Talk:Premenstrual dysphoric disorder/Archive 1

Deletion of past talk page
Earlier, the PMDD article was subjected to repeated vandalism, in the form of unsupported claims to the effect that there was "controversy" about whether PMDD existed. The controversy was given as pretext for misogynistic innuendo smearing PMDD as merely a socially constructed malady hyped by manipulative women to excuse periodic bitchy outbursts.

Refutation of the non-existent controversy included a Swedish P.E.T. study showing objectively that mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria. Since the past vandalism was persistent and recurring, this citation should not be lost.

The PubMed citation for the P.E.T. study is http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16515859&dopt=Abstract and the full article is as follows:

Psychiatry Res. 2006 Mar 31;146(2):107-16. Epub 2006 Mar 2.

Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria.

Eriksson O, Wall A, Marteinsdottir I, Agren H, Hartvig P, Blomqvist G, Långström B, Naessén T.

Department of Women's and Children's Health/Obstetrics and Gynecology, University Hospital, SE-751 85 Uppsala, Sweden. olle.eriksson@kbh.uu.se

The cardinal mood symptoms of premenstrual dysphoria can be effectively treated by serotonin-augmenting drugs. The aim of the study was to test the serotonin hypothesis of this disorder, i.e. of an association between premenstrual decline in brain serotonin function and concomitant worsening of self-rated cardinal mood symptoms. Positron emission tomography was used to assess changes in brain trapping of 11C-labeled 5-hydroxytryptophan, the immediate precursor of serotonin, in the follicular and premenstrual phases of the menstrual cycle in eight women with premenstrual dysphoria. Changes in mood and physical symptoms were assessed from daily visual analog scale ratings. Worsening of cardinal mood symptoms showed significant inverse associations with changes in brain serotonin precursor trapping; for the symptom "irritable", r(s)=-0.83, and for "depressed mood" r(s)=-0.81. Positive mood variables showed positive associations, whereas physical symptoms generally displayed weak or no associations. The data indicate strong inverse associations between worsening of cardinal symptoms of premenstrual dysphoria and brain serotonin precursor (11C-labeled 5-hydroxytryptophan) trapping. The results may in part support a role for serotonin in premenstrual dysphoria and may provide a clue to the effectiveness of serotonin-augmenting drugs in this disorder but should, due to small sample size and methodological shortcomings, be considered preliminary.

[PubMed - indexed for MEDLINE]


 * That there is an objective correlation doesn't resolve the controversy. Correlation doesn't mean causation, and so to say that mood and serotonin is correlated is to say that the two move together, only, AND that we should not claim that one CAUSES the other. I can't access the article in full to learn more about their methods, but it's generally safe to assume that proper double blinds were followed and yet the abstract itself states:
 * "Positive mood variables showed positive associations, whereas physical symptoms generally displayed weak or no associations."  AND "...due to small sample size and methodological shortcomings, be considered preliminary."  Let's not call this more than it is.  Especially when there is interviewing or self-report involved for mood symptoms.  It's a good start and quite typical in this sort of research, but that the physical symptom are not even weakly related gives me reason to say this is not strong evidence.Briholt (talk) 18:12, 1 April 2009 (UTC)

History section?
When I first heard of PMDD, it was in the context of the original Prozac patent ending. The owner of the patent to Prozac created a new trade name for the fluoxetine and basically said that this 'new' drug is useful for PMDD.

In other words, the pharmaceutical company created PMDD to justify having a new patent on fluoxetine, as a way to extend the life of their patent. I don't remember seeing PMDD in the DSM, but it may be there. When PMDD came out it seemed controversial, not because it was a social construct hyped by manipulative women" but a social construct hyped by the pharma industry to extend a patent. I don't claim to be an expert here, so having someone point to the original research would be helpful.Briholt (talk) 00:27, 30 December 2008 (UTC)
 * here is an opinion/review article that backs up my claim above: From the article:

[...]According to the Wall Street Journal [July 2000], however, industry analysts do not expect Sarafem to have a significant impact on Prozac sales. If Sarafem were prescribed only for those 3%-5% of women who qualify for the diagnosis of PMDD, this might be the case. At present, Prozac is so widely prescribed, for even minor cases of depression, that in 1990, just three years after the drug came onto the market, the New York Times (December 3, 1993) referred to the rise of a "legal drug culture". Just as the anti-anxiety drug Valium (diazepam) attained wide popularity in the 1960s and 1970s, in 1994 Newsweek wrote that ‘Prozac has attained the familiarity of Kleenex and the social status of spring water" (February 7). Against this background, the substantial number of women who experience minor symptoms of PMS, even if they do not suffer from full-blown PMDD, promises to greatly enlarge market for a drug that is already the #2 best-selling drug in the world (#1 is the ulcer drug Zantac).

In addition, the patent protections on Prozac, which began in 1987 are about to run out. Marketing essentially the same drug (fluoxetine hydrochloride) under a new trade name effectively extends patent protections for another 14 years.[...] (emphasis mine) --Briholt (talk) 05:09, 30 December 2008 (UTC)

signed by SineBot-->
 * Lady, this is an argument about an article about a so-called mental illness. Lots of women get acne etc. depending on their hormonal fluctuations. And it takes me (a man) a lot more than Tylenol III to get rid of a sore throat. And I've been thinking for a while that the pain of (uncomplicated) childbirth is exaggerated. I've seen dogs give birth, and they don't seem to get much pain, so why should humans? 118.209.221.57 (talk) 17:27, 16 June 2013 (UTC)

I think The Veronicas have been promoting the awareness of this? ... sad ...
The Veronicas have been promoting the awareness of this?

