March 3, 2023 • 15 mins
Most women have experienced PMS; but if you’re spending half the month feeling moody, super-irritable and bloated, you could be suffering from premenstrual dysphoric disorder or PMDD. Dr. Saltz tells how to deal with it.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Women menstruate for the
majority of their lives, and many women struggle with symptoms
related to menstruation, either physical symptoms or mental health symptoms,
sometimes before, sometimes during, sometimes even after menstruation, which take
(00:52):
up a good deal of their lives. So today I'm
answering a question from a woman who is wondering what
her difficult symptoms may mean. There is a diagnosis called
pre menstrual dysphoric disorder, and its symptoms include depression or
(01:12):
mood swings, anxiety or irritability, tension, feelings of stress, insomnia
or different kinds of sleep issues, Physical symptoms like fatigue, bloating,
breast tenderness, changes in appetite even food cravings, decrease libido
(01:35):
or interest in sects, and difficulty concentrating or making decisions
For people with pre menstrual dysphoric disorder, These symptoms usually
occur seven to ten days before menstruation and then subside
sometime after the onset of menses. PMDD and pre menstrual
(01:59):
syndrome or PMS are both conditions that affect some women
during their menstrual cycle, but they also have some differences.
Those differences are, for example, in severity. In PMDD, you
have more severe symptoms, more severe symptoms that often overlap
(02:22):
with PMS, but the symptoms are so severe that they
affect a woman's daily life and relationships. PMS symptoms are
generally less intense. There's a difference in the number of symptoms.
With PMDD, it's characterized by at least five of the
symptoms I mentioned before, but PMS can be just one
(02:46):
or two symptoms. They can differ in duration. PMDD usually
occurs in the week or sometimes even two before menstruation
and then goes away once the period starts, but PMS
symptoms can start just several days before menstruation and usually
(03:07):
subside again after the first maybe two days or three
days after the period starts, and they also differ in
terms of treatment. PMDD is considered a psychiatric disorder, and
it can be treated with medication, with therapy, or the
combination of both, whereas PMS symptoms are usually managed with
(03:31):
lifestyle changes or over the counter remedies. It is important
to see a doctor for an accurate diagnosis of whether
you're struggling with PMDD or PMS, because it can really
impact a woman's quality of life. The exact cause of
(03:51):
pre menstrual dysphoric disorder is not known, but it is
believed to be related to hormonal fluctuations during the menstrual
cycle and therefore imbalances in neurotransmitters like serotonin. But basically
the most likely cause is the hormonal fluctuations that occur
during the menstrual cycle. Those changes, especially in the levels
(04:15):
of estrogen and progesterone, can affect the levels of neurotransmitters
like serotonin and therefore lead to mood changes, but all
by itself, neurotransmitter imbalances like serotonin that regulate mood and
appetite and sleep can also cause symptoms. It is thought
(04:39):
that women with PMDD do have an imbalance of serotonin,
which does contribute to their symptoms. Another area of cause
is likely genetics. Basically, this condition does tend to run
in families. Typically a mom struggles with it and her
daughter then struggles with it, and so there is something
(05:01):
genetically that predisposes one to p m d D. Another
factor is stress. Chronic stress can exacerbate the symptoms of
p m d D, as well as other physical and
mental health conditions that can go along with it. Then
there are environmental factors. Some people think that exposure to
(05:24):
certain environmental toxins like pesticides heavy metals can disrupt the
endocrine system in general and contribute to p m d
D and past experiences of trauma or abuse. Women who
have a history of trauma or abuse may be more
susceptible to p m d D, and the psychological and
(05:47):
emotional stress of these experiences also affect the brain like
neurotransmitters and therefore exacerbate the symptoms. While the exact cause
of PMDD may differ actually from person to person, it
tends to be a combination of factors that lead ultimately
(06:09):
to this problem, and there are reasons why women may
not even realize that what they are struggling with is
pre menstrual dysphoric disorder. That's because they have a lack
of awareness, which is frankly why I'm answering this question today.
