PMS has become a household word and the brunt of many jokes. According
to a recent survey, many women remain unaware of its more severe form, premenstrual
dysphoric disorder or PMDD. Among 500 women recently surveyed, 8 out of 10
did not know that severe premenstrual problems have been officially classified
as PMDD, nor did they know that such problems can be diagnosed and treated.
Even more disturbing is that the one in 4 respondents who described their premenstrual
symptoms as strong or severe were among those unaware of PMDD.
"We've got to educate women that they do not have to tolerate debilitating
premenstrual symptoms," said Phyllis Greenberger, MSW, Executive Director of
the Society for Women's Health Research, which commissioned the Yankelovich
Partners survey (sponsored by a grant from Eli Lilly, manufacturers of Prozac).
"Women have a right to know if what they are experiencing month to month is
actually PMDD, and how to get help."
What is PMDD?
PMDD stands for Premenstrual Dysphoric Disorder. It is the acronym for the
more severe form of PMS (Premenstrual Syndrome). Like PMS, PMDD occurs the week
before the onset of menstruation and disappears a few days after. PMDD is characterized
by severe monthly mood swings and physical symptoms that interfere with
everyday life, especially a woman's relationships with her family and friends.
PMDD symptoms go far beyond what are considered manageable or normal premenstrual
PMDD is a combination of symptoms
that may include irritability, depressed mood, anxiety, sleep disturbance, difficulty
concentrating, angry outbursts, breast tenderness and bloating. The diagnostic
criteria emphasize symptoms of depressed mood, anxiety, mood swings or irritability.
The condition affects up to one in 20 American women who have regular menstrual
What is the Difference Between PMS and PMDD?
The physical symptom list is identical for PMS and PMDD; while the emotional
symptoms are similar, they are significantly more serious with PMDD. In PMDD,
the criteria focus on the mood rather than the physical symptoms. With PMS,
sadness or mild depression is not uncommon. With PMDD, however, significant
depression and hopelessness may occur; in extreme cases, women may feel like
killing themselves or others. Attributing suicidal or homicidal feelings to
"it's just PMS" is inappropriate; these feelings must be taken as seriously
as they are in anyone else and should be promptly brought to the attention of
mental health professionals.
Women who have a history of
depression are at increased risk for PMDD. Similarly, women who have had PMDD
are at increased risk for depression after menopause. In simplest terms, the
difference between PMS and PMDD can be likened to the difference between a mild
headache and a migraine.
While nearly all of the women
in the survey reported experiencing premenstrual symptoms in the last 12 months,
nearly half (45 percent) have never discussed PMS with their doctors. Even among
women with strong or severe symptoms, more than one out of four (27 percent)
had never talked with their doctors about PMS, despite the fact that
most in this group reported that the symptoms interfere with their daily activities.
When asked about their reluctance
to seek medical treatment even if they thought they had PMDD, nine of every
10 respondents who would not seek treatment said that they could cope
with their problems on their own, and about one of every four felt their doctors
would not take their complaints seriously if they did bring it up.
PMDD has recently been listed as an official psychiatric diagnosis.
The fear of this stigma may contribute to women's reluctance to discuss it with
their doctors. "I frequently work with patients who have waited years to ask
a doctor about premenstrual problems or have been turned away by their health
care provider when they tried to discuss symptoms," said Jean Endicott, Ph.D.,
Director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical
Center. "They fear becoming the target of jokes or that seeking help is a sign
of weakness. Informing women and providers about diagnosing and treating PMDD
helps clear the way to effective medical care."
Survey respondents reporting strong or severe symptoms revealed the classic
PMDD features of impaired social functioning and predominant mood symptoms.
Two out of three women (67 percent) with moderate, strong or severe symptoms
reported interference with their daily activities. One third of these women
said they find their mood changes, not their physical symptoms, to be
The survey also found that
women with strong or severe premenstrual symptoms were five times as likely
as those with moderate symptoms (26 percent vs. 5 percent) to experience these
symptoms every month. A key part of the PMDD diagnosis is determining whether
symptoms have occurred during most cycles of the past year and are clearly documented
for at least two consecutive menstrual cycles.
When asked what they would
do if they thought they had PMDD, two out of three women (66 percent) in the
survey said they would most likely get information from their obstetrician or
gynecologist, as opposed to consulting friends or using Internet resources.
This is encouraging, according to Dr. Endicott, because the American College
of Obstetricians and Gynecologists (ACOG) issued treatment guidelines for premenstrual
symptoms earlier this year. It recommended the newer form of anti-depressant
medications called "SSRIs" (selective serotonin reuptake inhibitors) as the
preferred method for treating symptoms associated with PMDD.