Dear Maybe PMDD?,

Many women experience Premenstrual Syndrome (PMS), that is, discomfort, irritability, even mood shifts, before their period. For some, PMS interferes a bit with day-to-day activities. However, a small percentage of women experience severe physical and emotional distress that can be debilitating. Women with these symptoms can be diagnosed with Premenstrual Dysphoric Disorder (PMDD).

PMDD is believed to be caused by an imbalance of serotonin, a chemical found in the brain. The normal cyclical changes in female hormones may interact with serotonin, causing the imbalance and resulting in the mood and physical symptoms of PMDD. Similar to testing for PMS, blood or other diagnostic tests are not available to tell if a woman has PMDD. Health care providers often diagnose this disorder by having a woman keep a daily journal for at least two months. In this daily journal, she keeps track of the dates of her period, also noting her physical, emotional, and behavioral changes/symptoms throughout her cycle. Providers generally evaluate the journal to rule out the possibility of any mood or mental disorder that may get worse before menstruation. Women receive the diagnosis of having PMDD when their symptoms match a range of criteria that are listed in the DSM-IV, otherwise known as the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

These criteria are as follows:

Criteria A
Women who have PMDD have five or more of the following symptoms in most menstrual cycles for at least a year. Often these symptoms are most severe right before menstruation, diminish during menstruation, and are absent after menstruation.

• marked depressed mood, feelings of hopelessness, or self-depreciating thoughts
• marked anxiety, tension
• marked affective chemical, physical, or biological change
• persistent and marked anger or irritability, or increased interpersonal conflicts
• decreased interest in usual activities
• subjective sense of difficulty in concentrating
• lethargy, easy fatigability, or marked lack of energy
• marked change in appetite, overeating, or specific food cravings
• hypersomnia or insomnia
• subjective sense of being overwhelmed or out of control
• other physical symptoms, such as breast tenderness, headaches, bloating, weight gain, joint or muscle pain

Criteria B
The disturbance markedly interferes with work, school, social activities, and/or relationships with other people.

Criteria C
The disturbance is more than the worsened symptoms of another disorder.

Criteria D
Criterias A, B, and C need to be confirmed by keeping track of daily symptoms for at least two months.

Women who experience symptoms of PMS or PMDD and/or are diagnosed are often encouraged to exercise; avoid alcohol, caffeine, and sugar; take certain vitamins such as calcium and B-6 supplements; and, eat low-fat foods. Counseling may help alleviate symptoms if they are related to stress and anxiety. If this approach does not reduce symptoms within a couple of months, medications such as fluoxetine (under the brand name Sarafem) may be prescribed. Birth control pills or other drugs are alternatives to help improve symptoms.

No one knows your body better than you. Since you are concerned that you may have PMDD, Alice suggests that you contact your health care provider. If you are a Columbia student, you can call x4-2284 to make an appointment with Primary Care Medical Services. Let the provider know how you feel, and describe your symptoms so that you can both figure out an appropriate action plan.

Alice

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