PMDD: Fact or Fiction
Biology 103
2002 First Paper
On Serendip
PMDD: Fact or Fiction
Margaret Hoyt
"PMS, PMDD, or whatever label you put on it, is, has been, and
probably always will be one big excuse for being grumpy and nasty,"
posts Marianne E (1).
A faceless Internet user posting her thoughts on a web forum, Marianne
shares an opinion with many other Americans. Many people, mostly men,
feel that female sexual disorders exist purely as a defense for a bad
mood. A handful of women and a few members of the medical community
might agree with Marianne. However, a significant amount of research
and medical opinion contradicts Marianne's assertation. As many women
can attest, PMDD, or Premenstrual Dysphoric Disorder, can be a fact of
life.
It is estimated that 70-90% of women will experience some form of premenstrual grief at some point during their fertile years. Of those women, between 30-40% of women can be diagnosed as having Premenstrual Syndrome. Narrowing the field even more, 3-7% of those women have Premenstrual Dysphoric Disorder (2).
In general terms, PMDD can be considered a severe form of Premenstrual Syndrome, or PMS. Because the two disorders share many of the same symptoms, a problem results in distinguishing between the two. A simple answer exists in terms of severity: a woman with PMDD experiences the same ailments as a woman with PMS, only the woman with PMDD suffers to a far greater degree. The medical community has attempted to provide clinical descriptions to help specify these disorders. A PMDD website maintained by the drug company Lilly describes PMDD as a combination of psychological and physical effects occurring from one to two weeks before a woman begins her period (3). Furthermore, all of the symptoms associated with the onset of a woman's period can be separated into three categories: PMD, or Premenstrual Discomfort; PMS, or Premenstrual Syndrome; and PMDD, or Premenstrual Dysphoric Disorder. The most common symptoms associated with Premenstrual Discomfort consist of physical changes: bloating, weight gain, acne, dizziness, headaches, breast tenderness, cramping, backaches, food craving, and fatigue. Those symptoms associated with Premenstrual Syndrome tend to be more psychological changes: sudden mood swings, unexplained crying, irritability, forgetfulness, decreased concentration, and emotional over-responsiveness. Premenstrual Dysphoric Disorder consists of symptoms more commonly associated with chronic depression: sad, anxious, or empty moods; feelings of pessimism or hopelessness; emotions such as guilt or worthlessness; insomnia; oversleeping; change in appetite, resulting in weight gain or loss; suicidal thoughts/attempts; uncontrollable rage or anger; lack of self control; denial; anxiety; and frequent tearfulness (4).
PMDD is often confused not only with PMS, but also with depression. As previously mentioned the PMDD symptoms must exist in such severity as to inhibit the woman's day to day living, to separate the disorder from PMS. PMDD affects a woman's work environment, personal relationships and family life. What separates PMDD from depression is a sudden disappearance of most symptoms shortly after a woman's period begins. To further complicate matters, if PMDD is left untreated for several years, the symptoms may override the menstrual cycle, occurring during ovulation or at any time during the cycle (5).
Because PMDD shares symptoms similar to many other disorders, debate exists over where to classify PMDD. The fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) lists PMDD in its index, calling it a depressive disorder (6). However, lack of information and understanding of exactly how PMDD works prevents it from being classified in an official mental illness category. Basic research links the onset of PMDD to neurological and hormonal differences in some women's bodies. A study completed by the National Institute of Mental Health linked PMS with abnormal levels of estrogen and progesterone (7). In the article introducing the study as it was published in the New England Journal of Medicine, Dr. Joseph Mortola wrote, "premenstrual syndrome is probably the result of complex interaction between ovarian steroids and central neurotransmitters," (7). A Psychiatric News bulletin describes how PMDD specifically works, "in a press release on the advisory committee's recommendation, Lilly said that although the etiology of PMDD is not clearly established, it "could be caused by an abnormal biochemical response to normal hormonal changes." Routine changes in estrogen and progesterone associated with menses may, in vulnerable women, induce a serotonin deficiency that could trigger the symptoms of PMDD." (8).
Some women's bodies cannot effectively handle the hormonal shifts that occur every week in a menstrual cycle. Lilley suggest that these women lack the level of serotonin, a neurotransmitter, needed to make smooth hormonal and emotional transitions from week to week. Several antidepressants have had the most successful results in terms of strong effects on serotonin levels -- the medical community has dubbed these drugs as SSRIs, or Selective Serotonin Reuptake Inhibitor (9). The FDA has only approved two SSRIs in the treatment of PMDD: Sarafem and Prozac. These two drugs contain Fluoxetine, which is thought to correct the serotonin imbalance in women who experience PMDD.
