Premenstrual disorders and PMDD – a review Original paper
Researched by:
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Divine Aleru
ID
Divine Aleru
I am a biochemist with a deep curiosity for the human microbiome and how it shapes human health, and I enjoy making microbiome science more accessible through research and writing. With 2 years experience in microbiome research, I have curated microbiome studies, analyzed microbial signatures, and now focus on interventions as a Microbiome Signatures and Interventions Research Coordinator.
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Women’s Health
Women’s Health
Women’s health, a vital aspect of medical science, encompasses various conditions unique to women’s physiological makeup. Historically, women were often excluded from clinical research, leading to a gap in understanding the intricacies of women’s health needs. However, recent advancements have highlighted the significant role that the microbiome plays in these conditions, offering new insights and potential therapies. MicrobiomeSignatures.com is at the forefront of exploring the microbiome signature of each of these conditions to unravel the etiology of these diseases and develop targeted microbiome therapies.
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Premenstrual Dysphoric Disorder (PMDD)
Premenstrual Dysphoric Disorder (PMDD)
OverviewPremenstrual Dysphoric Disorder (PMDD) affects roughly 3–9% of women of reproductive age and manifests as severe mood, behavioral, and physical symptoms tightly linked to the luteal phase of the menstrual cycle, distinguishing it from milder premenstrual syndrome (PMS).[1][2] Central to PMDD’s pathophysiology is an altered sensitivity of the central nervous system to normal fluctuations of […]
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Divine Aleru
Researched by:
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Divine Aleru
ID
Divine Aleru
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Divine Aleru
What was reviewed?
This paper provides a comprehensive review of premenstrual disorders (PMDs), with a specific focus on premenstrual dysphoric disorder (PMDD). It synthesizes current knowledge regarding the definitions, classification, prevalence, diagnosis, etiology, and treatment of PMDs and PMDD. The review covers consensus guidelines from professional bodies such as the International Society for Premenstrual Disorders (ISPMD), diagnostic criteria from DSM-V and ICD-11, and evaluates various therapeutic approaches, including non-pharmacological interventions, pharmacotherapy (particularly SSRIs), hormonal treatments, novel agents targeting neuroactive steroids, and surgical options. It also highlights challenges in diagnosis, the significant impact on quality of life and suicidality risk, and research gaps.
Who was reviewed?
The review critically assesses a wide body of clinical, epidemiological, and mechanistic studies involving women experiencing PMDs and PMDD worldwide. It references population prevalence data, genetic and neurobiological studies, clinical trials evaluating treatments such as SSRIs and combined oral contraceptive pills (COCPs), and guidelines developed by multidisciplinary expert panels. The authors draw upon systematic reviews, randomized controlled trials, observational studies, and consensus statements to present a balanced perspective. The review specifically incorporates data related to symptom measurement tools like the Daily Record of Severity of Problems (DRSP) and discusses patient management strategies applicable in primary and specialist care settings.
What were the most important findings?
The review clarifies that PMDD represents a severe subset of PMDs, affecting approximately 5% of women, and carries significant physical, psychological, and social burdens, including a markedly increased risk of suicide attempts. It emphasizes that PMDD symptoms arise from abnormal sensitivity to normal menstrual hormonal fluctuations, especially allopregnanolone’s paradoxical effect on GABA-A receptors, rather than altered hormone levels per se. Genetic factors, serotonergic dysregulation, inflammation, and stress history also contribute to pathophysiology. Accurate diagnosis depends on prospective symptom tracking over at least two menstrual cycles to confirm symptom cyclicity, severity, and functional impact.
Treatment must be multidisciplinary and individualized. SSRIs are the first-line pharmacological treatment, acting rapidly and effectively even when dosed intermittently in the luteal phase or symptom-onset, mitigating side effects associated with continuous dosing. Hormonal treatments, particularly COCPs containing drospirenone, show efficacy, though hormonal sensitivity varies and progestogen intolerance complicates therapy. Emerging therapies targeting allopregnanolone modulation and 5-alpha reductase inhibitors are under investigation but require further evidence. GnRH analogues and surgical oophorectomy remain options for severe refractory cases but carry significant risks, including bone density loss. Non-pharmacological approaches, including cognitive behavioral therapy (CBT), dietary modifications, and supplements (calcium, magnesium, vitamin B6), provide complementary benefits.
What are the greatest implications of this review?
This review bridges the knowledge gap between evolving scientific insights into PMDD’s neuroendocrine mechanisms and practical clinical management strategies. It advocates for a precision medicine approach tailored to individual hormonal sensitivities and symptom profiles. By synthesizing current evidence, it empowers clinicians to improve diagnostic accuracy through prospective symptom monitoring, recognize the disorder’s profound impact on mental health, and adopt evidence-based treatments, minimizing side effects. The emphasis on rapid SSRI efficacy and flexible dosing regimens offers clinicians practical tools to enhance adherence and patient quality of life. Moreover, highlighting the multidisciplinary nature of optimal care and emerging pharmacotherapies signals future directions for research and therapeutic innovation.