Premenstrual dysphoric disorder (PMDD) is not just a challenging period; it's a life-disrupting condition affecting up to 5-10% of women of reproductive age. Imagine your usual monthly cycle amplified to a degree where distress becomes the norm, not the exception. 

As healthcare providers, our mission is to deepen our understanding of conditions like these and strive to manage them more effectively. In this article, we will unpack PMDD, its intricacies, and how consistent, bi-annual testing could open new doors to improved patient management. 

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What is Premenstrual Dysphoric Disorder (PMDD)? 

Premenstrual dysphoric disorder (PMDD) is an amplified and debilitating form of premenstrual syndrome (PMS), characterized by serious physical and emotional symptoms emerging in the weeks preceding menstruation. Unlike common PMS, PMDD is marked by extreme symptoms, including pronounced depression, irritability, sleep disturbances, and physical discomforts that can critically disrupt an individual's daily life, work, and personal relationships. 

A significant number of women experience some form of PMS, but PMDD is a more serious condition that can severely drain those affected, making even regular daily activities a challenge. Diagnosing PMDD isn't simple as there isn't a distinct diagnostic test; instead, it involves meeting specific criteria, such as symptoms not being triggered or worsened by other conditions and causing significant interference with daily functions. Moreover, at least five specific symptoms, like mood swings, appetite changes, and difficulties in concentration, must be present. Ultimately, PMDD is a serious health problem that extends beyond regular PMS, deeply affecting the lives of those who experience it.

What Causes Premenstrual Dysphoric Disorder (PMDD)?  

While the exact cause of PMDD remains unknown, it's understood that various factors likely contribute to its development. Some experts hypothesize that PMDD could be an abnormal reaction to the hormonal changes associated with the menstrual cycle. This is supported by observations of symptom relief during pregnancy and menopause, suggesting that the cyclical nature of reproductive hormones plays a significant role in PMDD. Moreover, those with PMDD often exhibit irregularities in the hypothalamic-pituitary-adrenal (HPA) axis and an altered cortisol awakening response, indicating that endocrine dysfunction goes beyond ovarian function. Certain lifestyle factors, such as a history of traumatic events, anxiety, smoking, and obesity, have also been identified as potential risk factors for developing PMDD (2).

Further exploring the hormonal aspect, the temporary increase and subsequent drop in levels of progesterone and its metabolite, allopregnanolone, during the menstrual cycle may be associated with the onset of PMDD symptoms. This connection is underlined by studies indicating that some women saw a reduction in core PMDD symptoms when taking an inhibitor that prevents allopregnanolone formation. Interestingly, levels of a brain neurotransmitter called GABA have been found to rise in women with PMDD during the luteal phase, suggesting a potential correlation between allopregnanolone, GABA, and symptom development (2,3).     

Serotonin, a chemical in the brain that helps transmit nerve signals, and is known to control mood, attention, sleep, and pain, is also implicated in PMDD. Low serotonin levels, perhaps triggered by hormonal changes or genetic factors linked to serotonin metabolism, could lead to PMDD symptoms. In addition to hormones and neurotransmitters, micronutrient deficiencies such as calcium, magnesium, and certain B vitamins and exposure to endocrine-disrupting chemicals like dioxin or Bisphenol A (BPA) may exacerbate the condition. Moreover, some women with PMDD might possess certain genetic variations that make them more responsive to even minor fluctuations in estrogen and progesterone levels (2,4). 

Premenstrual Dysphoric Disorder (PMDD) Symptoms

PMDD presents a host of symptoms that often become evident in a week or two leading up to the start of a woman's period and typically subside within the first few days of menstruation. While some of these symptoms align with those commonly associated with PMS, such as breast tenderness and bloating, the range and intensity of PMDD symptoms are usually more severe and exhaustive. These can include (2,3):

• Mood swings
• Depression or feelings of hopelessness
• Intense anger and conflicts with other people
• Tension, anxiety, and irritability
• A marked decrease in interest in usual activities
• Trouble focusing
• Fatigue
• Changes in appetite, including food cravings or binge eating
• Feelings of being out of control
• Sleep issues
• Physical discomforts such as cramps, bloating, headaches, joint or muscle pain, and hot flashes.

