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That Time of the Month

Posted Mar 01 2008 12:00am

Women suffering from PMDD battle more than monthly crankiness and tears

Story by Silvia Milanova // Photo Illustrations by Steven Gardner

Bloating. Cramps. Mood Swings. Many women suffer from these symptoms at some point or another, but about three to eight percent of women of childbearing age experience a more extreme version: PMDD, or premenstrual dysphoric disorder.

When asked about PMDD, Erin Choi, a sophomore at Syracuse University, says she isn’t sure, but that she experiences bad cramps, crying spells, headaches, and a backache. She locks herself in her room, and sometimes she unexpectedly snaps back at people. “When I am home, I tell my family that I have my period and for them to leave me alone. Maybe I have PMDD,” she says.
Choi is not the only young woman on campus that is not aware of this serious condition. Some girls might experience the symptoms of PMDD and think that it’s simply PMS. Choi’s roommate, Courtney Greenberg, also a sophomore at SU, had no idea that PMDD even existed.

“What is PMDD?” she asked, overhearing Erin talking about it. “I have never heard of it.”
PMDD is a subset of PMS. PMDD can increase the risk of physical symptoms resulting from premenstruation, such as severe cramps, headaches, breast tenderness, joint or muscle pain, bloating, and weight gain. The emotional and behavioral symptoms of PMDD include sadness and crying, feeling anxious and irritable, problems concentrating, increased food cravings, confusion, and trouble sleeping, according to Dr. Judith Hersh, an obstetrician and gynecologist at Central Jersey’s Women’s Health Associates in Bedminster, N.J.

“It really has to be incapacitating to count as PMDD,” says Dr. Mary Jane Minkin, a clinical professor of obstetrics and gynecology at Yale University’s School of Medicine and the owner of a private practice in New Haven, Conn.

In order for a woman to be diagnosed with PMDD, she needs to have at least five of the symptoms mentioned above. Irritability and depression are very common symptoms of PMDD, which may not be necessarily common in “regular” PMS; however, the symptoms and their severity differ for each individual. A doctor would have to carefully study the woman and her behavior for at least two or three consecutive menstrual cycles, says Dr. Anita L. Nelson, a professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles, and the author of “Contraceptive Technology.” Symptoms may vary from cycle to cycle, and women with a family history of depression, severe PMS, or a mood disorder are also at a higher risk for PMDD. One study showed that 59 percent of women with PMS also had clinical depressive anxiety, according to Nelson’s book.

The exact cause of PMDD is unknown. According to the University of Virginia Health System, “One theory states that women who experience PMDD may have abnormal reactions to normal hormone changes that occur with each menstrual cycle. This may include fluctuation of estrogen and progesterone levels that normally occurs with menstruation, causing a serotonin deficiency in some women.” This serotonin deficiency would be the possible trigger for depressive episodes.
Symptoms usually occur during the late luteal phase of the menstrual cycle or the week before a woman’s cycle, and disappear within a few days after the period starts, Nelson says.

Diagnosing this condition is very important. PMDD affects college-aged women and their daily social lives, but many of them are not aware of the fact that they might have it. Many have never even heard of it. PMDD is now gaining more awareness as more women are finding out that they have it. Although there is no cure, PMDD can be treated with a new birth control pill, YAZ. This pill has been shown to alleviate PMDD symptoms with a 24-day hormone schedule and four days of placebos, in contrast to the usual 21 hormone pills and seven placebos found in most common birth control pills. Antidepressant therapy using selective serotonin reuptake inhibitors, or SSRIs, has also shown promise.

“Treatment of PMDD with a serotonergic antidepressant significantly improves functioning. Both continuous dosing and intermittent luteal dosing strategies lead to rapid improvement in symptoms,” says Dr. Ellen W. Freeman, an obstetrics and gynecology professor at the University of Pennsylvania.

YAZ is unlike other birth control pills because “it’s the only birth control pill that’s also approved by the FDA to treat emotional and physical premenstrual symptoms that are severe enough to impact the lives of women who choose the Pill for contraception,” YAZ’s Web site states. The pill can also treat moderate cases of acne. Other, more domestic and simple methods used to decrease the symptoms of PMDD include a change in diet, daily or regular exercise, stress management, and vitamin intake.

Choi, who does not use YAZ, is on another birth control pill, Ortho Tri-Cy Lo, because of her severe and uncomfortable monthly cramps. “The initial reason that I went on the Pill was because of my period,” she says. “Midol does not take care of it. Birth control helps with the cramps, although it does not get rid of them completely.” Ortho Tri-Cyclin Lo does not treat or lessen the symptoms of PMDD. It is only effective in clearing up skin.

The U.S. Food and Drug Administration, has yet to recognize PMDD as a medical condition. Therefore, there have not been any medications developed to specifically treat PMDD.

“Appropriate recognition of the disorder and its impact should lead to treatment of more women with PMS/PMDD,” according to Psychoneuroendocrinology, an article written by professors at the department of psychiatry at the State University of New York at Buffalo.

Although there is no set cure, effective treatments can alleviate a woman’s symptoms so she can worry about things other than having mood swings.

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