
  
  
• Multiple Vitamin/Mineral s.

In conclusion, when diagnosing and treating PMDD, it is important to consider the following:

• It is important to look at the symptoms experienced and to rule out any other conditions;
  
  
• Chart the symptoms and the time line of the symptoms;
  
  
• Implement dietary changes with the support of a professional;
  
  
• Follow guidelines for a supplementation program with the support of a professional;
  
  
• Establish a program for stress relief;
  
  
• Initiate an exercise program.