Premenstrual dysphoria disorder: It’s biology, not a behavior choice – Harvard Health Blog

Almost all women have some mild premenstrual symptoms that signal the imminent arrival of their period every month. These symptoms are typically just an annoyance and don’t cause any distress.

But for some women, these symptoms are much more significant. About 20% of menstruating women suffer from premenstrual syndrome, or PMS. Women with PMS have mostly physical symptoms and some minor mood disturbances caused by the changing hormone levels in the second half (or luteal phase) of the menstrual cycle. These hormone-induced symptoms can cause significant physical distress in the days leading up to menstruation.

PMDD: More than PMS

Sometimes — in about 5% to 8% of menstruating women — debilitating mood changes accompany these premenstrual physical symptoms. Globally this is often referred to as severe PMS, but in the United States this combination of physical symptoms and mood disturbances is called premenstrual dysphoria disorder, or PMDD.

Unfortunately, women with PMDD are often misdiagnosed. Sometimes they go undiagnosed, being told they are just hormonal and need to get over it. And sometimes they are overdiagnosed. Unfortunately, it is all too common for women with PMDD to be incorrectly diagnosed with bipolar disorder.

What causes PMDD?

Broadly speaking, if you have PMDD, you have an increased sensitivity to your reproductive hormones during the two weeks before your period starts. This sensitivity leads to alterations in the brain chemicals and neurologic pathways that control your mood and your general sense of well-being. Exactly what that sensitivity is and what causes it has not been well understood. And treatment options have been limited.

Fortunately, progress is being made with some exciting new discoveries. Researchers at the National Institutes of Health (NIH) have found that women with PMDD have an altered gene complex that processes the body’s response to hormones and stressors. This is a very important…

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