It is a relatively new diagnosis, and many people are
(06:29):
really not familiar with the symptoms or how it differs
from PMS. They just assume that the terrible struggle they're
having is just bad PMS. There's been this normalization of symptoms.
Many women experience mild to moderate symptoms of PMS, like
mood swings, bloating, and fatigue, and tend to think these
(06:53):
symptoms are just a normal part of menstruating, and there
is the stigma. Women are often reluctant to talk about
their menstrual related symptoms, especially if they're more severe, because
of the stigma associated with it. In general, some women
have difficulty in identifying their symptoms and mistake it for
(07:17):
something else like depression and anxiety disorder, or just chock
it up distress, making it difficult for a woman to
realize that actually what she has is a treatable condition.
And there are a lot of misconceptions about PMDD that
women are using it just as an excuse for bad
(07:39):
behavior or mood swings, and that stigmatizes it further, making
a woman feel that she can't really speak about it
or realize that that's what's going on. So with that,
right after the break, we'll get to my listener's question.
(08:08):
Welcome back. Let's get to my listener's question and see
how can I help, dear doctor Sons. I have always
struggled with what I considered to be garden variety pre
menstrual syndrome, basically feeling a little moody and bloated in
the day or two before my period and during the
(08:30):
first few days after it starts. But in the last
six months, I find this period is now lasting longer,
more like a week or sometimes even closer to two.
And I'm still very moody and bloated. But in addition,
I find myself not only super irritable, but very quick
(08:52):
to anger. This had not been an issue before, and frankly,
it's not a good one. Out of nowhere, my husband
or a friend of mine or my mom gets super
under my skin and can say something where I just
see red, and then I lash out. My husband is
(09:15):
wondering what the heck is going on, and I feel
badly later, wondering why I had to get so mad,
and then I feel crushingly guilty. Can PMS just get
worse like this? Is there something I can do to
help myself? As this basically leaves me two weeks of
the month I feel like myself and the other two
(09:37):
I'm pretty miserable and making those around me miserable too.
PMS can get worse, and it can get better from
month to month or from year to year, so that
is a possibility. However, given how many days this is
now lasting and the added symptom being related to irrit
(10:00):
ability and anger, this may no longer classify as PMS,
but might actually fall into the diagnosis of preminstual dysphoric disorder.
If half of the month is spent feeling moody, irritable,
and bloated, it really sounds more like PMDD, and people
(10:22):
with PMS can sometimes have their symptoms grow worse and
basically grow into PMDD. The value of checking with your
gynecologist about whether this is now PMDD is that not
only are there things you can do for PMDD, there
(10:42):
are things you should do because being miserable so much
and risking your relationships along the way is not a
good option. Your gynecologist may suggest putting you on a
form of birth control to even out your hormones, specifically
estrogen and progesterone. By keeping you from having big fluctuations,
(11:07):
it may really decrease your symptoms. Some kynecologists actually recommend
a birth control pill that only has your menstruate four
times per year, which also cuts down on the amount
of time having any pre menstrual symptoms at all. Another
option is to consult with a psychiatrist who treats PMDD.
