From disabling mood changes to pain that prevents simple tasks, understanding the difference between common PMS and premenstrual dysphoric disorder (TDPM) is the first step to seeking help and recovering quality of life.
When the intensity escapes the control
Up to 80% of women report some symptom of premenstrual tension-mild irritability, swelling, breast sensitivity. However, in about 3% to 8%, the intensity exceeds the tolerable limit, receiving another name: TDPM (premenstrual dysphoric disorder). In this picture, deep sadness, crises of crying, anger or anxiety appear in the luteal phase (10 to 14 days before menstruation) and disappear shortly after the start of the flow. Many women report inability to work, family conflicts and even self -deprecating thoughts.
The diagnosis is clinical: it is necessary to record, for at least two cycles in a row, five or more symptoms, one of them being obligatorily emotional (depressed mood, irritability or striking anxiety). The intensity of symptoms should interfere with daily activities – a criterion that differentiates the usual PMS TDPM.
The importance of diagnosis and how to confirm
The doctor may request blood tests such as blood count, dose of thyroid hormones and vitamins such as iron to rule out anemia or hypothyroidism, conditions that aggravate premenstrual tiredness. Standardized questionnaires, such as the Daily Record of Severity of Problems, help to quantify symptoms. Understanding whether there are comorbidities, such as depression or anxiety disorder, is critical: in up to half the cases of TDPM, there is previous psychiatric history.
Treatment: Multiple fronts for symptom relief
• First line medication – Selective serotonin reuptake inhibitors (fluoxetine, sertraline) in continuous dose or only in the second half of the cycle reduce symptoms by up to 60%. Contraceptives combined with draospineone or estradiol can stabilize hormonal oscillation and relieve cramps.
• Food and lifestyle – Diet rich in magnesium, calcium and vitamin B6 (green leaves, oilseeds, whole grains) has a slight reduction in edema and emotional lability. Avoid caffeine, alcohol and excess salt in the 10 premenstrual days aids in swelling and irritability. Moderate aerobic exercises release endorphins, improve sleep, and diminish anxiety.
• Supplements with moderate evidence – Primula oil, vitamin D and omega-3 can be supporting; Professional prescription for dose adjustment is recommended.
• Psychological support – Cognitive behavioral therapy teaches coping strategies, restructuring negative thoughts, and improves affective relationships impaired by cyclic symptoms.
Resistant cases may require combination of approaches or, rarely, more aggressive hormonal intervention (GnRH analogs), always with gynecological and psychiatric accompaniment.
Seek help: suffering is not mandatory
Feeling exhausted, depressed or conflict with each cycle is not normal, nor is part of the “female nature.” The TDPM is a condition recognized by the World Health Organization, treatable and with direct impact on productivity, self -esteem and mental health. Note symptoms, talking openly with the gynecologist and seeking psychological support are decisive steps to transform the premenstrual phase into another period of well-being-not suffering.
Ana Horovitz (CRM 111739)
Gynecologist and member of Brazil Health
