The American College of Obstetricians and Gynecologists estimates that 85 percent of menstruating women show at least one symptom of premenstrual syndrome (PMS). According to the US Department of Health and Human Services, the most common symptoms include acne, swollen or tender breasts, headaches, muscle pain, and anxiety or depression. While the symptoms of PMS are generally common enough, in rare cases women also suffer from a more extreme form of PMS known as Premenstrual Dysphoric Disorder (PMDD).
The National Library of Medicine describes PMDD as a severe type of PMS that affects mental health in a way that mimics depression and anxiety. According to the National Association for Premenstrual Syndrome in the UK, PMDD is sometimes treated with ovulation suppressants and SSRIs. While PMDD is certainly real, much research hasn't been able to pinpoint the exact cause, leading some doctors to misdiagnose it as bipolar disorder or other mood disorders. New research, however, has linked PMDD to cellular changes. Advocates hope this new research will make it easier to properly diagnose PMDD.
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In studying the white blood cells of those with and without symptoms of PMDD, researchers at the National Institute of Health determined that cutting off estrogen and progesterone in women fully halted symptoms in those who have PMDD. After studying the behavior of these cells, researchers found "cellular evidence of abnormal signaling in cells derived from women with PMDD, and a plausible biological cause for their abnormal behavioral sensitivity to estrogen and progesterone," explained Peter Schmidt, one of the lead researchers of the study, in a press release.
Speaking to Broadly, head researcher of the study, Dr. David Goldman of the NIH's National Institute on Alcohol Abuse and Alcoholism, says he believes these new findings will help when diagnosing PMDD correctly and taking the disorder seriously. "MDD is now recognized as a DSM 5 diagnosis, having clear criteria that take it beyond ordinary differences in mood that most women experience during the course of the ovarian cycle," Goldman says.
PMDD was officially added as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. "But this new research, pointing to molecular causation, further helps put PMDD on the same footing as other medical diseases," says Goldman. In Goldman's experience, part of the reason why PMDD so far has been misdiagnosed as bipolar disorder or other mood disorders has mostly to do with how complex it is to identify the subtypes of any psychiatric illness. "To some extent, the challenge has probably been to ask the right questions," Goldman told Broadly.
Speaking to Dr. Nanette Santoro, professor and chair of the Department of Obstetrics and Gynecology at the University of Colorado, research like this is imperative in diagnosing PMDD. According to Santoro, finding a way to show women with PMDD react differently to hormones has been the "holy grail" of PMDD research. "There is abundant evidence that circulating hormones in women with PMDD are 100 percent identical to those of women without PMDD." Santoro believes that the new findings are ultimately positive for the future of properly diagnosing PMDD. "This is a nice step in the direction of finally assessing where that sensitivity lies for women who have PMDD and might be able to be exploited to help treat the condition."
Still, the researchers behind the study believe it will likely take years to properly use these findings for treating and preventing PMDD. Goldman believes further research is needed. "It will be necessary to identify the drivers of the cellular differences that were observed in the PMDD women," Goldman says. This includes exploring any further genetic differences seen in those diagnosed with PMDD in comparison to those who were not, as well as looking at different cell types.