Testing for premenstrual dysphoric disorder (PMDD)

Dear Alice,

How do they test for PMDD? I think I may have it! My mood shifts dramatically, I'm extremely irritable, and I feel terribly uncomfortable around that time of the month, among other feelings.

Maybe PMDD?

Dear Maybe PMDD?,

Many folks experience premenstrual syndrome (PMS), a condition that causes discomfort, irritability, and mood shifts seven to ten days before the onset of a person’s menstrual period; in some cases these symptoms subtly interfere with day-to-day activities. However, three to five percent of those who are pre-menopausal experience a much more severe and even debilitating form of PMS called premenstrual dysmorphic disorder (PMDD). There’s no definitive test or understanding of the cause of these conditions, but health care providers are able to make a diagnosis based on the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-V) published by the American Psychiatric Association. If what you’re dealing with is indeed PMDD, the good news is that there are a number of potential treatments, ranging from prescription medications and therapies to the adoption of healthy lifestyle behaviors that may help alleviate some of the associated symptoms.

Currently, there are no physical exams or tests to diagnose PMDD. As such, ruling out any other possible conditions or disorders is done before investigating whether the reported symptoms match the diagnostic criteria for the condition. As part of this process, you may be asked to keep a daily journal of any physical symptoms or mood changes to determine whether it’s linked to the menstrual cycle. Often, people with depression, anxiety, or thyroid issues mistake their symptoms for PMDD and find that these changes are not linked to their cycle. Thus, PMDD is an unlikely cause for their reported symptoms. Once other disorders are ruled out, PMDD may be diagnosed based on when you experience symptoms and what type of symptoms you have. Generally speaking, symptoms must occur within seven to ten days before menstruation and then go away within a couple of days after you start menstruating to receive a PMDD diagnosis. And, at least five of the following symptoms must be present:

  • Mood swings
  • Marked anger
  • Irritability
  • Tension
  • Decreased interest in usual activities
  • Fatigue
  • Change in appetite
  • Sleep problems
  • Physical problems, such as bloating

List from the Cleveland Clinic.

Although the exact causes of PMS and PMDD remain unknown, researchers speculate that the imbalance of serotonin (a mood-altering neurotransmitter in the brain), family history, and other hormone imbalances may play a role in the development of PMDD. While there’s no cure for PMDD, symptoms can be addressed through engaging in healthy lifestyle behaviors, including being physically active, maintaining a well-balanced diet, getting enough sleep, and avoiding alcohol and caffeine. As far as treatment for the condition goes, options vary. The use of over-the-counter pain relievers, such as aspirin or ibuprofen, may be recommended to address pain associated with PMDD. A prescription for birth control pills and other hormonal therapies to address mood-related, psychosomatic, and physical symptoms associated with the condition may also be in order. Cognitive behavioral therapy, support groups, couples therapy, anger management, and antidepressants may also be helpful in the treatment of PMDD.

No one knows your body better than you. If you still think you may have PMDD, consider contacting your health care provider for more information. Once you explain your symptoms and feelings, you and your provider can determine an appropriate action plan to address your concerns.

Hang in there!

Last updated May 27, 2016
Originally published Sep 06, 2002

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