Premenstrual dysphoric disorder: an expert overview - Online interview

Overview of Premenstrual Dysphoric Disorder (PMDD)

• Definition: PMDD is a severe combination of physical and psychological symptoms that significantly impact a woman's life during the premenstrual phase (one to two weeks before a period). In the UK, it is often referred to as "severe PMS."
• Psychological Symptoms: Key signs include extreme irritability, intense mood swings, food cravings, difficulty concentrating, fatigue, insomnia, anxiety, panic attacks, depression, and potentially suicidal thoughts.
• Physical Symptoms: Common physical complaints include headaches, nausea, bloating, breast tenderness, fluid retention leading to swelling, and general body aches or malaise.
• Prevalence: While standard PMS affects roughly 40% of menstruating individuals, PMDD is much less common, affecting an estimated 5% to 8% of women (and up to 10% in the UK).

Diagnosis and Management

• Tracking Symptoms: Because PMDD symptoms can easily overlap with other gynecological or mental health conditions, a formal diagnosis requires a patient to prospectively track both their physical and psychological symptoms on a chart for at least two consecutive menstrual cycles.
• Diagnostic Testing: If the tracking chart is inconclusive, clinicians may administer a GnRH analog injection. This injection temporarily induces a menopause-like state to halt regular hormonal fluctuations. If the symptoms clear up during this trial, it confirms the diagnosis is hormone-driven PMS/PMDD.
• Surgical Options: In severe cases where all medical treatments have been entirely exhausted, a surgical solution involving a hysterectomy and the removal of the fallopian tubes and ovaries may be considered as a permanent, final option.