Treatment depends on PMDD symptoms. "There is a role for antidepressants and hormonal treatments like oral contraceptives," Estes said. According to Hartlage, these sometimes are prescribed at lower doses than would be used to treat depression or anxiety.
PMS, on the other hand, is typically treated with lifestyle changes, such as regular exercise, eating a healthy diet and caffeine avoidance as well as prescription or over-the-counter medication, including nonsteroidal anti-inflammatory drugs.
The American College of Obstetricians and Gynecologists says that women considered to have PMS suffer for at least three menstrual cycles with at least one symptom, such as depression, insomnia or food cravings, that emerges within five days before a woman's period and ends within four days after the start of menstrual flow. These emotional and/or physical symptoms interfere with some aspect of daily life but to a lesser extent than PMDD.
The number of symptoms required for a PMDD diagnosis needs further exploration, the authors commented. The DSM-IV, the current edition, requires five symptoms, while the authors found that some women are impaired with three or four symptoms. These women would be excluded under the current definition.
Dr. Donnica Moore, an obstetrician-gynecologist and president of Sapphire Women's Health Group in Far Hills, N.J., said the study raises awareness among psychiatrists about the full scope of PMDD.
"It has been very clear to women all along that PMDD symptoms persist after the first day of menstruation," Moore said. "If you have any kind of menstrual symptoms that interfere with your activities of daily living, whether physical or emotional, discuss them with your doctor."
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