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Premenstrual Dysphoric Disorder Information

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome,[3] afflicting 3% to 8% of women.[4] It is a diagnosis associated with the luteal phase of the menstrual cycle.

Contents

Symptoms

PMDD is a severe form of premenstrual syndrome (PMS).

Like less severe forms of PMS, premenstrual dysphoric disorder always follows a predictable, cyclic pattern. Symptoms always begin in the late luteal phase of the menstrual cycle (after ovulation) and always end completely shortly after menstruation begins.[5]

Emotional symptoms are always present, and in PMDD, mood symptoms are dominant.[5] Substantial disruption to personal relationships is typical for women with PMDD.[5] The cardinal symptom—always surfacing between ovulation and menstruation, and always disappearing within a few days after the onset of the bleeding—is irritability.[6] Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include[7]

Common physical symptoms include:

Five or more of these symptoms may indicate PMDD. Symptoms occur during the 2 weeks before the menstrual cycle and disappear within a few days after the onset of the bleeding.

Genetic links and possible causes

In 2007, the first significant genetic finding in premenstrual dysphoric disorder was reported.[8][9] Variants in the estrogen receptor alpha gene that are associated with PMDD. Women with these genetic variants were more likely to suffer from PMDD. They also discovered that this association is seen only in women with a variant form of another gene, catechol—o—methyltransferase (COMT), which is involved in regulating the function of the prefrontal cortex, a critical regulator of mood.

Previously, research showed that women with PMDD have an abnormal response to normal hormone levels, and, thus, are differentially sensitive to their own natural hormone changes.

There is objective correlational evidence of a neurological connection for PMDD distress. The self-rated cardinal mood symptoms of women suffering premenstrual dysphoria was found to be significantly correlated with the concomitant worsening of their brain serotonin precursors, measured by positron emission tomography (PET).[10]

While the cause of PMDD has not been definitively established, a leading theory suggests it is due to the lack of serotonin (a neurotransmitter) and mediated by the fluctuations of the levels of sex hormones (progesterone, estrogen, and testosterone) in the luteal phase of the menstrual cycle.[10]

Supporting the hypothesized important role of serotonin, a number of selective serotonin reuptake inhibitors (SSRIs) have been shown in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase.

Women with PMDD but have never experienced major depressive disorder (MDD) have lower sensitivity and response to stress and pain than people with MDD.[11] This suggests that PMDD is a separate disease from MDD.

Unipolar depression, anxiety disorders, and other Axis I disorders are more common in women with premenstrual dysphoric disorder (PMDD) than in women without PMDD.[12]

Status and controversy

Originally called late luteal phase dysphoric disorder (LLPDD), the disorder was renamed PMDD by the American Psychiatric Association in its May 1993 revision of the DSM-IV. It is not recognized as a disorder in the DSM-IV. PMDD was moved from a position the DSM-IV in the appendix of the manual to a "disorder requiring further study."[13][14]

PMDD is accepted as an illness by the Food and Drug Administration (FDA) but has not as yet been listed as a separate disorder in the World Health Organization's International Classification of Diseases. In 2003, the manufacturer of Prozac (fluoxetine) was required by the Committee for Proprietary Medicinal Products to remove PMDD from the list of indications for fluoxetine sold in Europe.[15] The committee found that

...PMDD is not a well-established disease entity across Europe... There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.[16]

In Australia, although PMDD is recognized by the Therapeutic Goods Administration, SSRIs are not reimbursed for it under the Pharmaceutical Benefits Scheme.[17]

Some commentators suggest that PMDD (along with heart disease, borderline high blood pressure, mild hypercholesterolemia, social anxiety disorder, restless leg syndrome, and female sexual dysfunction) has been marketed by pharmaceutical companies in order to increase the demand for treatments.[18] Some psychiatrists and women's groups say that labeling this severe form of PMS as a psychiatric disorder, rather than a physical disorder, is stigmatizing. Psychologist Peggy Kleinplatz has criticized the diagnosis as part of a trend in medicalization of normal human behavior.[19]

Treatment

The primary goal of treatment is to reduce the woman's suffering and the disruption to her social relationships.

Lifestyle changes such as regular exercise and a well balanced diet may ameliorate some of the effects of PMDD. There is some evidence that vitamin B6 can alleviate symptoms.[20]

Certain SSRIs provide relief as well.[21] The U.S. Food and Drug Administration (FDA) has approved four medications for the treatment of PMDD: Fluoxetine (available as generic or as Prozac or Sarafem), sertraline (Zoloft), paroxetine (Paxil) and escitalopram oxalate (Lexapro).

