Premenstrual dysphoric disorder  or PMDD ca n be described as an acute form of premenstrual syndrome , that can affect between 3% and 8% of women, mainly within the “luteal” phase in the female menstrual cycle . Only one-third of women diagnosed with PMDD experience symptoms in the first two to three days of the follicular phase .

Symptoms
Premenstrual dysphoric disorder (PMDD) is a serious form of Premenstrual Syndrome (PMS). PMDD, like PMS, appears in cyclically recurring phases. Symptoms begin to appear at the end of the luteal phase of the menstrual cycle (after ovulation) and end shortly after the onset of menstruation.

In most cases, there are emotional symptoms, especially mood swings. PMDD very often negatively affects the personal relationships of affected women. Often, anxiety, anger and depression occur.

The main symptoms that can make life uncomfortable for women include:

• feelings of deep sorrow and helplessness
• feelings of intense tension and anxiety
• increased hypersensitivity to rejection or criticism
• panic attacks
• rapid and pronounced mood swings, seizures of uncontrollable crying
• irritability or anger, frequent conflicts with the environment; the sick usually do not realize the impact of their behavior on their loved ones
• apathy, lack of interest in everyday activities and relationships
• problems with concentrating
• chronic fatigue
• increased appetite, overeating
• insomnia or fatigue; the need for longer sleep than usual, or (in a smaller percentage of women) problems with sleep
• a feeling of crushing, amazement, a woman has the feeling that nothing is in control, nothing holds out
• increased or decreased appetite for sex
• increased need for emotional proximity

Common physical symptoms:

• breast tension and swelling
• heartbeat
• severe headache, joints and muscles
• swollen face and nose
• altered perception of one’s own body – the woman feels swollen, bulky and fat, but there is often a real weight gain

If at least five of the above symptoms appear in the affected person, it is a PMDD.

What causes PMDD
In 2007, there was the first important genetic discovery about PMDD. Scientists have found that PMDD is related to differences in the level of the alpha gene that is the estrogen hormone transporter. Women with these genetic differences were more likely to have PMDD. However, this relationship has only been demonstrated in women who have another form of another gene, Catechol-O-methyl transferase or COMT, which controls the function of the prefrontal cortex, the part of the brain responsible for mood control.

Earlier research has confirmed that women with PMDD have abnormal responses to normal hormone levels and are therefore hypersensitive to their natural hormonal changes.

Objective evidence confirms that PMDD is of a neurological nature, and studies have shown that women experiencing significant mood swings at PMDD also show decreased serotonin production in the brain.

So far, it is not entirely clear what exactly causes PMDD, but most experts agree that the cause is the lack of serotonin (neurotransmitter) caused by fluctuations of sex hormones (progesterone, estrogen and testosterone) during the luteal phase of the menstrual cycle.

The role of serotonin has also been confirmed by other studies in which women with PMDD have been given selective serotonin reuptake inhibitors (SSRIs) that have had a positive effect on moodiness during the dysphoric phase.

Women with PMDD who have never had experience with clinical depression have decreased sensitivity and are more resistant to stress and pain than women with previous experience with depression. This means that PMDD is a separate disease, different from clinical depression.

Women with PMDD have a more frequent occurrence of unipolar depressions and anxiety disorders than women who do not suffer from this disease.

An important role is also played by stress in women’s lives. Research confirms the relationship between PMDD and feelings of discrimination, especially among women from ethnic minorities who have experience of discrimination not only because of their skin colour but also because of their gender.

Read more about treating PMDD here.