Signs and Symptoms
Typically, women with PMDD have severe mood and physical symptoms in the week before their period. These symptoms include sadness and crying; nervousness, anxiety or irritability; mood swings, and problems concentrating and paying attention. They can also feel overwhelmed, have strong food cravings, sleep problems, fatigue, joint and muscle pain, bloating, and headaches. Typically, irritability is the most prominent and disabling symptom.
Fact
PMDD symptoms are burdensome and disrupt women’s relationships. A survey of 1,022 women, published in the
As in PMS, in PMDD the symptoms are tied to your menstrual cycle, so they disappear when your period begins. However, in PMDD, you experience more symptoms and the symptoms are more severe than in PMS (severe enough to interfere with work, school, or interpersonal relationships), and you must have them over at least two consecutive months. Women who have PMDD, rather than an underlying mood disorder, do not experience any physical or mental symptoms for seven to ten days after their menstrual cycle every month.
PMDD’s Different Patterns
There is more than one pattern to PMDD: symptoms can last for one week or two, they can appear full-force and then disappear, or they can start gradually and worsen over time. Common patterns include symptoms that begin at ovulation and worsen gradually until you get your period; symptoms that begin at ovulation and persist throughout your entire period (that is, they don't end just before or immediately after your period); and symptoms that appear briefly at ovulation, clear up, and then reappear in the week before your period. A diagnosis of PMDD, assuming that it meets all the other criteria for symptoms (outlined in Chapter 12), requires that symptoms occur in the week before your period.
It May Not Be PMDD
However, sometimes what appears to be PMDD is something else entirely. As many as 40 percent of women who seek treatment for PMDD do not actually have the disorder. Instead, they may a medical or psychiatric condition that comes and goes, or condition that gets worse during the premenstrual phase, than a separate case of PMDD.
Alert
Women overwhelmingly underdiagnose their PMDD! The study that found women with PMDD have more social interference women with PMS also found that, compared to using DSM-IV criteria, women were much less likely to self-diagnose as having severe symptoms. Only 4.9 percent of 1,022 women self-reported severe symptoms, but a DSM-IV-adapted approach identified percent of the same group as actually having PMDD.
There are a number of medical and psychiatric conditions can be confused with PMDD, including major depression, depression (also known as dysthemia), generalized anxiety social anxiety disorder, bipolar disorder, anemia, chronic syndrome, hypothyroidism, diabetes, seizure disorders, disorders, perimenopausal mood symptoms, allergy, collagen vascular disease, and endometriosis. That's why proper diagnosis is so important.
Diagnosing PMDD
In some ways, PMDD is a diagnosis of exclusion. There's no laboratory test for PMDD, so doctors typically consider a patient's medical history, a PMS diary, and self-reported symptoms. They use laboratory tests such as thyroid function tests, follicle-stimulating hormone levels, and complete blood cell counts to exclude other possible health conditions (such as anemia, thyroid disorders, or perimenopause) before diagnosing PMDD.
