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