It is sad to think that with such medical advances that the subject of Pmdd is so controversial. If this was a disease of all people the treatment would be sought and that would be the end of discussion. Just like depression, something the coincides with pmdd for years has been marked as "all in someone's head". Granted there should not be a pat answer of pushing medication, but in the same token there should be an answer not just a criticism. —Preceding unsigned comment added by 72.19.34.193 (talk) 03:42, 7 September 2007 (UTC)
 * There is a difference between saying PMDD does not exist and the symptoms are all in your head. --69.146.108.94 (talk) 22:17, 6 May 2010 (UTC)

How do you get a treatment ... without applying a psychiatric label?
Menses and perimenopause are part of a healthy life, yet cause some women unpleasant or disabling symptoms. Under the U.S. medical model it seems there is no treatment without a diagnosis of pathology. The model isn't well-adapted to the situation where a treatment can reduce the hardship some women experience in normal or perimenopausal menstrual cycles.

Treatment with SSRIs is effective, but does have side effects, which ideally would be weighed by a woman against her symptoms, perhaps aided by her doctor, to allow her to decide based on her own balance. Since menses and perimenopause are both normal, she shouldn't have to first be declared to suffer from a psychiatric disorder. Normal menses makes many demands on the body, but that hardly makes it a pathology -- like menses-related iron-depletion anemia, the sufferer and the symptoms deserve respect -- and the sufferer deserves to have the symptoms treated without being labeled as diseased. Anyone who can think of suggestions about how to get relief from PMDD for those women who need it, without applying a psychiatric label, please add them below. Please feel free to think outside the box. 67.101.68.116 14:01, 16 September 2007 (UTC)ocdcntx


 * Make one or more SSRIs available over the counter?


 * Some clinicians prescribe generic Prozac, in a substantial quantity. This empowers the PMDD sufferer to take whenever may seem indicated for symptoms, much as she might use aspirin, ibuprofen, coffee, tampons, etc. for other unwanted symptoms encountered around the time of menses.  This achieves a maximum of empowerment of the sufferer while allowing minimum oversight by the woman's chosen health professional of any side effects that might appear from the use of SSRIs.

There is a non-psychiatric treatment option
I suffer from this condition and am being treated by a Reproductive Endocrinologist by being put into chemical menopause via Lupron, and then having a small amount of Estrogen add back therapy. It has completely eliminated all of my symptoms. However, I cannot tolerate progestins/progesterone and have to have endometrial biopsies often because inducing a period causes symptoms to start again so I only do it once a year. --Ieatbugs (talk) 01:31, 10 November 2008 (UTC)

I know well a case of PMDD that was diminished by using the mesigyna monthly contraceptive, using pill, diu or using nothing at all was the worst scenario. May someone add some references to that ? i think mesigyna is the ultimate solution to PMDD. By the way mesigyna must be injected SLOWLY —Preceding unsigned comment added by 189.231.90.147 (talk) 16:21, 7 October 2009 (UTC)


 * On its face, above appears a commercial advertisement. —Preceding unsigned comment added by 66.167.61.214 (talk) 18:05, 18 April 2010 (UTC)


 * COMMENT: I agree with the possibility of the above being an ad (not leatbugs' comment, but the unsigned and unindented one just below it).  I have PMDD and I've been on many different hormonal birth control pills for most of my reproductive life (mesigyna is a shot but the hormones still mimic progestin and estrogen) and none of them helped with my symptoms (and not to complain or present biased information, but the newer pills that contains drospirenone have caused me and thousands of other women significant health problems but these pills are being advertised as PMDD treatments..perhaps mentioning these pills and then the lawsuits against Bayer would be a good addition to the page.. there is a Yasmin Survivor's Forum if that tells you anything..), and I have yet to hear or read a testimonial about any of them actually working for the treatment of PMDD (and the first website I point out below backs me up by listing it as one of the least effective treatments for PMDD).


 * I have also been on all SSRIs (except for those released since 2011) and many other antidepressants after being misdiagnosed with MDD for over 10 years. It was PMDD the entire time.  I was put on a mood stabilizer called Geodon for about 4 years for "treatment-resistant depression," and those 4 years were some of the most productive of my life since graduating high school, but there is little to no research on the use of these for PMDD. It also stopped working quite abruptly at the end of the 4 years, but that could be from the drospirenone OCP I talked about above or possibly an autoimmune disorder.  We are still not sure what happened.  I have been off AD's for just over a year now.  Coming out of the 13-year drug fog and numbness (I can't watch scary movies anymore!) has been bittersweet.  I don't want any more people to go through what I have.  The side effects of these mind-altering drugs are so debilitating.


