CHAPEL HILL — There may be more answers and treatment options for women with premenstrual dysphoric disorder, or PMDD, a common but often misunderstood condition.
Researchers at UNC's Center for Women's Mood Disorders found that women who have experienced sexual or physical abuse have different sensitivity to pain caused by PMDD and were more likely to experience a complex migraine than women with no abuse history.
The research, which included two studies, both supervised by Dr. Susan Girdler, director of UNC's Menstrually Related Mood Disorders Program, affirmed that PMDD is a stress-related disorder, rather than being solely biologically based, Girdler said. PMDD women who experienced a history of abuse had symptoms that distinguished them from PMDD women without abuse.
"A history of abuse identified a clinically unique subgroup of women with PMDD. They are a unique subgroup in terms of their biology," she said. "This will help us develop individualized treatment based on their histories [that] these women need."
Girdler said her team hasn't pinpointed specific individual treatments for PMDD women, but understanding psychological symptoms and causes of the disorder will help. She'll explore new treatment options in her next phase of research, she said.
The team was to present its research Saturday at the American Psychosomatic Society meeting in San Antonio, Texas.
PMDD has been treated with antidepressants and even contraceptive pills, but they don't always work for everyone, she said.
"One size doesn't fit all, one pill doesn't work for everybody," Girdler said. "If we can identify from a clinical interview without a fancy blood test, that such abuse issues can biologically distinguish subgroups of PMDD, this would really impact our ability to individualize treatment."
Current treatments for PMDD are only effective in about half of women. The disorder affects about 8 percent of women toward the second half of their menstrual cycle. Women with PMDD experience severe depression, irritability and anxiety. Although about 8 percent are clinically diagnosed with the disorder, 20 percent of all women report symptoms, Girdler said.
"It's a very misunderstood disorder in terms of the severity of the symptoms for some women and the impact," she said.
The first study, by Diana Fleischman, studied the link between PMDD, abuse history and tolerance to pain. She found that women without an abuse history were more sensitive to physical pain. Women without PMDD but with a history of abuse had a higher tolerance to physical pain but were more sensitive to emotional rejection.
The second study by Adomas Bunevicius looked at the same group of women. His research showed that PMDD and migraines share a common biological mechanism. Almost all PMDD women who had a sexual abuse history also were more likely to get migraines with aura or complex migraines. The link is significant, because complex migraines are a risk factor for cardiovascular disease, Bunevicius said.
"[There] are studies showing that migraine disorders significantly increase risk for a stroke ... that's especially true with women with migraine disorders," he said.
There is still demand for research in the psychological basis of PMDD because so many women suffer from the disorder and treatment isn't always effective, Girdler said.
"It affects more women than a lot of psychiatric illness does," she said. "When you consider how long they suffer from this disorder, this is something that lasts their entire reproductive lives. ... It has huge public health significance."
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