Three options exist for treatment of PMDD (9). Doctors may choose to take a medicinal approach, administering antidepressants, antianxiety drugs or hormones. Health care providers may also try focusing on the psychobehavioral aspects of the disorder. This includes stress management, psychotherapy, and relaxation. The third option is a nutritional modification, including dietary restrictions, extra vitamins, rigorous exercise, and herbal remedies. Women are encouraged to speak to her gynecologist to find the most appropriate method of treating her PMDD.
Many factors contribute to the reason why PMDD is regarded as a controversial topic. Little is known about the disorder: the American Psychiatric Association has not formally accepted PMDD as a mental illness; PMDD is listed merely as a disorder. Many doctors have found homeopathic remedies are most effective, thereby decreasing the validity of Fluoxetine drugs. Furthermore, since such a small percentage of women suffer from PMDD, it is entirely possible never to hear a personal experience. After hearing just one woman's story, it becomes that much more difficult to doubt the legitimacy behind her experience. With continued research, the medical field may be able to separate the divide between those who see PMDD as fact and those who see PMDD as fiction.
References
1) It Sure Feels Real; Forum response to article, , "Women Behaving Badly?" by Neil Osterweil.
2)USA Today Health Section, "PMS and PMDD Cause Serious Suffering," by A.J.S. Rayl.
3)PMDD informational site, maintained by drug company Lilly
4)Essay: PMS and PMDD - an Expose", by Anthea.
5)informational site, maintained by drug company Lilly
6)ABCNews.com, "The PMDD Debate: A Real Condition, or Just PMS by another name?"
7)Medicine and Biology article,"Estrogen, Progesterone Implicated in Provoking PMS," by Kenneth J. Bender, Pharm.D., M.A.
8)Psychiatric News, FDA Panel Recommends Fluoxetine for PMDD.
9)PMDD Facts for Health informational website
Comments made prior to 2007
I would like to know if the people who do not believe in PMDD have ever had severe symptoms. For the last eight months I have either abused my meds to the point of overdose just trying to sleep and cope with life. I also have attempted serioous suicide attempts all within 2 days of my period ... Kim, 5 May 2007
People like Marianne greatly
People like Marianne greatly contribute to the frustration and social stigma people who have legitimate menstrual disorders face on a daily basis. Not everything is a figment of someone's imagination. I'd love to have Marianne switch bodies with me and try living with this as many years as I have, i.e. severe abnormal blood loss, dibilitating cramps, a hormone imbalance, and intense and rapidly fluctuating depression, anxiety, and suicidal ideations. PMDD has been an absolute nightmare for me, not to mention the flippant attitude people who don't know anything about it can harbor. A little compassion goes a long way, I hope people get the facts before they make this kind of judgment. I would expect a female to be more aware of problems affecting their gender.
Scared to ask for help
I think I have had PMDD since I was 14. Physically, my periods were intolerable...... I would faint, vomit, shake uncontrollably. My teachers and classmates thought I was faking to get out of school. I am now on high dose birth control and have been for 4 years but the emotional symptoms are still here and getting worse.
I get the regular cravings and irritability but I also get paranoid and anxious. Any news or direction that puts me off my "plan" for the day causes a small break in my emotional state. I either start to laugh or cry.
Sometimes I stay up late at night and pace around my apartment worried, about absolutely nothing! My mind is blank but it feels as though something horrible is going to happen, or that people hate me, or that the night simply won't end.
These feelings used to only come a week before my period. Now it can happen either before of after and I am feeling cramping pains two weeks into my cycle.
I am on anti-inflammatories for the pain but its the emotions that are killing me.
I feel trapped in my head/body and feel desperately like I need help or I won't survive the night. The, and this is the worst part, it goes away and I feel perfectly happy. When I am happy I tell myself what I felt was nothing and I forget what it was like. This happens every two or three weeks.
I am afraid though that my doctor won't help me. That I'll be told I'm whining and that its normal and there's nothing anyone can do.
It's really scary and I don't know how much longer I can live like this.
That is, until, I get a happy stretch and forget all that I typed!
PMDD Its Real
PMDD its real, I didn't even know I had it, I didn't even know what I was suffering from on a monthly basis, getting so irritated, crazy-angry to the point of insanity. I started experiencing PMDD about 1 year after having my second child. I also suffered from post partum after the birth of my 2nd child, but it went untreated. I thought I just had a crappy marriage and was just unhappy about life and angry about life all at once. I had no desire for sex, out of control anger towards my children and no one to tell me that I was experiencing something medically wrong. It would come and go, but as my everyday stressors built up so did my emotions (this PMDD thing really effected me.) I suffered from weight gain, uncontrollable emotions, depression, temporary memory loss, or memory fatigue. I had disturbed thoughts of hurting my self and I really didn't know why and it was totally temporary. I would suffer with these out of control feelings for about 1-2 weeks and then my period would start and I was back to my normal, sweet, under control self. I have been suffering from this for about 4 years now. Im 34 and a nursing student and non of this has been covered in my studies. I found some clinical trials about it, but they are closed out now. And my mind can't help but wonder if PMDD is in some way connected to post partum syndrome and pregnancy induced psychosis. These other mental issues have something to do with that leutin phase of the menstral cycle and the ups and downs of progesteron, prolactin and estrogen hormones and seritonin levels. So if anyone has any information in regards to these issues please comment, There is something going on with women and we need to figure out what's missing or why this is happening and better ways of controlling it, maybe even curing it. Im begining to think that there might be a link between PMDD and abortions. I think its definantly worth looking into.
