By Liisa Hantsoo, Ph.D.
Premenstrual Dysphoric Disorder (PMDD) is a cyclic mood disorder that affects approximately 3-5% of women (1). This translates to millions of women worldwide. While many of PMDD’s symptoms are similar to those of major depression (e.g. irritability, low mood, hopelessness, anxiety), it is unique in that symptoms only occur in the luteal (premenstrual) phase of the menstrual cycle. This can include physical symptoms as well, such as bloating, headaches or breast tenderness. For some women, symptoms may only last two or three days, but for others, symptoms can last for as long as two weeks each month. When not in the luteal phase, women with PMDD report feeling well and functioning normally. PMDD is also different from premenstrual syndrome (PMS); while both occur in the luteal phase, PMS is characterized by fewer symptoms than PMDD, and affects a larger proportion of women, around 20% (2). If we consider only premenstrual symptoms, whether mood or physical, the majority of women , roughly 80%, will experience at least one symptom (3). While PMDD is less common than major depressive disorder, it has roughly the same lifetime prevalence as panic disorder, and a higher prevalence than bipolar disorder and obsessive compulsive disorder (OCD) (4).
PMDD is more prevalent in the U.S. than bipolar disorder or panic disorder. (Data from the US National Comorbidity Survey Replication (4).)
As recently described in The New York Times (5), “the average woman has her period for 2,535 days of her life,” which is nearly 7 years. If we consider this in the context of PMDD, the average woman with PMDD may experience debilitating mood symptoms for the same amount of time. Indeed, if a woman with PMDD has 450 periods over the course of her lifetime, and is symptomatic for 5 days each cycle, she spends over 6 years of her life experiencing PMDD symptoms. This is similar to the cumulative amount of time that someone with major depressive disorder would be symptomatic over the course of their life (6).
The average woman has 450 periods over the course of her life. For women with PMDD, this translates to a cumulative 6 years spent symptomatic. (Assumes menarche at age 12 and menopause at age 50.)
Therefore, the need to study PMDD, and its more common counterpart, PMS, is clear. With PMDD and PMS together affecting around a third of women worldwide, understanding the etiology of these cyclic disorders, and improving treatment options, is critical. When a woman is experiencing PMDD symptoms, it can interfere with her ability to be productive at work or school, affects her ability to take care of herself and family, and can have a major impact on her relationships with friends, partner, or family (7). An especially serious concern is that some women with PMDD experience suicidal ideation during the luteal phase (8). For this reason alone, it is crucial that we raise awareness of PMDD and work to improve treatment availability. PMDD is also quite unique in comparison to other mood or anxiety disorders, in its cyclicity. While disorders such as bipolar disorder or seasonal affective disorder also exhibit cyclicity, no other disorder has the clear onset and offset that occurs with PMDD across the hormonal fluctuations of the menstrual cycle. This, therefore, can give us important information on how hormones, such as estrogens and progesterone, act in the brain to affect mood and cognition. At a broader scale, this may provide important insights to sex differences in disorders such as major depression, anxiety disorders, or addiction.
References:
1. Hantsoo L, Epperson CN. Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Curr Psychiatry Rep. 2015;17(11):87. doi:10.1007/s11920-015-0628-3
2. Dennerstein L, Lehert P, Heinemann K. Epidemiology of premenstrual symptoms and disorders. Menopause Int. 2012;18(2):48-51. doi:10.1258/mi.2012.012013
3. Budeiri DJ, Li Wan Po A, Dornan JC. Clinical trials of treatments of premenstrual syndrome: entry criteria and scales for measuring treatment outcomes. Br J Obstet Gynaecol. 1994;101(8):689-695.
4. KESSLER RC, PETUKHOVA M, SAMPSON NA, ZASLAVSKY AM, WITTCHEN H-U. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169-184. doi:10.1002/mpr.1359
5. Zraick K. It’s Not Just the Tampon Tax: Why Periods Are Political. The New York Times. https://www.nytimes.com/2018/07/22/health/tampon-tax-periods-menstruation-nyt.html. Published July 26, 2018. Accessed August 6, 2018.
6. Burcusa SL, Iacono WG. Risk for Recurrence in Depression. Clin Psychol Rev. 2007;27(8):959-985. doi:10.1016/j.cpr.2007.02.005
7. Halbreich U, Borenstein J, Pearlstein T, Kahn LS. The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology. 2003;28 Suppl 3:1-23.
8. Pilver CE, Libby DJ, Hoff RA. Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol. 2013;48(3):437-446. doi:10.1007/s00127-012-0548-z