Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome characterized by marked mood disturbances, irritability, anxiety, and physical symptoms in the luteal phase of the menstrual cycle, significantly affecting daily functioning.

Definition

Epidemiology

Affects 3–8% of women of reproductive age
Symptoms occur in the luteal phase and resolve with menstruation
Higher prevalence in women with a history of mood disorders
Peak onset in late 20s to early 40s
Family history of PMS or PMDD increases susceptibility

Etiology

Hormonal fluctuations: sensitivity to normal changes in estrogen and progesterone
Neurotransmitter dysregulation: serotonin and GABA pathways
Genetic predisposition and family history
Psychosocial stressors exacerbating symptoms
History of depression or anxiety disorders
Environmental triggers, including stress and lifestyle factors

Pathophysiology

Altered serotonergic activity leading to mood and affect disturbances
Abnormal response to progesterone metabolites affecting GABA receptors
Sensitivity to estrogen and progesterone fluctuations rather than absolute hormone levels
HPA axis dysregulation contributing to stress response
Neurobiological vulnerability interacting with psychosocial stressors
Feedback loop between mood symptoms and somatic complaints
Potential genetic and epigenetic contributions