L-tryptophan, a serotonin precursor, was found in two studies to provide significant relief when supplemented daily in a large dose.[22]

See also

References

  1. ^ Halbreich U (December 2004). "The diagnosis of premenstrual syndromes and premenstrual dysphoric disorder--clinical procedures and research perspectives". Gynecol. Endocrinol. 19 (6): 320–34. doi:10.1080/0951590400018215. PMID 15724807.
  2. ^ Endicott J, McLaughlin TP, Grudzinski AN (December 2003). "Comparison of managed care charges among patients treated with selective serotonin reuptake inhibitors for premenstrual dysphoric disorder". J Clin Psychiatry 64 (12): 1511–6. doi:10.4088/JCP.v64n1216. PMID 14728114.
  3. ^ "Premenstrual dysphoric disorder (PMDD) is the severe form of PMS." http://patients.uptodate.com/topic.asp?file=endocrin/10662
  4. ^ PMDD affects "... 3-8% of women of reproductive age. Assessment of published reports demonstrate that the prevalence of clinically relevant dysphoric premenstrual disorder is probably higher. 13-18% of women of reproductive age may have premenstrual dysphoric symptoms severe enough to induce impairment and distress, though the number of symptoms may not meet the arbitrary count of 5 symptoms on the PMDD list." PMID 12892987
  5. ^ a b c Steiner, Pearlstein, et al. "Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs." J Womens Health (Larchmt). 2006 Jan-Feb;15(1):57-69 PMID 16417420
  6. ^ Eriksson E, Andersch B, Ho HP, Landén M, Sundblad C (August 2001). "[Serotonin uptake inhibitors provide rapid relief from premenstrual dysphoria. New findings shed light on how serotonin modulates sex hormone-related behavior]" (in Swedish). Lakartidningen 98 (34): 3524–30. PMID 11571794.
  7. ^ "Premenstrual Syndrome" ("What is Premenstrual Dysphoric Disorder (PMDD?)"
  8. ^ Huo L, Straub RE, Roca C, Schmidt PJ, Shi K, Vakkalanka R, Weinberger DR, Rubinow DR (October 2007). "Risk for premenstrual dysphoric disorder is associated with genetic variation in ESR1, the estrogen receptor alpha gene". Biol. Psychiatry 62 (8): 925–33. doi:10.1016/j.biopsych.2006.12.019. PMC 2762203. PMID 17599809. http://linkinghub.elsevier.com/retrieve/pii/S0006-3223(06)01558-7.
  9. ^ "UNC Center for Women's Mood Disorders" http://www.med.unc.edu/psych/wmd/research/pmdd
  10. ^ a b Eriksson O, Wall A, Marteinsdottir I, et al. (March 2006). "Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria". Psychiatry Res 146 (2): 107–16. doi:10.1016/j.pscychresns.2005.02.012. PMID 16515859.
  11. ^ Klatzkin RR, Lindgren ME, Forneris CA, Girdler SS (May 2010). "Histories of major depression and premenstrual dysphoric disorder: Evidence for phenotypic differences". Biol Psychol 84 (2): 235–47. doi:10.1016/j.biopsycho.2010.01.018. PMID 20138113.
  12. ^ Kim DR, Gyulai L, Freeman EW, Morrison MF, Baldassano C, Dubé B (February 2004). "Premenstrual dysphoric disorder and psychiatric co-morbidity". Arch Womens Ment Health 7 (1): 37–47. doi:10.1007/s00737-003-0027-3. PMID 14963731.
  13. ^ Laurence, Leslie (1993-05-16). "Psychiatric group scruitinzes categorizing form of PMS". Chicago Tribune.
  14. ^ Lehman, Betsy (1993-05-10). "A little revision is creating a big furor". Boston Globe.
  15. ^ Ray Moynihan (2004-02-14). "Controversial disease dropped from Prozac product information". BMJ 328 (7436): 7436. doi:10.1136/bmj.328.7436.365. PMC 341379. PMID 14962861. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=341379.
  16. ^ European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products (2003-06-13). "Summary Information...for Prozac and associated names". http://www.emea.eu.int/pdfs/human/referral/326303en.pdf.
  17. ^ Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD) National Prescribing Service Limited. (Australia)
  18. ^ Mintzes B (April 2006). "Disease mongering in drug promotion: do governments have a regulatory role?". PLoS Med. 3 (4): e198. doi:10.1371/journal.pmed.0030198. PMC 1434509. PMID 16597181. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1434509.
  19. ^ Offman A, Kleinplatz PJ (2004). Does PMDD Belong in the DSM? Challenging the Medicalization of Women's Bodies. The Canadian Journal of Human Sexuality, Vol. 13
  20. ^ [1]
  21. ^ Premenstrual Syndrome
  22. ^ Steinberg S, Annable L, Young SN, Liyanage N (1999). "A placebo-controlled study of the effects of L-tryptophan in patients with premenstrual dysphoria". Adv. Exp. Med. Biol. 467: 85–8. PMID 10721042.

External links

· · Menstrual cycle
Events and phases Menstruation · Follicular phase · Ovulation · Luteal phase
Life stages Menarche · Menopause
Tracking
Signs Basal body temperature · Cervical mucus · Mittelschmerz
Systems Fertility awareness · Calendar-based methods · Billings Ovulation Method · Creighton Model
Suppression Extended cycle combined hormonal contraceptive · Lactational amenorrhea method
Disorders Amenorrhoea · Anovulation · Dysmenorrhea · Hypomenorrhea · Irregular menstruation · Menometrorrhagia · Menorrhagia · Metrorrhagia · Oligomenorrhea
Related events Folliculogenesis · McClintock effect · Premenstrual syndrome / Premenstrual dysphoric disorder
In culture and religion Chhaupadi · Menstrual taboo · Niddah

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