(11:31):
Those are usually psychiatrists who specialize in women's mental health issues,
who may offer you a serotonin reuptake inhibitor, a type
of antidepressant that treats PMDD and will attend to the
mood associated with its symptoms. Additionally, helpful can be psychotherapy,
(11:52):
which can give you specific tools to help you with mood, irritability,
and anger man management, all of which can help with
PMDD over the long run. The sooner you go, the better,
because all of these ideas can take at least a
few weeks, and there is no need to suffer longer
(12:15):
than you already have. It's also helpful to let your
partner or your friend or your mom know if you
have blown up at them that you realize you have
been struggling with this with this PMDD and are planning
to get some help, but to please understand, bear with
you and support you. Assure them that it is even
(12:39):
less pleasant for you than it is for them. Remind
them that you love them and are just going through
a hormonally difficult period. I hope that was helpful. There
are multiple treatments available for PMDD. Antidepressants, which are often
(13:01):
in the category of selective serotonin reuptake inhibitors, are the
most commonly prescribed medication for PMDD. Examples would be fluoxytine
or searcherlene or peroxytine. They help regulate mood and reduce
PMDD symptoms. Typically, women with PMDD take SSRIs daily for
(13:25):
the entire month to help regulate their mood, but some
women may find that they can take the medication only
during what's called the luteal phase or the days leading
up to menstruation, and that can be effective by itself
in managing their symptoms, but this is something that needs
to be discussed and decided on with your psychiatrist. Don't
(13:51):
decide when you will and won't take the pills on
your own. It's important to follow the specific dosing instructions
that your doctor provides to adjust the medication. Individual responses
can vary, and your doctor can work with you to
find the right dosing schedule and the right medication to
best manage your personal PMDD symptoms. Another option is hormonal
(14:16):
birth control, which can regulate hormones and alleviate PMDD. Examples
include certain birth control pills, an iud, and even the
depot Privaras shot, which is another form of birth control.
Another option is psychotherapy, because talking to a mental health
professional can help women learn coping strategies and improve their
(14:41):
overall well being. Therapy is like cognitive behavioral therapy or
interpersonal therapy, are known to be particularly effective for women
with PMDD. Sometimes lifestyle changes can be helpful, like changing
your diet and exercise routine to something that is healthier,
(15:02):
reducing your stress, and important to get adequate sleep, which
does help reduce PMDD symptoms. Some women even try alternative
therapies like complimentary therapy like acupuncture, massage, or herbal remedies. However,
if you want to stick with the science, you really
(15:24):
should look at psychotherapy, ormonal birth control, and psychiatric medications.
Do you have a problem I can help with If so,
email me yet. How can I help at senecawomen dot com.
All centers remain anonymous and listen every Friday too. How
(15:45):
can I help with me Doctor Gale's salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. Women menstruate for the
majority of their lives, and many women struggle with symptoms
related to menstruation, either physical symptoms or mental health symptoms,
sometimes before, sometimes during, sometimes even after menstruation, which take
(00:52):
up a good deal of their lives. So today I'm
answering a question from a woman who is wondering what
her difficult symptoms may mean. There is a diagnosis called
pre menstrual dysphoric disorder, and its symptoms include depression or
(01:12):
mood swings, anxiety or irritability, tension, feelings of stress, insomnia
or different kinds of sleep issues, Physical symptoms like fatigue, bloating,
breast tenderness, changes in appetite even food cravings, decrease libido
(01:35):
or interest in sects, and difficulty concentrating or making decisions
For people with pre menstrual dysphoric disorder, These symptoms usually
occur seven to ten days before menstruation and then subside
sometime after the onset of menses. PMDD and pre menstrual
(01:59):
syndrome or PMS are both conditions that affect some women
during their menstrual cycle, but they also have some differences.
Those differences are, for example, in severity. In PMDD, you
have more severe symptoms, more severe symptoms that often overlap
(02:22):
with PMS, but the symptoms are so severe that they
affect a woman's daily life and relationships. PMS symptoms are
generally less intense. There's a difference in the number of symptoms.