PMDD reality
I have PMDD, for 25 years now. The cycles of PMDD I have been coping with for what seems like an eternity now and for anyone that suspects that this PMS thing is just and excuse for women to behave poorly, walk a mile in my shoes and then be thankful for whatever good health you have enjoyed. I was told it was all in my head and that I just have to ignore my symptoms, easy to say if your not the one experiencing this period of time when your body seems to turn against you causing numerous physical and cognitive problems. Just 7 years ago a search on the internet would turn up just a handful of hits, at least now there are numerous sites and studies being done on this illness that harms the quality of life of these women and their relationships with their children, family,and loved ones.
PMDD
It wasn't until I had an ablation for severe menstrual bleeding while in peri-menopause that I realized that I had PMDD all these years since adolescene. After the ablation, my severe mood swings & what I called "nesting instincts" before my periods disappeared. I celebrated the fact that I have a life again! It's amazing. I had 4 children and with every one I went off anti-depressants and felt the best I had ever felt in my life -- that is another indication that it was PMDD and not another type of mental disorder.
There are some really good books written by women about PMDD and they document real symptoms that will help others distinguish what it is they are dealing with. Medical science needs to catch up -- this may not affect vast numbers of women, but for the ones it does it can be life-threatening and devastating to careers and families.
PMDD
To all of you reluctant to try sarafem/prozac (yes, its the same thing) - get over your prejudices. Its prescribed for other things than depression (OCD and bulimia for example). It has literally saved my life - in 1995 I decided to give myself 6 months more (after 5 years doing the rounds of doctors and treatments) to try to sort it out before suicide as my life was so awful. I was prescribed prozac, and it works. I take 2x20mg daily - at first for whole cycle, now just last 2 weeks of cycle. It completely takes away all the symptoms - physical and mental, and I feel just normal and fine on it. I hate taking a drug for this long, but when I stop it, the PMDD is back, just as bad as before. I tried 20mg daily at first, which reduced the symptoms, but the40mg is the jackpot.
So, like I said, get rid of your prejudices and try it. It could really help you to live a normal, happy, healthy life.
I'm 19, and...
...from the research I've done, I'm positive I'm suffering from PMDD. I went to my gynecologist three months ago to get help, and she prescribed birth control pills. They help with the horrible cramps and heavy periods, but the mood swings stayed exactly the same.
Less than a month ago, I went back, and she wrote a prescription for Sarafem. I told her I was reluctant to take an anti-depressant, but she assured me it was different, and that I only needed to take it 14 days a month, before my period. When I went to the pharmacy to get it, the pharmacist informed me that Sarafem is ONLY Prozac in a prettier box. I was shocked! I felt lied to, and taken advantage of. It's sick what the drug companies are doing to patients, misrepresenting a medication simply to give us a false sense of security. Needless to say, that prescription didn't get filled.
I don't know what to do next. It's about a week before my period, and right on schedule, I feel like dirt.
I can literally feel like, a hormone shift, like someone's throwing a switch in my body. A few weeks every month I feel awesome, then it's back to this; crying everywhere, feeling overwhelmed, hating men (yes, men in particular), feeling hopeless, guilty, and dark. When I'm my normal self, these are all the complete opposite.
I actually had a health professor tell me that I should look into Bipolar Disorder. It scared me terribly, but now I'm positive this is PMDD.
If I have any advice for other people dealing with this, it's to do your own research before doing ANYthing. It's your body; know what's going on.
PMDD YAZ NEVER give up
I have a suggestion for you: YAZ I've had pmdd for 25 years and I have been on it for about a year now (soon as it was released) and it has been helpful, not a cure but 25% better is still better. When I started I was 21 years old. Take heart, every year they seem to learn just a little bit more. As you wrote, keep searching the internet for more info and support. When a time is particularly bad I remind myself, tomorrow will be better, don't do anything drastic because it will pass those horribly bad feelings that are so dark. After 25 years experience I think have earned the right to say Never give up, Cheryl
YAZ
My daughter lost her job and YAZ is to expensive now----any suggestions to an alternative?