 * What I have found is that not having a period means no PMDD symptoms, but this has nothing to do with anovulation. Birth control pills stop ovulation but I still had PMDD while on them as long as menstruation was present.  (And after reading leatbugs' comment, I am looking into Lupron.) Also the pattern of my PMDD episodes did not always coincide with the luteal phase and/or the follicular phase which is one reason why it took me so long to get diagnosed.  There is wording on the wiki PMDD page that makes it sound like the symptoms HAVE to occur during the luteal phase and end after menstruation begins, but this is not always the case and I have read accounts of other women experiencing the same.  I think this should be edited.  ("Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins.[6]")


 * I have a few links to sites that provide good information and even forms people can fill out to track their symptoms, but I am new to editing wikipedia so I thought I would just put it here for someone else to use.


 * Not sure how to add these links properly... http://www.aafp.org/afp/2002/1001/p1239.html ...This site has great info, including a DSM reference. It also has several tables of treatment information that I have run across sporadically on other sites, but never together on one site like this one.  There is even an algorithm/flow chart of which treatments to use first and what to do next if they fail.  The flowchart does not include the final and most controversial treatment, which is a bilateral oophorectomy, or surgically removing the ovaries, but it is mentioned in the table above the chart.


 * With each treatment, I think the side effects should really be emphasized (they are downplayed at the above website as they are at most medical sites) because the suggested GnRH agonists are used by those undergoing gender reassignment and essentially hormonally and even physically turn women into men. I am talking facial hair, deepening voice, etc. and of course menopause.


 * Another link: http://www.livingwithpmdd.com is another great site, but this is more of a personal standpoint/advice from a woman who lived with it her entire life and is now going through menopause. I know blogs, etc. are not allowed but there is just so much info here that is relevant to PMDD.  I'm sure there are legit sources for what she says (other than the strictly personal things).  She has blog posts just for the significant others of PMDD sufferers and gives great tips on what to do and what not to do during an episode.  She has one blog post about how women through history have been deemed insane when it could very well have been PMDD (really, any outspoken woman back then was deemed insane and locked up or killed) but it is still happening to this day because PMDD is not well-known.


 * She also gives nutrition advice and explains the serotonin/carbohydrate/exercise cycle, which basically says that PMDD causes low serotonin levels and carbs are a great way to raise these levels, but carbs cause weight gain, so exercise is indicated, but exercise burns off carbs which causes low serotonin levels, so you should eat carbs to raise those levels, but carbs cause weight gain, etc. etc. She also lists exactly what hormones cause weight gain and why eating less and burning more doesn't always work (which is another wiki page that should be created.. almost the entire industry of nutrition and bariatrics is based on this equation).


 * Also, suicidal ideation is probably one of the worst symptoms of PMDD and I don't think it is talked about enough. When you are in the throes of a PMDD episode, you can cycle thoughts in your mind that at the time make you feel like your only option is suicide, and a lot of that has to do with the fact that you have this THING that takes over your mind and body for a several days a month but nothing is helping you and no doctor or person fully understands what is going on.  You really feel insane for those few days and so alone because everyone thinks it is in your head.  It's not like clinical depression, because millions of people have clinical depression.


 * Which leads me to the most recent addition to my bookmarks, http://www.experienceproject.com. If you go to the "I have PMDD" experience, you will read stories about how people feel and what they experience during their PMDD episodes.  There are also spousal accounts of what happens and how they feel.  This is the site that ultimately pointed me to PMDD and made me realize that this was what I had been dealing with since the months before menarche.  I was reading a page out of my own life when I read these stories.  PMDD has restricted my life severely.  Before I had PMDD I wanted to become a doctor and had the brains and creativity to do just about anything I wanted really, but after I turned 11, I realized that my mood problems would not allow that.  So I tried to fit things around the PMDD, which at the time we all thought was simply depression.  I have not achieved my true potential and because the info on PMDD is so limited, I may not ever.  I hope someone uses the information I have provided here. Angziety (talk) 16:07, 28 December 2011 (UTC)

The cardinal symptom is -- tiredness
A survey of women found that overwhelmingly, tiredness was the most distressing symptom of PMDD for them. Not anger, though an aside from an abstract of a study that did not actually study the issue of what women found most distressing is given by the article as a demonstration that anger is the "cardinal symptom". Maybe it is for those for whom anger may be inconvenient -- perhaps even for some PMDD sufferers. But shouldn't the view of the majority of women surveyed on the exact subject -- that tiredness is the most important of the constellation of symptoms -- be given some weight? It was taken down, with cite, when I posted it here some time back.

Vitamin B and Magnesium
" Yet, many patients report a significant decrease of symptoms, to their almost complete disappearence, by following a simple therapy with magnesium orotate, B vitamins and folic acid. (source needed)"


 * This needs to be removed, there is no source for this because this information is incorrect. —Preceding unsigned comment added by 68.84.140.25 (talk) 16:49, 16 August 2009 (UTC)


 * Magnesium "orotate" is a proprietary blend of mostly the cheapest (and worst kind) magnesium oxide, the kind most likely to cause diarrhea, mixed with small amounts of a couple of better forms. So this amounts to ad copy. However, calcium, or magnesium aspartate or citrate, may actually help and such info, with citation to pubmed, would be welcome. Ocdnctx (talk) 22:42, 27 December 2013 (UTC)

Mayo Clinic places incidence of PMDD as up to 10% of menstruating women, distinguishes from PMS by severity
From: http://www.mayoclinic.com/health/pmdd/AN01372

Question:

":What is premenstrual dysphoric disorder (PMDD)? How is it treated?