With PMDD, it's characterized by at least five of the
symptoms I mentioned before, but PMS can be just one
(02:46):
or two symptoms. They can differ in duration. PMDD usually
occurs in the week or sometimes even two before menstruation
and then goes away once the period starts, but PMS
symptoms can start just several days before menstruation and usually
(03:07):
subside again after the first maybe two days or three
days after the period starts, and they also differ in
terms of treatment. PMDD is considered a psychiatric disorder, and
it can be treated with medication, with therapy, or the
combination of both, whereas PMS symptoms are usually managed with
(03:31):
lifestyle changes or over the counter remedies. It is important
to see a doctor for an accurate diagnosis of whether
you're struggling with PMDD or PMS, because it can really
impact a woman's quality of life. The exact cause of
(03:51):
pre menstrual dysphoric disorder is not known, but it is
believed to be related to hormonal fluctuations during the menstrual
cycle and therefore imbalances in neurotransmitters like serotonin. But basically
the most likely cause is the hormonal fluctuations that occur
during the menstrual cycle. Those changes, especially in the levels
(04:15):
of estrogen and progesterone, can affect the levels of neurotransmitters
like serotonin and therefore lead to mood changes, but all
by itself, neurotransmitter imbalances like serotonin that regulate mood and
appetite and sleep can also cause symptoms. It is thought
(04:39):
that women with PMDD do have an imbalance of serotonin,
which does contribute to their symptoms. Another area of cause
is likely genetics. Basically, this condition does tend to run
in families. Typically a mom struggles with it and her
daughter then struggles with it, and so there is something
(05:01):
genetically that predisposes one to p m d D. Another
factor is stress. Chronic stress can exacerbate the symptoms of
p m d D, as well as other physical and
mental health conditions that can go along with it. Then
there are environmental factors. Some people think that exposure to
(05:24):
certain environmental toxins like pesticides heavy metals can disrupt the
endocrine system in general and contribute to p m d
D and past experiences of trauma or abuse. Women who
have a history of trauma or abuse may be more
susceptible to p m d D, and the psychological and
(05:47):
emotional stress of these experiences also affect the brain like
neurotransmitters and therefore exacerbate the symptoms. While the exact cause
of PMDD may differ actually from person to person, it
tends to be a combination of factors that lead ultimately
(06:09):
to this problem, and there are reasons why women may
not even realize that what they are struggling with is
pre menstrual dysphoric disorder. That's because they have a lack
of awareness, which is frankly why I'm answering this question today.
It is a relatively new diagnosis, and many people are
(06:29):
really not familiar with the symptoms or how it differs
from PMS. They just assume that the terrible struggle they're
having is just bad PMS. There's been this normalization of symptoms.
Many women experience mild to moderate symptoms of PMS, like
mood swings, bloating, and fatigue, and tend to think these
(06:53):
symptoms are just a normal part of menstruating, and there
is the stigma. Women are often reluctant to talk about
their menstrual related symptoms, especially if they're more severe, because
of the stigma associated with it. In general, some women
have difficulty in identifying their symptoms and mistake it for
(07:17):
something else like depression and anxiety disorder, or just chock
it up distress, making it difficult for a woman to
realize that actually what she has is a treatable condition.
And there are a lot of misconceptions about PMDD that
women are using it just as an excuse for bad
(07:39):
behavior or mood swings, and that stigmatizes it further, making
a woman feel that she can't really speak about it
or realize that that's what's going on. So with that,
right after the break, we'll get to my listener's question.
(08:08):
Welcome back. Let's get to my listener's question and see
how can I help, dear doctor Sons. I have always
struggled with what I considered to be garden variety pre
menstrual syndrome, basically feeling a little moody and bloated in
the day or two before my period and during the
(08:30):
first few days after it starts. But in the last
six months, I find this period is now lasting longer,
more like a week or sometimes even closer to two.
And I'm still very moody and bloated. But in addition,
I find myself not only super irritable, but very quick
(08:52):
to anger. This had not been an issue before, and frankly,
it's not a good one. Out of nowhere, my husband
or a friend of mine or my mom gets super
under my skin and can say something where I just
see red, and then I lash out. My husband is
(09:15):
wondering what the heck is going on, and I feel
badly later, wondering why I had to get so mad,
and then I feel crushingly guilty. Can PMS just get
worse like this? Is there something I can do to
help myself? As this basically leaves me two weeks of
the month I feel like myself and the other two
(09:37):
I'm pretty miserable and making those around me miserable too.
