While symptoms of PMS tend to consist of: headaches, bloating, acne, cramps, irritability/mood swings, depression, difficulty sleeping, and more - PMDD is associated with all of the aforementioned symptoms, to higher degree. This includes, but is not limited to: extreme fatigue, joint/muscle pain, appetite changes, hot flashes, bouts of extreme rage/sadness, difficulty concentrating, feelings of hopelessness, suicidal thoughts, spending lots of time in bed, and many others.

Rutgers University

Premenstrual Dysphoric Disorder, otherwise known as PMDD, can be more easily understood as a more severe form of Premenstrual Syndrome, or PMS. In this manner, symptoms are stronger and longer-lasting, and tend to coincide with (and worsen) pre-existing mental health conditions, such as major depressive disorder, generalized anxiety disorder, and bipolar disorder. There is seen to be correlation between those with a history of trauma, physical or emotional abuse, and extreme stress who are diagnosed with PMDD, yet no specific causes (hormonal/physical) are fully known. 

Premenstrual Dysphoric Disorder

PMDD: Symptoms

 At this point, most researchers point to the hormonal fluctuations of the menstrual cycle. The follicular phase of the menstrual cycle is associated with higher mood levels overall. The estrogen hormone is related to the production of serotonin neurotransmitters, which increase positive affect. On the other hand, the luteal phase is associated with the lowest mood levels, due to the major drop in both estrogen and progesterone (another serotonin producer), and release of norepinephrine. Norepinephrine is a hormone and neurotransmitter which halts production and release of both dopamine and serotonin, significantly influencing one’s mood. So, although not all people who menstruate experience PMDD, there is evidence to explain consistent mood drops right before menstruation begins. This is the only assumed biological cause of PMDD, but the disorder is also associated with history of trauma, extreme stress, physical/emotional abuse, and family history of mental health issues/mood disorders.

PMDD: Causes

Due to the lack of research and discussion of female reproductive health in the medical field, there is no standard treatment or cure for PMDD. There are several pills and medical interventions which could be used to help reduce symptoms and improve one’s daily function, however, they all produce inconsistent results (SSRIs, oral contraceptives, hormonal treatments). Those with PMDD are commonly co-diagnosed with another mental illness or mood disorder, and therefore might find improvement of mood and emotional symptoms in talk therapy.

PMDD: Treatments

The diagnostic process for PMDD can be controversial. Although it's estimated that less than 10% of those who menstruate meet the diagnostic requirements for PMDD, about 18% have severe enough symptoms and should be treated/diagnosed. 

PMDD is currently registered as a mood disorder and requires that 5 or more symptoms (decreased interest in, activities, difficulty concentrating, lack of energy, change in appetite, muscle/joint aches, bloating...) during the late luteal phase for at least 3 consecutive cycles within the last year, and must be free of these symptoms for at least 1 week during the follicular phase. Many may have severe degrees of common PMDD symptoms, but not 5 of those - or, the 1-week clearance may be difficult to measure due to pre-existing mental health conditions, which may simply be worsening during this time. 

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