Premenstrual dysphoric disorder (PMDD): A severe form of PMS

The symptoms you describe likely are due to a condition known as premenstrual dysphoric disorder (PMDD). About 75 percent of menstruating women experience mild to moderate premenstrual symptoms. But up to 8 percent of menstruating women have PMDD — a severe, sometimes disabling form of premenstrual syndrome (PMS).

Premenstrual dysphoric disorder is distinguished from PMS by the severity of its symptoms and its impact on relationships and daily activities. Symptoms of PMDD occur in the last week of the menstrual cycle and usually improve within a few days after menstruation begins. These include:

• Persistent sadness or depression
• Marked anxiety, feelings of being "keyed up" or "on edge"
• Mood swings often marked by periods of teariness
• Persistent or marked anger or irritability
• Decreased interest in usual activities
• Fatigue or lethargy
• A feeling of being overwhelmed or out of control
• Flu-like symptoms, including muscle aches, headaches and joint pain
• Changes in sleep patterns — problems falling and staying asleep or sleeping too much
• Changes in appetite — overeating, lack of appetite or specific food cravings

The cause of PMDD isn't clear. Major depression is very common with PMDD. But PMDD can also occur in women who do not have a history of major depression.

A doctor may diagnose premenstrual dysphoric disorder based on its pattern of symptoms. Your doctor may recommend that you keep a diary to record the type, severity, duration and timing of your symptoms. This information may help your doctor diagnose PMDD and determine the most appropriate treatment for you.

Treatment of PMDD is directed at preventing or minimizing symptoms and may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) reduce symptoms such as fatigue, food cravings and sleep problems.
• Oral contraceptives. Oral contraceptives stop ovulation and stabilize hormone fluctuations, which reduces mood swings.
• Nutritional supplements. Consuming 1,000 milligrams of dietary and supplemental calcium daily may reduce the physical and emotional symptoms of PMDD.
• Herbal remedies. Clinical trials suggest that chasteberry — also called chaste tree berry — may reduce irritability, mood swings, anger and headaches associated with PMDD.
• Diet and lifestyle changes. Regular exercise often reduces premenstrual symptoms. Decreasing caffeine intake can alleviate anxiety and irritability. Also, eating more carbohydrates in the week before your period may improve mood and memory.

It's important that you review your symptoms with your doctor. A thorough medical evaluation can determine if symptoms are due to PMDD or some other condition. If you are diagnosed with PMDD, your doctor can recommend specific treatments to help minimize the impact PMDD has on the days you experience symptoms.