Women's Behavioral Health: PMS and PMDD Services at UPMC in South Central Pa.

The psychiatrists and therapists at Women’s Behavioral Health Specialists help women who experience premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) manage the emotional and behavioral effects of these conditions.

Treatment for PMS and PMDD

Treatment for PMS and PMDD depends upon the type and severity of your symptoms and may include a combination of lifestyle or behavioral changes and medication management. Your doctor may ask you to track the start and end of your symptoms for a few months to help them decide on the best treatment for you.

Depending on your symptoms, your doctor may recommend:

• Medication for PMS and PMDD
• Antidepressants and anti-anxiety medications. Antidepressants may help to reduce mood disorder symptoms and are often the first line of treatment for PMDD or severe PMS. These medications are usually taken daily, but some women with PMS or PMDD may only need to take an antidepressant during the two weeks before menstruation begins.
• Hormonal contraceptives. Hormonal contraceptives, also called birth control, may bring relief from PMS and PMDD symptoms. A variety of birth control options are available, and your doctor will recommend the best option for you depending on your overall health and plans for future childbearing.
• Counseling for PMS and PMDD. For some women, the emotional symptoms of PMS and PMDD can be disruptive enough to affect their quality of life. Our practice offers one-on-one counseling and group therapy to help women discuss and manage symptoms that can include feelings of hopelessness, depression, anxiety, irritability, and significant mood imbalances.

What is PMS?

Premenstrual syndrome (PMS) is a combination of symptoms that affect many women in the two weeks before their period. Symptoms are usually mild, but some women experience severe symptoms that prevent them from performing normal daily activities, such as attending work or school.

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a severe, sometimes-disabling condition with a wide range of physical and emotional symptoms. PMDD is considered an extreme form of PMS. Although PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can be disruptive to your everyday life.

There is no lab test to diagnose PMDD, and the cause is unknown. Studies have shown a relationship between PMDD and low levels of serotonin, a chemical in your brain associated with mood, attention, sleep, and pain. Monthly hormonal changes may cause a decrease in serotonin which can worsen PMDD symptoms.

Women with PMDD also may experience an abnormal reaction to the hormonal changes that are associated with menstruation. This reaction may cause symptoms of underlying depression and anxiety to worsen.

What are the symptoms of PMS?

Symptoms of PMS usually occur a week or two before your period starts and range from mild to severe. Physical symptoms of PMS may include:

• Breast tenderness or swelling
• Constipation or diarrhea
• Feeling bloated or gassy
• Cramps
• Headache
• Backache

Emotional symptoms of PMS may include:

• Irritability
• Hostile behavior
• Sleeping too much or too little
• Appetite changes
• Food cravings
• Trouble concentrating
• Forgetfulness
• Tension
• Anxiety
• Depression, feelings of sadness, or crying spells
• Moodiness
• Decreased interest in sex

What are the symptoms of PMDD?

PMDD can dramatically affect every aspect of your life, including your work, school, social life, and your relationships. PMDD symptoms usually begin seven to 10 days before your period starts and continue for the first few days. Physical symptoms of PMDD may include:

• Bloating
• Cramps
• Headaches
• Joint or muscle pain
• Hot flashes
• Breast tenderness
• Fatigue
• Changes in sleeping patterns and eating habits

Emotional symptoms of PMDD may include:

• Mood swings
• Depression
• Feelings of sadness or hopelessness
• Intense anger
• Conflict with other people
• Tension, anxiety, and irritability
• Decreased interest in usual activities
• Difficulty concentrating
• Feeling out of control

Who is at risk for PMS and PMDD?

PMDD affects between 3 percent and 8 percent of menstruating women, while 75 percent of women experience some physical and/or emotional symptoms of PMS. Women with a family history of PMS or PMDD, or a personal or family history of other mood disorders, may be at a higher risk of developing PMS or PMDD.

How can I prevent PMS and PMDD?

For some women, there are lifestyle changes that may help relieve some of their PMS or PMDD symptoms. Eating healthy, exercising, and learning to cope with stress can help you manage or reduce your PMS and PMDD symptoms.

Diet and Nutrition

• Eat smaller, more frequent meals to help reduce bloating and the uncomfortable feeling of fullness.
• Limit your salt intake to reduce bloating and fluid retention.
• Eat foods high in complex carbohydrates such as fruits, vegetables, and whole grains.
• Choose foods rich in calcium.
• Avoid caffeine and alcohol.

Exercise

• Do at least 30 minutes of brisk walking, cycling, swimming, or other aerobic activity almost every day. Regular exercise can help improve your overall health and address certain symptoms like fatigue and a depressed mood.

Stress Management

• Get plenty of sleep.
• Practice muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety, or trouble sleeping (insomnia).
• Try yoga or massage to help relax.

Podcast

Perinatal Mood Disorders, Featuring: Nazanin E. Silver, MD

Need more information?

Phone: 717-988-9430

Our Providers

• Jennifer Ryan, LCSW
• Nazanin E. Silver, MD
• David F. Silver, MD
• Virginia L. Getz, LPC