Premenstrual dysphoric disorder (PMDD) — Ask Dr Jean

Question

Why is it there are almost no doctors who know about premenstrual dysphoric disorder (PMDD)? So many women are suffering and so are their families due to a lack of care options as well as knowledgeable doctors, gynaecologists, obstetricians, psychologists and psychiatrists.

Answer

About 3-8% of women suffer with PMDD, with 20-30% of women with moderate to severe symptoms & 50% with some symptoms of varying severity (mild to moderate).

Many health professionals know about PMDD, but often struggle, with the different therapies available, to find the correct therapies.

The forms of treatment available are:

• Vitex castus agnus (chasteberry)
• SSRIs – a group of antidepressants which are suitable and include fluoxetine (Lovan), escitalopram (Lexapro) and paroxetine (Aropax)
• Hormone therapies:
  • Oral contraceptive pills
  • Spironolactone, which acts as an anti-testosterone derivative, reducing swelling and bloating
  • GnRH agonists, which cause a temporary 'chemical menopause' – addback therapy is recommended of oestrogen with progestogen if woman has a uterus
• Cognitive behaviour therapy long-term has shown to be helpful
• Surgery – with bilateral salpingo-oophorectomy (both ovaries and fallopian tubes) is a last resort.

There is still much that is unknown about PMDD, including:

• why it occurs
• why only some women are sensitive to normal hormonal fluctuations
• why treatments do not completely relieve symptoms in many women.

There may be different types of PMDD which are yet to be defined.

Read more about PMDD in the Periods (Health A-Z) section of our website.