PMDD: a menstrual disorder significantly more severe than PMS; understand more about this female condition
This disorder, which can have a significant impact on women's lives, was officially recognized by the World Health Organization in 2019, despite being mentioned in medical literature since the 1960s.
Dysphoric Premenstrual Disorder (PDMD) refers to the brain's negative response to natural hormonal changes that occur approximately one or two weeks before the menstrual period - Photo Reproduction/Getty Images
Most women of reproductive age have experienced premenstrual syndrome (PMS), that uncomfortable, irritating feeling that precedes menstruation. However, there is a lesser-known but significantly more serious female condition called Premenstrual Dysphoric Disorder (PMDD). This disorder can have a profound impact on women's lives, intensely affecting their mental, emotional and physical health.
Studies have shown that women are less likely than men to get early diagnoses for conditions ranging from heart disease to cancer, and are more likely to have their medical concerns dismissed or misdiagnosed. Due to the long history of underestimating disorders that specifically affect women, there is still much to be discovered about their causes and treatments.
According to an article published in the scientific magazine Scientific American, the lack of investment in women's health over decades has created significant gaps in medicine. This problem is so prevalent that in the United States, President Joe Biden signed an executive order this year to promote research and innovation in women's health. In recent years, Brazil has made significant progress in women's health, with notable improvements in the availability and quality of services, increased awareness and greater investment both public and private.
However, despite these advances, disparities persist when compared to reference countries such as Sweden, Norway and Canada. These countries offer a greater diversity of services, carry out prevention and education campaigns on sensitive issues such as menopause, cancers specific to women and mental health. Furthermore, they demonstrate greater effectiveness in reproductive and maternal health services, ensuring equity and ease of access for all women, including minority and vulnerable groups.
What is PMDD?
PMDD is a severe form of PMS that affects approximately 3 to 8% of women of childbearing age. While PMS can cause discomforts such as irritability, bloating and mood changes, PMDD is an adverse reaction of the brain to natural hormonal changes that occur a week or two before the start of the menstrual period and takes these symptoms to an extreme, often debilitating level. Unlike the mild discomfort of premenstrual syndrome, known as PMS, the effects of premenstrual dysphoric disorder have a significant impact on the lives of those affected. It is estimated that these individuals may suffer almost four years of cumulative disability throughout their lives.
Sintomas do PMDD
Women with PMDD may experience severe depression, anxiety, anger, intense irritability and, in some cases, even suicidal thoughts. Other symptoms may include fatigue, joint and muscle pain, and changes in appetite and sleep patterns, with improvement when bleeding begins. Symptoms of PMDD usually begin in the luteal phase of the menstrual cycle, which is the second half of the cycle, after ovulation, and disappear a few days after the start of menstruation. Among the most common symptoms are:
Intense depression: Feelings of deep sadness and hopelessness.
Anxiety: Constant feeling of nervousness or tension.
Extreme irritability: Feelings of anger and irritation that can lead to interpersonal conflicts.
Mood changes: Severe emotional swings.
Fatigue: Feeling of extreme tiredness and lack of energy.
Difficulty concentrating: Trouble concentrating or making decisions.
Changes in appetite: Significant increase or decrease in appetite.
Sleep disorders: Insomnia or excessive need to sleep.
Diagnosis
In a 2022 study of PMS patients published in the Journal of Women's Health, more than 30% of participants reported that their family doctors had limited knowledge about premenstrual disorder and its treatment options. Approximately 40% mentioned that the same lack of knowledge applied to their mental health therapists.
The condition known as MDPD is little studied by researchers, which makes the cause a mystery and treatments limited. PMDD was officially recognized by the World Health Organization in 2019, although references in medical literature date back to the 1960s.
Diagnosis of PMDD requires careful assessment of symptoms over at least two menstrual cycles. The woman should document daily symptoms, and the doctor may use specific criteria established by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is essential to rule out other medical or psychiatric conditions that may present similar symptoms.
Treatment
Although there is no universal approach defined by doctors to treat symptoms, three main treatments have emerged to deal with the disorder. PMDD treatment is multifaceted and may include:
Medication: Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), may be effective. In some cases, hormonal contraceptives are also prescribed to stabilize hormone levels.
Cognitive-Behavioral Therapy (CBT): Helps women deal with emotional and behavioral symptoms.
Lifestyle changes: Balanced diet, regular exercise and stress management techniques can improve symptoms.
Supplements: Some women find relief with supplements such as calcium, magnesium and vitamin B6, although effectiveness may vary.
Recognizing and treating PMDD is crucial to improving the quality of life for affected women. Without treatment, PMDD can lead to serious mental and emotional health problems, interfering with personal relationships, work performance and general well-being.