 * Answer
 * from Sandhya Pruthi, M.D.


 * About 75 percent of menstruating women experience mild to moderate premenstrual symptoms. But up to 10 percent of menstruating women have premenstrual dysphoric disorder (PMDD) — a severe, sometimes disabling form of premenstrual syndrome (PMS).


 * Premenstrual dysphoric disorder is distinguished from PMS by the severity of its symptoms and its impact on relationships and daily activities. Symptoms of PMDD — which occur in the last week of the menstrual cycle and usually improve within a few days after menstruation begins — include:" —Preceding unsigned comment added by 66.167.61.214 (talk) 18:31, 18 April 2010 (UTC)

What about the fact that many intersex people have symptoms of this as well because of how their bodies are put together? I don't appreciate only reading about women- when females are NOT the only people with periods.

Yeah, you may have a problem with that, but get over it. This is the real world, and we DO EXIST. —Preceding unsigned comment added by 71.244.139.7 (talk) 20:55, 10 July 2010 (UTC)

Article gives misinformation regarding "cardinal symptom"
Diagnosis of PMDD is made by the presence of a minimum of 5 out of a list of several symptoms authoritatively set forth in the DSM. Irritability can be one of the five, but the presence of irritability alone is insufficient for diagnosis. Irritability is thus not a "cardinal" symptom.


 * From Symptom - Wikipedia, the free encyclopedia,
 * The symptom that ultimately leads to a diagnosis is called a "cardinal symptom". http://en.wikipedia.org/wiki/Cardinal_symptom#Types

By stating that irritability is "the" symptom that "ultimately leads to a diagnosis" our PMDD article current erroneously attributes to irritability a diagnostic primacy and definitiveness that it lacks.

The PMID synopsis footnoted and relied on for the "cardinal" symptom language may be out of date or may simply be off-base -- the article itself is about the benefits of SSRIs for treatment, and does not purport to be a study of, or to focus on, diagnosis.

At the risk of stating the obvious, the hallmark of PMS/PMDD symptoms is that they are cyclic. This common sense observation is also authoritative. Would non-cyclic irritability be taken as diagnostic of PMDD? No. Would cyclic occurrence of five other DSM factors, but not irritability, lead to a diagnosis of PMDD? The DSM says so, and its authority is buttressed by common sense.

The singling out of irritability as the "cardinal" symptom is not only contrary to the PMDD but also to the experience of women polled in a separate study, who stated that fatigue, not irritability, was the most disturbing feature for the women themselves.

The current article needs to be changed to conform to the DSM, by the removal of the false irritability = cardinal symptom statement. —Preceding unsigned comment added by 68.165.11.243 (talk) 20:29, 6 September 2010 (UTC)


 * Have removed the false "cardinal symptom" statement, only to have it re-inserted by its author. Will the committee that looks at vandalism via false original research larded with original fabrication please see what can be done to upgrade the quality of the article.  — Preceding unsigned comment added by 66.167.61.61 (talk) 12:50, 2 August 2011 (UTC)

eMedicine on DSM-IV consensus / FDA Neuropharmacology Advisory Committee
Htay, Aung

Premenstrual Dysphoric Disorder

http://emedicine.medscape.com/article/293257-overview


 * In 1987, the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) included criteria for late luteal phase dysphoric disorder (LLPDD).3 In the DSM-IV, published by the American Psychiatric Association, the name was changed from LLPDD to PMDD, with criteria that were almost identical to those of LLPDD (only 1 item was added). The DSM-IV included PMDD as an example of a depressive disorder not otherwise specified. In October 1998, a panel of experts evaluated the evidence then available, and a consensus was reached that PMDD was a distinct clinical entity. Subsequently, in November 1999, the US Food and Drug Administration (FDA) Neuropharmacology Advisory Committee supported this concept. ...

—Preceding unsigned comment added by 68.165.11.243 (talk) 00:17, 7 September 2010 (UTC)

DSM-IV; 11 criteria -- 5 needed for diagnosis, must be cyclical
The American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000:717-8

A. In most menstrual cycles during the past year, at least 5 of the following symptoms were present for most of the time during the last week of the luteal phase, began to remit within a few days after the onset of the follicular phase, and were absent in the week postmenses, with at least 1 of the symptoms being either (1), (2), (3), or (4):

1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

2. Marked anxiety, tension, feelings of being "keyed up" or "on edge"

3. Marked affective lability (eg, feeling suddenly sad or tearful or increased sensitivity to rejection)

4. Persistent and marked anger or irritability or increased interpersonal conflicts

5. Decreased interest in usual activities (eg, work, school, friends, hobbies)

6. Subjective sense of difficulty in concentrating

7. Lethargy, easy fatigability, or marked lack of energy

8. Marked change in appetite, overeating, or specific food cravings

9. Hypersomnia or insomnia

10. A subjective sense of being overwhelmed or out of control

11. Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain


 * The DSM criteria should be clearly stated in the article. Mind you, I'm a dude, and I get 5 or more of these 11 pretty regularly. If I had a "luteal phase" I guess I'd be eligible for a diagnosis of PMS psychiatric disorder ... 118.209.221.57 (talk) 17:31, 16 June 2013 (UTC)

Incorrect original research should be removed
This article has contained the false (and mildly misogynistic) assertion "The cardinal symptom—always surfacing between ovulation and menstruation, and always disappearing within a few days after the onset of the bleeding—is irritability.[6]"

The assertions that

1. there is a "cardinal" symptom; and

2. that it is irritability

both contradict the DSM.

