When Premenstrual Symptoms Disrupt Life

Over the last 15 years, the abbreviation "PMS" has become a well-worn part of Americans' everyday language. The term is tossed around in conversations at home, and even the office, sometimes to describe a generally cranky state of mind.

But for some women, PMS, or premenstrual syndrome, is a disabling condition involving multiple physical and emotional symptoms.

Although most women are able to manage premenstrual symptoms by getting more sleep or drinking less caffeine, or at least weather the symptoms without too much trouble, others have severe PMS.

A smaller group of women have premenstrual dysphoric disorder, or PMDD. Women with PMDD experience severe symptoms that disrupt their lives by affecting their relationships and ability to perform their jobs or schoolwork.

Although many questions about PMDD remain unanswered, researchers such as Ellen Freeman, a research professor and codirector of the Human Behavior and Reproductive Unit in Obstetrics and Gynecology at University of Pennsylvania in Philadelphia, are studying treatments for PMDD, such as serotonin reuptake inhibitor, or SSRI, antidepressants and oral contraceptives.

Below, Freeman explains the difference between PMS and PMDD, and reviews available treatments.

What is PMS? PMS involves mood, behavioral and physical symptoms that occur in the days before the menstrual period. The most common symptoms are usually irritability, anxiety, tension, mood swings, breast tenderness, bloating and swelling. It's likely that nearly all women who seek treatment have at least two or three symptoms. And they probably have a mixture of mood and physical symptoms.

What is PMDD? Unlike PMS, PMDD is a condition that is classified as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. A woman must have at least five symptoms from a list of 11 symptoms. These symptoms must occur premenstrually and not other times: They must abate or go into remission during the menstrual period and then there's a symptom-free interval. So PMDD is not just a magnification of a psychological disorder such as depression. For a diagnosis of PMDD to be made, it's also required that these symptoms cause impairment in functioning of some sort, and that they be confirmed with daily symptoms ratings for at least two menstrual cycles. This confirmation is done with a symptom diary in which the woman records her symptoms.