Dr. Olga Sambolska. – Photo courtesy of Family Medical Practice

by Dr Olga Sambolska*

Let's talk about an important health issue called Premenstrual Syndrome and its  most severe form Premenstrual Dysphoric Disorder (PMDD) - an endocrine disorder, which can cause many emotional and physical symptoms every month during the week or two before you start your period.

But how do you know if you have PMDD?

To talk about the topic of PMDD (PMS), we also need to talk about premenstrual symptoms. Almost everyone has some kind of sign before their period is due. In fact, four in 10 women suffer from PMS. It could range from tenderness in the breast or acne popping up all over the face and sometimes on your body.

Many of us suffer from fatigue, bloating (due to fluid retention), temporary weight gain, sleep disturbance and changes in appetite. These signs can be physical, emotional, or behavioural. The changes appear one to two weeks before your period. Once your period starts, they go away.

There are a few ways to deal with your PMS: for example, making changes to improve your sleep, your diet, and exercise. You can practise techniques to relax your body and mind with meditation and mindfulness exercises. If none of these seem to work, you can always seek advice from your doctor.

What causes PMDD?

Researchers do not know for sure what causes PMDD or PMS. Fluctuations of circulating estrogen and progesterone play a certain role. A brain chemical called serotonin is associated with symptoms such as irritability, depressed mood and carbohydrate craving in PMDD. Serotonin levels change throughout the menstrual cycle. Some women may be more sensitive to these changes.

How can PMDD be diagnosed ?

There isn't laboratory test for PMDD, qualified health care professionals should begin the diagnostic process by ruling out -through a personal history, a physical and a laboratory examination - syndromes (thyroid disorder, chronic fatigue syndrome, lupus, mood and anxiety disorders, etc.) that could mimic the symptoms of PMDD.

Your doctor will talk to you about your health history and do a physical examination. You will need to keep a calendar or diary of your symptoms to help your doctor diagnose PMDD. You must have five or more PMS symptoms, including one mood-related symptom, to be diagnosed with PMDD.

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) may reduce symptoms such as emotional symptoms, fatigue, food cravings and sleep problems. You can reduce symptoms of PMDD by taking SSRIs all month or only in the interval between ovulation and the start of your period.
• Birth control pills. Taking birth control pills with no pill-free interval or with a shortened pill-free interval may reduce PMS and PMDD symptoms for some women.
• Nutritional supplements. Consuming 1,200 milligrams of dietary and supplemental calcium daily may possibly reduce symptoms of PMS and PMDD in some women. Vitamin B-6, magnesium and L-tryptophan also may help, but talk with your doctor for advice before taking any supplements.
• Herbal remedies. Some research suggests that chasteberry (Vitex agnus-castus) may possibly reduce irritability, mood swings, breast tenderness, swelling, cramps and food cravings associated with PMDD, but more research is needed. The Food and Drug Administration doesn't regulate herbal supplements, so talk with your doctor before trying one.
• Diet and lifestyle changes. Regular exercise often reduces premenstrual symptoms. Cutting back caffeine, avoiding alcohol and stopping smoking may ease symptoms, too. Getting enough sleep and using relaxation techniques, such as mindfulness, meditation and yoga, also may help. Avoid stressful and emotional triggers, such as arguments over financial issues or relationship problems, whenever possible.

Review your symptoms with your doctor. A thorough medical evaluation may determine if symptoms are due to PMDD or some other condition. If you're diagnosed with PMDD, your doctor can recommend specific treatments to help minimise symptoms.

What can you do about it?

If you suffer from these extreme levels of PMS, please seek a doctor’s advice.

PMDD is now listed as a mental health problem and we need to talk about it to generate awareness. (PMDD was recently listed in the DSM-5 - one of the main manuals that doctors use to categorise and diagnose mental health problems). So hopefully all medical doctors and gynaecologists should be aware of it.

The other thing you can do is talk about it. You never know - your best friend or your neighbour next door might be suffering from PMDD and you could be there to help her or at least talk about it, to find the right ways to seek help.

Another way to become more aware of your symptoms is by knowing your body and tracking your cycle and mental states. During that one week of PMDD episode, please start recording your mood at Mood Tracker or other apps like this. It's really helpful. Nowadays there are various apps you can use to track your period and the PMS window. – Family Medical Practice

* Dr Olga Sambolska graduated from the Lviv National Medical University in 1996 and commenced her medical career at the Volyn Regional Maternity Hospital, Ukraine. Since 1998 she has been a registered Obstetric and Gynaecology doctor providing care to women with gynaecological health matters as well as managing low-risk and complex obstetric cases throughout pregnancy, labour and the postpartum period. Her main focus has been intrapartum care (during labour) and she is competent in all types of delivery: vaginal, instrumental and operative (Caesarean Section).

Family Medical Practice was the first foreign-owned primary healthcare provider in Việt Nam, and has consistently remained at the forefront of international-standard medicine since 1995. It offers extensive healthcare and emergency medical services nationwide to Vietnamese, expatriate and corporate customers.

 For more advice on any medical topics, visit Family Medical Practice Hanoi at: 298 I Kim Mã, Ba Đình. Tel: (024) 3843 0748.  E: hanoi@vietnammedicalpractice.com.

FMP’s downtown Hồ Chí Minh City location is: Diamond Plaza, 34 Lê Duẩn, District 1; 95 Thảo Điền, District 2. Tel: (028) 38227848. E: hcmc@vietnammedicalpractice.com

FMP Đà Nẵng is located at 96-98 Nguyễn Văn Linh, Hải Châu District, Đà Nẵng. Tel: (0236) 3582 699. E: danang@vietnammedicalpractice.com.