The assertions

that irritability "always" occurs, and

that it "always" goes away

are also false original research.

Irritability is only one of the first four symptoms listed in the DSM, only one of which must be present to make the diagnosis. PMDD can, and commonly is, diagnosed without irritability.

Under the DSM, there is no "cardinal" symptom. Irritability is only one the first four symptoms listed by the DSM, only one of which need be present when accompanied by sufficient additional factors as listed. Hence PMDD is not dependent upon irritability for diagnosis. The DSM refutes the notion that any one of the four is "cardinal" or is "always" present.

See the DSM (quoted in the discussion section above) for accurate diagnosis information. It is a larger failure that this article fails to better conform to the DSM overall.

Note the authors of the study cited for for the "cardinal" quote were studying SSRI treatment not diagnosis. In this SSRI treatment study, the authors' comment on "cardinal" was an offhanded introduction to the PMDD syndrome as the entity whose treatment was reported. Their research report addresses issues of treatment with SSRIs, and does not purport to be authoritative on diagnosis.

Note to make a bad article worse, the WP writer added the word "always"  -- twice --  without any justification from the cited treatment study, which does not include it. Our WP article thus misquotes even the original SSRI treatment source for the article's doubtful diagnosis assertions. The word "always" twice was added as original research, as it does not exist in the treatment article cited, in addition to being directly contrary to the DSM.

The authors of the the SSRI treatment study mis-quoted in the diagnosis section made findings that are authoritative and valuable about the issue they did study -- treatment with SSRIs. These SSRI treatment comments may well find a place in the section on treatment with SSRIs, since the authors were in fact studying that issue. Their comments, as opposed to their findings, are of little authority regarding diagnosis -- rather clearly less than the DSM's. Its contradiction of the DSM should not lead our article's diagnosis section, as it now does. Instead, the DSM, which was produced by authors who did very thoroughly study accurate diagnosis, is authoritative, and the approach of the DSM should be much more clearly set forth in this article.

The SSRI treatment study mis-quoted in the diagnosis section is reproduced below:

Lakartidningen. 2001 Aug 22;98(34):3524-30. [Serotonin uptake inhibitors provide rapid relief from premenstrual dysphoria. New findings shed light on how serotonin modulates sex hormone-related behavior].

[Article in Swedish]

Eriksson E, Andersch B, Ho HP, Landén M, Sundblad C.

Avdelningen för farmakologi, institutionen för fysiologi och farmakologi, Göteborgs Universitet. Abstract

Premenstrual dysphoria (PMD) is a severe form of premenstrual syndrome, afflicting 5-10% of all women. The cardinal symptom--surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding--is irritability. Serotonin reuptake inhibitors (SRIs), but not non-serotonergic antidepressants, reduce the symptoms of PMD very effectively. Since the, onset of action of SRIs is rapid when used for PMD, medication may be restricted to the luteal phase. The finding that SRIs are effective for PMD lends support for the hypothesis that a major role for brain serotonin is to modulate sex steroid-driven behavior.

[PubMed - indexed for MEDLINE]

— Preceding unsigned comment added by Ocdnctx (talk • contribs) 01:49, 8 April 2011


 * It might be mistaken, but how is it misogynistic ("hating women")? 118.209.221.57 (talk) 17:33, 16 June 2013 (UTC)

Redundant sentence moved here from Symptoms section, where it less elegantly or accurately, but otherwise redundantly, said again what was better said in 3rd sentence.
Symptoms occur during the 2 weeks before the menstrual cycle and disappear within a few days after the onset of menses. — Preceding unsigned comment added by 66.167.61.61 (talk) 20:08, 10 August 2011 (UTC)

== The needed citations showing selective serotonin reuptake inhibitors (SSRIs) are effective have been provided, then erroneously redacted, and should be available in the history of the article. Prozac was one, Effexor was probably another of 3 or so ==

Supplies citation pointed to be needed below.


 * Supporting the hypothesized important role of serotonin, a number of selective serotonin reuptake inhibitors (SSRIs) have been shown[citation needed] in clinical trials to effectively treat the mood component of PMDD when taken during the dysphoric phase. — Preceding unsigned comment added by 99.190.133.143 (talk) 04:54, 5 February 2012 (UTC)


 * Fixed with reference to
 * ref name=Steiner Steiner, Pearlstein, et al. "Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs." J Womens Health (Larchmt). 2006 Jan-Feb;15(1):57-69

and to the Treatment section below, which already cited various studies.

