Premenstrual Dysphoric Disorder Treatment and Siddha Remedies

Premenstrual dysphoric disorder (PMDD) is a severe and disabling form of premenstrual syndrome affecting 1.8–5.8% of menstruating women. The disorder consists of a variety of affective, behavioral, and somatic symptoms that recur monthly during the luteal phase of the menstrual cycle. It affects women from their early teens up until menopause, excluding those with hypothalamic amenorrhea or during pregnancy and breastfeeding. Women with PMDD are at higher risk of suicide, with rates of suicidal thoughts 2.8 times higher, history of suicidal planning 4.15 times, and suicide attempts 3.3 times. PMDD being a drastic problem, Siddha Spirituality of Swami Hardas Life System appeals to all the women to read this article for well-being.

What is Premenstrual dysphoric disorder?

Premenstrual dysphoric disorder (PMDD) is a condition in which a woman has severe depression symptoms, irritability, and tension before menstruation. The symptoms of PMDD are more severe than those seen with premenstrual syndrome (PMS). PMS refers to a wide range of physical or emotional symptoms that most often occur about 5 to 11 days before a woman starts her monthly menstrual cycle. In most cases, the symptoms stop when, or shortly after, her period begins.

Premenstrual dysphoric disorder Symptoms

Menstrual cycle

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Like PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle after ovulation and end shortly after menstruation begins.

Out of cycle

On average, the symptoms last six days but can start up to two weeks before menses, meaning symptoms can be felt for up to three weeks out of a cycle. Severe symptoms can begin and worsen until the onset of menstruation, with many not feeling relief until a few days after menstruation ends. The most intense symptoms occurring in the week and days leading up to the first day of menstrual blood flow.

Start or a few days after menstruation

The symptoms usually cease shortly after the start of the menstrual period or a few days after it ending. The onset of symptoms only during or around the luteal phase is key for diagnosing a woman with PMDD rather than any other mood disorders.

Mood patterns

The symptoms can be physical or emotional, but mood symptoms must be present for the diagnosis. Women with PMDD may have thoughts of suicide. A mood log in which a woman records mood patterns over time may help direct.

Categories of Premenstrual dysphoric disorder

The International Society for the Study of Premenstrual Disorders (ISPMD) defines two categories of premenstrual disorders (PMD):

• Core PMD, and
• Variant PMD.

Core PMD has six characteristics, all mainly focusing on the cyclical nature of PMDD and its typical onset pre-menses tracked over the course of more than two menstrual cycles. The four classified Variant PMDs involve more unexpected variables that cause the onset of premenstrual distress; such as, PMD with absent menstruation or premenstrual exacerbation, wherein the symptoms of another preexisting psychological disorder may be heightened as a result of PMDD onset.

Associated conditions of Premenstrual dysphoric disorder

Bipolar depression, anxiety disorders, and other Axis I disorders are more common in those with PMDD. In women with PMDD, there is a 50-78% lifetime incidence of various psychiatric disorders such as generalized anxiety disorder, seasonal affective disorder, and major depressive disorder.

Premenstrual dysphoric disorder Causes

Mood swings

PMDD mood symptoms are only present in menstruating women. Thus, symptoms do not occur during pregnancy and after menopause. Other mood disorders typically persist across all reproductive life events and are independent of a woman’s menstrual cycle or lack thereof.

The most agreed-upon possibilities for what causes PMDD currently are heightened sensitivity to fluctuating levels of certain hormones i.e. the reproductive hormones, environmental stress, and genetic predisposition. The sex steroids—estrogen and progesterone—are neuroactive. Serotonin is involved in mood regulation alongside estrogen.

Hormonal fluctuations

The timing of symptoms suggests hormonal fluctuations as the cause of PMDD. A demonstrable hormonal imbalance in women with PMDD has not been identified. In fact, levels of reproductive hormones and their metabolites in women with and without PMDD are indistinguishable.

It is instead hypothesized that women with PMDD are more sensitive to normal levels of hormone fluctuations, predominantly estrogen and progesterone, which produces biochemical events in the nervous system that cause premenstrual symptoms. These symptoms are more predominant in women who have a predisposition to the disorder.

Heritability

PMDD has been reported by menstruating women worldwide, indicating a biological basis that is not geographically selective. There is evidence of the heritability of premenstrual symptoms from several twin and family studies done in the 1990s.

Environmental components

Genetics do not operate in a vacuum: environmental components such as stress, hormonal fluctuation, and epigenetics play a key role in the pathology and onset of the disorder. Some studies have noted evidence of interpersonal trauma i.e. domestic violence, physical or emotional trauma, or substance abuse, or seasonal changes having an impact on PMDD risk.