In some cases, symptoms may be so severe that they interfere with normal daily activities, leading to significant distress and functional impairment. It's also worth noting that severe emotional symptoms like anger, extreme irritability, feelings of being overwhelmed or 'on edge', and even suicidal ideation may be present in PMDD, distinguishing it from more typical premenstrual syndrome (2,3).

What Are The Benefits of Regular Lab Testing for Patients with Premenstrual Dysphoric Disorder (PMDD)?

Regular lab testing is a practical approach for managing patients with PMDD. It's important to note that while no lab tests can definitively diagnose PMDD, several evaluations are useful in ruling out conditions that can exhibit similar symptoms to PMDD, such as thyroid or mood disorders.

Consistent lab testing helps practitioners unearth underlying causes and factors contributing to PMDD symptoms. By doing so, practitioners can devise personalized treatment plans, improving patient outcomes. These tests also have a role in ensuring an accurate diagnosis by excluding other potential conditions, thus allowing appropriate and focused treatment for PMDD. The ability to distinguish PMDD from other conditions fosters a more effective treatment strategy and a stronger patient-provider relationship. Regular lab testing, therefore, is a fundamental component of a comprehensive PMDD management strategy.

Top Labs To Run Bi-Annually on Patients with Premenstrual Dysphoric Disorder (PMDD)

Consistent lab testing helps practitioners unearth underlying causes and factors contributing to PMDD symptoms. By doing so, practitioners can devise personalized treatment plans, improving patient outcomes. These tests also have a role in ensuring an accurate diagnosis by excluding other potential conditions, thus allowing appropriate and focused treatment for PMDD. 

Hormone Testing

Comprehensive female hormone testing can provide more insight into hormone level fluctuations throughout the menstrual cycle. Two options are the Female Hormone Panel and the DUTCH Complete. The Female Hormone Panel assesses all female hormones to detect and treat hormonal imbalances, while the DUTCH Complete provides further insight into possible contributing factors such as stress hormones like cortisol, thyroid function, and sleep hormones in addition to female sex hormones and other related biomarkers (2). 

Stool Testing 

Deficiencies in beneficial microbes within the gut are associated with PMDD. A comprehensive stool analysis, such as the GI-MAP can help evaluate the microbiome makeup and diagnose dysbiosis. Addressing gut health issues can lead to improved hormone metabolism and elimination, potentially reducing PMDD symptoms (2). 

Neurotransmitter Testing

As discussed above, abnormalities in serotonin metabolism, an important neurotransmitter, could lead to or worsen PMDD symptoms (2). 

Micronutrient Testing

As discussed above, micronutrient deficiencies such as calcium, magnesium, and certain B vitamins may exacerbate PMDD (2). 

Additional Labs to Check

Evaluating possible environmental toxins through a toxic burden test can be helpful for those with PMDD. This test helps to assess an individual's exposure to endocrine-disrupting chemicals, which may contribute to PMDD symptoms. Reducing exposure to such toxins can be a part of a holistic treatment plan to alleviate PMDD symptoms (2). 

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Summary

Premenstrual dysphoric disorder (PMDD) is a debilitating condition rooted in hormonal shifts, endocrine dysfunction, lifestyle factors, and potentially genetic susceptibilities. Regular lab testing is instrumental in uncovering these underlying factors, aiding in personalized treatment and accurate diagnosis. Adopting a holistic approach, including nutrient supplementation, a balanced diet, exercise, stress management, and reduced exposure to endocrine-disrupting chemicals, can further mitigate PMDD symptoms. As healthcare providers, continuous exploration and understanding of PMDD will drive improved patient outcomes and foster a better quality of life for those affected.