YAZ really DID work but there are NO generic for it.
This is so real......sadly real
I have been sufferring from PMDD for about 10 years...however each year it's getting worst. I have begged doctors to help me, cried in their office and begged them to help me. I have heavy periods with back pain and cramps that required pain killers. I cry at my desk at work, I feel peranoid, I yell at my family, I get upset if there are dishes in the sink...I eat, I feel so much pain, back pain, hips, headaches. Twice I was sent to the hospital because the walk in clinics I was at thought I had a stroke, results showed no stroke. My husband has almost left me twice, but i think he stays because of the children. I have refused prozac for years, because I am afraid of what it might do to me...but I am beatten down, I can't live my life this way any longer, I feel hopeless and there's no one to help me. So I am going to try prozac. Two weeks of the month I am a normal happy person, and then two weeks I am a crazy lady with lots of pain. I hate this, I hate it so much, I hate it.
Prozac, Lexapro, Whatever
I have had PMDD all of my adult life. I am 47 now. PMDD is real-period. This woman is exactly right. I am two different women 2 weeks sane and 2 weeks anxious, tense, emotional, teary, unhappy and generally whacked. This is 1/2 my life we are talking about here people.
I've tried everything. Calculus, B6, magnesium, vitex (chasteberry) antidepressants, Natural progeterone cream up to 200 mg a dose... blah, blah, blah.
I still have PMDD and every two weeks my life is hijacked. If the best the medical model and pharmaceutical giant can do is prozac, sarafem, lexapro... give me a break it doesn't work - I'll admit its better than nothing, but it doesn't cure PMDD it only helps us avoid suicide.
I have finally came to the conclusion that menopause is the only out I'll ever get from this insidious condition. I can hardly wait, please Goddess of the Womb send it Soon. Dry me up like the desert and let me have my whole month back its been over thirty years ......
I HATE LIFE during PMDD!!!!!!!!!!!!!!!!!!!!!!
Hi,
I feel exactly the way you do with my PMDD......I am exhausted by not being able to make my doctor know how bad I feel! I have been suicidal at times and when I expressed that to my doctor I got nothing! He said I know how you feel! I said........NOOOOOOOOOOOOOOOOO, there is now way you can know what it's like to experience PMDD!
OH it is real
I have been depressed or what I thought for the past 5 years (that I noticed). I have tried to antidepressants, glucopage (due to high testoserone), meditiation, therapy and I am still evil as h*ll, irritable, confused, fatigued, depressed, sad 2 weeks before my period. As soon as it is over I am back to the person that I know. I am not able to funciton at work and therefore feel that each job is not right for me. I have worked 6 different jobs in the last five years and more than that before I got my degree. I told my doctor that I felt it was PMDD about 1 year ago. I don't think she knew enough about it and put my on wellbutrin. That worked for a little while and then they found out my testorone level was too high. They put me on meds for that and guess what the symptoms are still there. I thought it was because I was eating to much sugar and so I cut that out. The problem still came to a head this month right before my period. I have did a little research to find a herbal remedy and found out about 5HPT. That is my next try and so we will see. This is very real and alot of women don't even realize this is what it is. I wish that the doctors would look into it. Guess that will never happen as long as they are in kahots with the insurance companies and pharacutical companies. Hope you women out there feel better. There is hope.
I'm not exactly sure why the
I'm not exactly sure why the medical profession is so mystified, but PMS and PMDD and PCOS and many infertility problems, perimenopause and menopause troubles all have one thing in common...hormonal imbalance.
But people act like they can't figure out what causes PMS or PMDD. Well, hmmm, if it's hormone related (which obviously it is) could it be hormonal imbalance? It's my belief, as someone who has a hormonal imbalane, that putting anti-depressants into your body isn't going to help anything. Hormones require a delicate balance, most of us don't have it living in the industrial age. Adding more heavy chemicals like in pharmaceuticals isn't helping matters.
For relief, try natural progesterone cream. If it doesn't seem to work, it could be the dose. This is a natural bioidentical hormone. Get your hormones tested, the saliva test is the most sensitive and find out if your progesterone is low.
Unfortunately even most doctors who DEAL with hormones all day long can't seem to grasp the progesterone link.
Hoping others find relief,
Z
PMDD
After having tried many avenues to combat my symptoms of PMDD, I have just been prescribed Prozac. It was a last resort. I will continue other lifestyle changes as well and look for some relief over the next three cycles. I say this to say for anyone wondering (male or female) if PMDD is fiction, I dare you to come see me right now (as I head toward menses in 9 days). I promise you will have no need to further question this "disorder". You will not NEED a double-blind or any other kind of research set-up. Trust me. And then come back on Day 1 or 2 of my cycle and see a completely different person.
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