Premenstrual Dysphoric Disorder (also known as Premenstrual Dysphoria, Late Luteal Phase Dysphoric Disorder, or PMDD) is a cyclical, hormone-based mood disorder with symptoms arising during the luteal phase of the menstrual cycle and lasting until the onset of menstrual flow.
It affects an estimated 5-10% of women & AFAB individuals of reproductive age, worldwide.
PMDD is not a hormone imbalance, but rather a severe negative reaction to the rise and fall of estrogen and progesterone. Symptoms of PMDD occur for 1 – 2 weeks before menstruation and go away after bleeding begins (typically a few days into menses). Most individuals with PMDD have normal hormone levels.
PMDD is not PMS. Premenstrual Syndrome (PMS), also known as Premenstrual Tension (PMT), refers to the milder group of symptoms experienced by almost 90% of women and AFAB individuals.
PMDD is oftentimes debilitating. PMDD can make functioning in our daily lives extremely difficult, if not impossible. All aspects of one's life can be dramatically impacted, such as: the ability to maintain employment, succeed in school, manage personal relationships, and complete daily living tasks
PMDD is not a condition experienced only by cisgender women. Any individual AFAB (assigned female at birth) can have PMDD.
Symptoms of PMDD include:
Marked depressed mood
Frequent crying or tearfulness
Feelings of anxiety, tension, or being “on edge”
Feelings of sadness, despair, or hopelessness
Lasting irritability or anger
Lack of interest in daily activities
Food cravings or binge eating
Insomnia or Hypersomnia (sleeping too little, or too much)
Feeling out of control
Physical symptoms - bloating, breast tenderness, headaches, and joint or muscle pain
Increased interpersonal conflicts
Thoughts of suicide
... .. So, basically you're a hot mess express.
If you are experiencing 5 or more of the above symptoms
1 – 2 weeks prior to the onset of your period, and those symptoms remit within a few days of bleeding - you may have PMDD.
Causes & Potential Contributors
PMDD is not completely understood, and is believed to be caused by a variety of factors.
PMDD is believed to be heritable. Studies of families and twins show a 30% - 80% range of heritability. This genetic susceptibility means that the cause of PMDD includes a neurobiological component.
A metabolite of progesterone, allopregnanalone (ALLO) is an anxiety reducing chemical. Typically, levels of progesterone and ALLO increase in the luteal phase and decrease around menses. Individuals with PMDD are thought to either have decreased levels of ALLO, or an abnormal reaction to increasing levels of ALLO, during the luteal phase.
The role of serotonin in the etiology of PMDD is not fully understood. Both dysfunction in the neurotransmitter's pathways, and deficiency are both being looked at as contributors.
Brain structural and functional differences
Individuals with PMDD have been found to have both physical and chemical differences present in the brain when compared to individuals without PMDD. According to the MGH Center for Women's Mental Health, "Women with PMDD have greater gray matter volume in the posterior cerebellum, greater gray matter density of hippocampal cortex, and lower gray matter density in the parahippocampal cortex." How exactly these structural and functional differences contribute to PMDD are still unknown.
HPA axis & HPG axis
The hypothalamic-pituitary-adrenal axis (HPA axis) refers to the central stress response system, which is responsible for the release of cortisol during times of stress. Some studies suggest that individuals with PMDD may have an altered HPA axis, experiencing higher levels of cortisol during the luteal phase of their cycle than during other times of stress.
The hypothalamic-pituitary-gonadal axis (HPG axis) regulates reproductive and immune systems, and determines the influence of progesterone and estrogen on one's mood . A dysfunction of the HPG axis could cause sleep dysregulation and mood symptoms. The interplay between these two systems may contribute to PMDD symptoms.
Hantsoo, L. (2019, Jan. 14). What is PMDD. Retrieved March 28, 2019, from https://iapmd.org/about-pmdd
Raffi, E. R., & Freeman, M. P. (2019, March 08). The etiology of premenstrual dysphoric disorder: 5 interwoven pieces.