PMS can get worse, and it can get better from
month to month or from year to year, so that
is a possibility. However, given how many days this is
now lasting and the added symptom being related to irrit
(10:00):
ability and anger, this may no longer classify as PMS,
but might actually fall into the diagnosis of preminstual dysphoric disorder.
If half of the month is spent feeling moody, irritable,
and bloated, it really sounds more like PMDD, and people
(10:22):
with PMS can sometimes have their symptoms grow worse and
basically grow into PMDD. The value of checking with your
gynecologist about whether this is now PMDD is that not
only are there things you can do for PMDD, there
(10:42):
are things you should do because being miserable so much
and risking your relationships along the way is not a
good option. Your gynecologist may suggest putting you on a
form of birth control to even out your hormones, specifically
estrogen and progesterone. By keeping you from having big fluctuations,
(11:07):
it may really decrease your symptoms. Some kynecologists actually recommend
a birth control pill that only has your menstruate four
times per year, which also cuts down on the amount
of time having any pre menstrual symptoms at all. Another
option is to consult with a psychiatrist who treats PMDD.
(11:31):
Those are usually psychiatrists who specialize in women's mental health issues,
who may offer you a serotonin reuptake inhibitor, a type
of antidepressant that treats PMDD and will attend to the
mood associated with its symptoms. Additionally, helpful can be psychotherapy,
(11:52):
which can give you specific tools to help you with mood, irritability,
and anger man management, all of which can help with
PMDD over the long run. The sooner you go, the better,
because all of these ideas can take at least a
few weeks, and there is no need to suffer longer
(12:15):
than you already have. It's also helpful to let your
partner or your friend or your mom know if you
have blown up at them that you realize you have
been struggling with this with this PMDD and are planning
to get some help, but to please understand, bear with
you and support you. Assure them that it is even
(12:39):
less pleasant for you than it is for them. Remind
them that you love them and are just going through
a hormonally difficult period. I hope that was helpful. There
are multiple treatments available for PMDD. Antidepressants, which are often
(13:01):
in the category of selective serotonin reuptake inhibitors, are the
most commonly prescribed medication for PMDD. Examples would be fluoxytine
or searcherlene or peroxytine. They help regulate mood and reduce
PMDD symptoms. Typically, women with PMDD take SSRIs daily for
(13:25):
the entire month to help regulate their mood, but some
women may find that they can take the medication only
during what's called the luteal phase or the days leading
up to menstruation, and that can be effective by itself
in managing their symptoms, but this is something that needs
to be discussed and decided on with your psychiatrist. Don't
(13:51):
decide when you will and won't take the pills on
your own. It's important to follow the specific dosing instructions
that your doctor provides to adjust the medication. Individual responses
can vary, and your doctor can work with you to
find the right dosing schedule and the right medication to
best manage your personal PMDD symptoms. Another option is hormonal
(14:16):
birth control, which can regulate hormones and alleviate PMDD. Examples
include certain birth control pills, an iud, and even the
depot Privaras shot, which is another form of birth control.
Another option is psychotherapy, because talking to a mental health
professional can help women learn coping strategies and improve their
(14:41):
overall well being. Therapy is like cognitive behavioral therapy or
interpersonal therapy, are known to be particularly effective for women
with PMDD. Sometimes lifestyle changes can be helpful, like changing
your diet and exercise routine to something that is healthier,
(15:02):
reducing your stress, and important to get adequate sleep, which
does help reduce PMDD symptoms. Some women even try alternative
therapies like complimentary therapy like acupuncture, massage, or herbal remedies. However,
if you want to stick with the science, you really
(15:24):
should look at psychotherapy, ormonal birth control, and psychiatric medications.
Do you have a problem I can help with If so,
email me yet. How can I help at senecawomen dot com.
All centers remain anonymous and listen every Friday too. How
(15:45):
can I help with me Doctor Gale's salts
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