— Preceding unsigned comment added by 99.190.133.143 (talk) 05:04, 5 February 2012 (UTC)

2009 Harv. Rev. Psych. Update on research and treatment of premenstrual dysphoric disorder.
Harv Rev Psychiatry. 2009;17(2):120-37. Update on research and treatment of premenstrual dysphoric disorder. Cunningham J, Yonkers KA, O'Brien S, Eriksson E.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19373620/?tool=pubmed — Preceding unsigned comment added by 99.190.133.143 (talk) 23:39, 11 February 2012 (UTC)

DSM-5 - recognition and criteria for diagnosis with link
Premenstrual dysphoric disorder (PMDD) consists of symptoms are similar to, but more severe than, PMS, and while primarily mood-related, may include physical symptoms such as bloating. PMDD is classified as a repeating transitory cyclic disorder with similarities to unipolar depression, and several antidepressants are approved as therapy.

If the constellation of symptoms PMS-like symptoms are sufficiently severe and closely tied to monthly cycle, the proposed DSM-5 handbook of the American Psychiatric Association includes a diagnosis of Premenstrual Dysphoric Disorder as a transient cyclical depressive disorder.


 * D 04 Premenstrual Dysphoric Disorder

http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=484

Cause / etiology / complementary treatments
From:

SUBHASH C. BHATIA, M.D., and SHASHI K. BHATIA, M.D.

Diagnosis and Treatment of Premenstrual Dysphoric Disorder

Am Fam Physician. 2002 Oct 1;66(7):1239-1249.

http://www.aafp.org/afp/2002/1001/p1239.html


 * "... Other studies also favor the serotonin theory as a cause of PMDD. In particular, the efficacy of l-tryptophan,15 a precursor of serotonin, and of pyridoxine,16 which serves as a cofactor in the conversion of tryptophan into serotonin, also favors serotonin deficiency as a cause of PMDD. Carbohydrate craving, often a symptom of PMDD, is also mediated through serotonin deficiency.


 * 15. Steinberg S, Annable  L, Young  SN, Liyanage  N.  A placebo-controlled clinical trial of l-tryptophan in pre-menstrual dysphoria.  Biol Psychiatry.  1999;45:313–20.
 * 16. Wyatt KM, Dimmock  PW, Jones  PW, Shaughn O’Brien  PM.  Efficacy of vitamin B-6 in the treatment of premenstrual syndrome.  BMJ.  1999;318:1375–81.
 * 16. Wyatt KM, Dimmock  PW, Jones  PW, Shaughn O’Brien  PM.  Efficacy of vitamin B-6 in the treatment of premenstrual syndrome.  BMJ.  1999;318:1375–81.

PMDD is further distinguished from major depressive disorder by fact that SSRIs work fast in PMDD, but take weeks in MDD
PMDD is further distinguished from major depressive disorder (MDD) by fact that SSRIs work quickly in PMDD, but take weeks to be effective in MDD. A possible reason is that hippocampus is generally shrunken in MDD and takes time to regrow (after which mood is generally restored) whereas in PMDD the hippocampus is intact and the problem is simply an acute lack of serotonin, so that mood can be restored rather quickly after serotonin is restored by taking SSRIs.

Cognitive-behavioral group treatment for menopausal symptoms: a pilot study.
Green SM, Haber E, McCabe RE, Soares CN.

Cognitive-behavioral group treatment for menopausal symptoms: a pilot study.

Arch Womens Ment Health. 2013 Aug;16(4):325-32. doi: 10.1007/s00737-013-0339-x. Epub 2013 Apr 21.

A pilot study of cognitive-behavioral group treatment (CBGT) program as an alternative or complementary treatment


 * ... confirmed a reduction in the frequency and interference associated with vasomotor symptoms, less depression and general anxiety, and an overall improvement in quality of life. Participants also reported high levels of satisfaction with this type of treatment for menopausal symptoms. Furthermore, there was a trend towards a reduction in sleep difficulties and sexual concerns ....

POV content
I just reverted the edits by Dlschutte and Floralformulas that seemed to question the validity of PMDD as a medical condition. Of course it's fine to have a debate, but the text these editor(s) added was obviously written with a very strong bias, as evidenced by phrases like "drug companies colluding with advertisers". "Colluding" incorporates an obvious value judgement that does not seem appropriate here. More generally, the text seemed to represent the minority view and was thus given undue weight in the article. Ckerr (talk) 08:05, 10 April 2014 (UTC)

Proposed changes to intro, cause and treatment sections
See bold and italicized edits in my sandbox.


 * The percentage used in the intro was outdated, showing a much higher percentage than the 2014 data.
 * It might be useful to include symptoms in the beginning.
 * I think it was important to include the fact that PMDD is considered a depressive disorder, and makes it easier to connect the dots to the similar treatments used for MDD and the mood symptoms.
 * I also think it's important to include that treatment does not have to be constant.

Ltroncoso (talk) 02:30, 15 April 2014 (UTC)

Negative mood symptoms in women with PMDD caused by paradoxical effect of allopregnanolone?
Allopregnanolone is a neurosteroid.


 * "These findings suggest that negative mood symptoms in women with PMDD are caused by the paradoxical effect of allopregnanolone mediated via the GABA-A receptor."

Bäckström, Bixo, Johansson, Nyberg, Ossewaarde, Ragagnin, Savic, Strömberg, Timby, van Broekhoven, van Wingen

Allopregnanolone and mood disorders.

Prog Neurobiol. 2014 Feb; 113:88-94; Epub 2013 Aug 23

doi: 10.1016/j.pneurobio.2013.07.005

http://www.ncbi.nlm.nih.gov/pubmed/23978486

Peer review for Yiciz89
Hi Yiciz89! Fantastic edits. I’ll go through your goals and each subheading one by one, then share any other comments I have.