But the most common pre-existing disorder found in those diagnosed with PMDD is major depression, wherein they either actually had it or were misdiagnosed when they should have only been diagnosed with PMDD. The last environmental factor is primarily sociological: the sociocultural aspects of being female, performing female gender roles, and stress from engaging in female sexual activity.

Relationship of Premenstrual dysphoric disorder to pregnancy

Women with PMDD usually see their symptoms disappear while they are pregnant. The premenstrual dysphoric disorder is primarily a mood disorder that is associated with the onset of menstruation; pregnancy, menopause, and hysterectomies all-cause menstruation to cease, thereby stopping the proposed sex steroid/serotonin-caused symptoms from occurring.

Although one might expect a higher rate of postpartum depression among those with PMDD, a large study of women with prospectively-confirmed PMDD did not find a higher prevalence of postpartum depression than in controls.

If a woman had experienced PPD beforehand, there was found to be a less than 12% chance of PMDD pathology emerging—hardly any differentiation from the regular population of those who have never experienced postpartum depression. However, PMDD symptoms can get worse following pregnancy, or other associated events such as birth and miscarriage.

Menopause launches a woman into an associated mood disorder called climacteric depression. The permanent stopping of the menstrual cycle causes a myriad of physiological and psychological symptoms and issues, all associated with the natural estrogen deficiency post-menopause.

Premenstrual dysphoric disorder Diagnosis

Diagnostic criteria for PMDD are provided by a number of expert medical guides. Diagnosis can be supported by having women who are seeking treatment for PMDD use a daily charting method. Daily charting helps to distinguish when mood disturbances are experienced and allows PMDD to be more easily distinguished from other mood disorders.

With PMDD, mood symptoms are present only during the luteal phase, or last two weeks, of the menstrual cycle. While PMDD mood symptoms are of a cyclical nature, other mood disorders are variable or constant over time.

There is a lack of consensus on the most efficient instrument. There are several validated scales for recording premenstrual symptoms include:

• The Calendar of Premenstrual Experiences (COPE)
• Daily Record of Severity of Problems (DRSP)
• Prospective Record of the Severity of Menstruation (PRISM). 

DSM-5

The DSM-5 established seven criteria for the diagnosis of PMDD. There is an overlap between the criteria for PMDD in the DSM-5 and the criteria found in the Daily Record of Severity of Problems (DRSP).

ICD 11

Diagnostic criteria for PMDD are also provided by the 2016 World Health Organization’s International Classification of Diseases (ICD-11-CM).

Early drafts of the ICD did not recognize PMDD as a separate condition. In the World Health Organisation’s classification system, the International Classification of Diseases (ICD-11), PMDD is listed as a “disease of the genitourinary system”.

Differential diagnosis of Premenstrual dysphoric disorder

In addition to Axis I disorders, several other medical illnesses such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and migraine disorder may present symptoms similar or identical to those of PMDD.

The symptoms which coincide with mood disorders i.e. major depressive disorder or BIPOLAR DISORDER, may worsen during the premenstrual period and thus may mimic PMDD.  

Premenstrual dysphoric disorder Treatment

Medications for Premenstrual dysphoric disorder

Several medications have received empirical support for the treatment of PMDD. Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication. The U.S. Food and Drug Administration (FDA) has approved four SSRIs for the treatment of PMDD:

• Fluoxetine (available as generic or as Prozac or Sarafem),
• Sertraline (Zoloft),
• Paroxetine (Paxil), and
• Escitalopram oxalate (Lexapro).

Unlike treatments for depressive disorders, SSRIs do not need to be taken daily.

Women taking SSRIs to ease PMDD generally report >50% alleviation in symptoms, which was a significant improvement compared to placebo. Although less studied, SNRIs have also shown benefits for those with PMDD. 

Another FDA-approved treatment for PMDD is the oral contraceptive with ethinylestradiol and drospirenone.

Another treatment, typically used when other options have failed, is the injection of a gonadotropin-releasing hormone agonist. These drugs create a temporary, drug-induced menopause-like condition. This generally necessitates the concurrent addback of progesterone to prevent estradiol-induced endometrial hyperplasia. 

Psychotherapy

Cognitive-behavioral therapy (CBT) has been shown to be effective for reducing premenstrual symptoms in women with (retrospectively-reported) PMS. CBT is an evidence-based approach for treating depression and focuses on the link between mood, thoughts, and actions to help people address current issues and symptoms. 

Surgery

When drug-based treatments are ineffective or produce significant side effects, then removing the ovaries through oophorectomy can produce an immediate and permanent cure. Typically, the uterus is removed during the same surgery, and the woman is prescribed a low-dose estrogen patch to reduce the symptoms produced by surgically induced menopause.

Siddha remedies for Premenstrual dysphoric disorder

 

Reference:

• https://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder
• https://medlineplus.gov/ency/article/007193.htm