Premenstrual Dysphoric Disorder, or PMDD, affects women a few days before menstruation and is a more severe form of premenstrual syndrome. This problem impairs the women’s ability to work, relate to people and self-care, as it generates symptoms such as a desire to isolate themselves, high irritability and sadness.
Cristina Marta Del Ben, professor at the Department of Neurosciences and Behavioral Sciences at USP’s Ribeirão Preto School of Medicine, explains that “women can feel sadder, more hopeless, they can also have symptoms of anxiety, cry easily and perceive variations , fluctuations of your mood”. In addition, somatic symptoms may occur, such as “having edema of the lower limbs —the legs become more swollen—, there may be headache, breast enlargement, greater sensitivity to touch”.
Because they have similar symptoms, PMDD can be confused with an anxiety or depression crisis. But the professor points out that they are two different medical conditions. “In a depressive disorder, symptoms last for several weeks without interruption.” Premenstrual Dysphoric Disorder, on the other hand, has a cyclical characteristic, appearing in the days before menstruation. “Usually, five to seven days before menstruation and tends to disappear two or three days after the onset of bleeding”, she ponders.
The causes would be associated with the abrupt drop, just before the premenstrual period, of the hormone progesterone and estrogen, which ends up reaching a neurotransmission system that helps to control anxiety.
According to Cristina, one of the hypotheses would be that the progesterone metabolite, allopregnanolone, in smaller amounts, interacts less with the GABAergic system — the main inhibitory agent of the central nervous system. “So, this abrupt drop, that is, the sudden lack of this metabolite, which would be activating a neurotransmission system that helps control anxiety symptoms, for example, would be responsible for these clinical changes”, she says.
diagnosis and treatment
Cristina highlights that it is important to record the occurrence of symptoms in different cycles. This facilitates the understanding of the situation and helps the doctor choose the best treatment. Knowing the patient’s condition, the gynecologist or, depending on the case, the psychiatrist, can indicate the best treatment for that situation. For the specialist, the ideal “would be for the woman, at first, to discuss with her gynecologist, describe her symptoms and seek the best alternative”.
There are non-pharmacological measures such as changes in life habits, a healthy diet, regular practice of physical activity and some psychotherapeutic interventions – the most studied is cognitive or behavioral therapy. “With regard to pharmacological treatment, one of the main options are selective serotonin reuptake inhibitors, medications that are also used for the treatment of depression and anxiety, and the use of contraceptives”, adds Cristina.
It is important for women to record what they feel, especially in the premenstrual period, to help them understand their situation and find the best way out, thus reducing the suffering during this period.