Organization within Subheadings:

·     I clearly saw that your target audience was the nonmedical public, and you added links to other Wiki pages for those wanting further information.

·     I don’t think there were sections that stood out as being particularly disorganized.

Citations:

·     I very rarely saw a sentence that called for more robust citation. Those that did, I tried to note within each section.

Lead Section:

·     Maybe italicize the spelled-out DSM-V name, and then put the abbreviation DSM-V in parentheses after it. I’d also suggest this for the “Diagnosis” section.

·     I actually really like the one sentence on unclear pathogenesis, and the sentence on treatment being available with SSRIs.

Symptoms:

·     “The symptoms should ceases shortly…” (subject-verb agreement)

·     “Mood symptoms being dominant” (suggest make this plural)

·     I don’t know in general about using long quotes in Wiki articles rather than paraphrasing. Maybe if you leave them in, add a phrase “Per the DSM-V…” rather than just citing via a footnote.

·     There is an extra space between the quotation mark and “abdominal bloating”

Causes:

·     Language is very readable! Good job with short sentence size.

·     “a hormonal fluctuations” (fix subject-verb agreement)

·     Second sentence could use a citation.

·     “predominantly estrogen and progesterone…that cause the premenstrual symptoms” – this sentence seem a bit long/run-on. Suggested edit: “predominantly estrogen and progesterone. These hormones are thought to produce biochemical events…”

·     Last sentence - what kind of predisposition? Genetic?

Diagnosis:

·     I like the fact that the criteria/symptoms are all listed in numbered form – easy to read.

·     “Marked lability, irritability, depressed mood, anxiety, and tension” – missing the close parenthesis

·     Some people would probably prefer you to re-cite the DSM-V for every sentence in the paragraph, but I think it’s fine as is.

·     I actually like the fact that the multiple international groups with diagnostic criteria were kept in. I know that’s something you were debating about, and I think incorporating other guidelines is something that makes Wiki unique as a medical info source.

Pharmacologic Treatment:

·     Again, fantastic job keeping language simple and sentences short!

·     “experience symptoms relief” à “experience symptomatic relief”

·     “drospirenon” – misspelled, should be drospirenone

Nonpharmacologic Treatment:

·     First two sentences seem opinionated, and would benefit from citation.

·     “poor quality” – make sure the source really says they are poor, rather than just having insufficient evidence

Psychotherapy:

·     If you have time, maybe try to find a citation for the first two sentences.

Epidemiology:

·     Very clear – nothing to add!

Adding additional sub-sections?

·     If anything, I might suggest a section on “course,” e.g. describing the typical natural history, duration of the syndrome without treatment. This could be within “symptoms.”

·     I saw on the talk page there were some users mentioning public knowledge of the disorder, public figures trying to raise awareness, etc. Perhaps a future goal could be an “in popular culture” section.

Other:

In general, this article is incredibly readable for a lay person audience! Fantastic job with the language. You also added a ton of great new points which were well-cited and flowed well with the existing article. Overall, wonderful job!

--Mschwarz6 (talk) 16:41, 16 November 2015 (UTC)

Changing “women” to “AFAB people.”
As the Wiki guidelines state: Be plain, direct, unambiguous, and specific. Avoid platitudes and generalities.

I was doing just this in editing “women” with “people.” I am a person with PMDD. I am not a woman. The use of the term “women” to describe a medical diagnosis caused by specific organs of the human body is wholly inaccurate & a sweeping generalization. In altering the term “women” for either “AFAB people” or just “people,” a much more accurate, non-exclusatory description is made. I don’t appreciate the reverting of these edits. Reading on a disorder I have is alienating when it completely ignores the fact that I exist. Please allow me to have this more concise, specific edit. Isajolie (talk) 06:27, 7 May 2018 (UTC)
 * This edit has already been made and undone at least once by other editors. It needs to be discussed so that editors can reach a consensus as to whether it should be included. And if it is included we cannot use the term "AFAB" without an explanation of what it means (assigned female at birth).
 * I'm open to suggestions for improvements, but "menstruating women" is the term used in the cited source, and I think it is clear. I don't see a need to rewrite this to include people who have ovaries and menstruate but don't label themselves as women. Meters (talk) 06:43, 7 May 2018 (UTC)
 * Just because you personally do not see a need doesn’t mean there isn’t one. Isajolie (talk) 20:35, 7 May 2018 (UTC)
 * Neither of our opinions decides what goes in the article. That's why we're discussing it on the talk page, so we can reach a consensus with other interested editors. Meters (talk) 22:06, 7 May 2018 (UTC)
 * "Woman" should be read to refer to sex, not gender. Gender is an identity that can be changed, while sex simply refers to what sex organs someone has. Someone without female sex organs cannot menstruate - that's all it is saying. Saying people who were born female is just unnecessarily wordy. ‡ Єl Cid of ᐺalencia  ᐐT₳LKᐬ  05:01, 10 May 2018 (UTC)

Working on this page for a project
Hi everyone! I'm a Biology student taking an Endocrinology course this semester, and I chose this page to work on for my semester-long project. Come next Monday (4/29), I will be adding in the majority, if not all, of the changes or additions that I've been working on these past few months. A little while ago I went through and added in a few links to relevant Wiki pages (SNRIs and the handful of listed drug treatments), but that was the most I have done to the live page as of right now. Just so y'all know exactly where to look (and thereby where to critique) on Monday, this is what I've been working on:


 * Beefing up the introductory paragraph with a couple more sources.
 * Overall fixing syntax, grammar, and punctuation issues.
 * Making some of the language a little more gender neutral, per the above talk topic. I'm not going in and changing everything to be completely gender neutral, but I am changing some of the "woman" or "women" mentions to "individuals" or "people" solely in the sentences where gender does not necessarily matter in terms of what is being discussed about the disorder. I'm leaving all of the "female" or "women" mentions in the places where it is necessary to maintain the fact that PMDD is stigmatized primarily in and around cisgender women.
 * I have been trying my best to get rid of the most repetitive sentences, and also looking back at some of the sources so that I could get rid of the quoted material in the Signs and Symptoms section. I will also be beefing up that section to the best of my ability.
 * Adding citations where necessary (primarily the Diagnosis section was the most glaring).
 * Adding in a definition for "clinically significant distress" to the Diagnosis section.
 * Adding some more actual information to the Relationship to Pregnancy section, using the sources that are already linked.

I also have an important question: should the History section be moved so that it is the first section past the introduction, or should it stay where it is?

Thanks all! Let me know if y'all have any critiques or questions before I go in and make the big changes!

Alabrutto (talk) 01:33, 24 April 2019 (UTC)

Added a proper list of symptoms
Hello

As the article's description of what the actual symptoms are was very vague and only mentioned a very few, I therefore took the liberty and added a proper list of symptoms. Okama-San (talk) 20:52, 25 October 2019 (UTC)

UCSF Medical Student Editing
Our workplan: https://docs.google.com/document/d/1Upim5OFa_y9gLOy7gBoOyrs43ub17fXM_O_FRb3Cqo8/edit

Agomez053 (talk) 17:34, 30 August 2021 (UTC)

Inclusive language
The current style advice for Wikipedia's medical content is that we do not use "people with X" when the overwhelming majority of the people in question are specifically "women". I realize that there are people who do not identify as women but who deal with medical conditions that fall under what's been called "women's health" for decades. However, we are following the patterns in the high-quality sources, which still write about "women", and we are writing for the majority case, in which the people who menstruate are "women". As a point of comparison, it is possible for cisgender males to get breast cancer, and yet Breast cancer still mentions "women" nearly 150 times, and "people with breast cancer" only rarely (and usually in a context that specifically applies to everyone regardless of assigned gender at birth or biological sex). WhatamIdoing (talk) 18:48, 22 January 2021 (UTC)

I recently completed a review of this article and I think it would benefit from the inclusion of person-center language and/or some acknowledgment that this syndrome can affect people who do not identify as "women"Ntrevoa(talk) 18:18, 19 September 2021 (UTC)

Recognizing that in past studies of large populations, methods of gathering gender information are often not specified, it makes sense to state "women" when citing the specific data from those articles. Even though those populations were likely "cis-gender women" or "patients assigned female at birth", it is possible that this is not specified in the article. When talking about the complete population of patients who experience this disease, it is more accurate to say "people with PMDD", "patients with PMDD", or "those with PMDD". This language is already incorporated into much of the article, so replacing these more inclusive terms with "women with PMDD" does not add clarity to the article and instead makes the article less consistent throughout the body of the text. Agomez053 (talk) 17:35, 20 September 2021 (UTC)

Suicidality
The intro mentions suicidality, based on a 2013 paper, and gives specific estimates. The estimates should be moved from the intro into one of the sections. There is a more recent paper which is a systematic review and meta-analysis. This paper should be used for the estimates. Doing this now. --Isabela31 (talk) 17:44, 29 October 2021 (UTC)

Epidemiology

 * A majority of menstruating women have feelings of premenstrual symptoms to some degree, with 20-30% feeling enough symptoms to qualify for diagnosis of PMS and 3-8% of that group qualifying for the diagnosis of PMDD.[2][3] With only a small fraction feeling such intense distress linked to the onset of menstruation, any fear of social pathologizing of normal emotional and physical symptoms as a result of menstruation is unnecessary; PMDD is distinct, and having it included in the DSM-5 works to affirm that.[22]

The first sentence mixes up the numbers. The papers do not claim 30% PMS. The second sentence does not belong in this section. Dealing with this now. --Isabela31 (talk) 18:35, 29 October 2021 (UTC)

Wiki Education Foundation-supported course assignment
This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Yiciz89. Peer reviewers: Mschwarz6.

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Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 15 January 2019 and 29 April 2019. Further details are available on the course page. Student editor(s): Alabrutto.

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Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 30 August 2021 and 21 September 2021. Further details are available on the course page. Student editor(s): Stellapom1996, Olivialeventhal, Agomez053.

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Wiki Education Foundation-supported course assignment
This article is currently the subject of a Wiki Education Foundation-supported course assignment, between 10 January 2022 and 4 February 2022. Further details are available on the course page. Student editor(s): FriendlyNeighborhoodPsychiatrst.

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