What the heck is Premenstrual Dysphoric Disorder (PMDD)?

Words by Lolly Heaney

For us menstruators, PMS symptoms — which range from acne breakouts, decreased energy levels, low moods, right through to feeling like a real-life demon — have become a begrudgingly accepted part of our monthly routine. For most of us, these symptoms typically play out in the few days leading up to our period. And while they are a nuisance, they become much worse when their severity and longevity are greatly intensified. For some, this is the harsh reality. 

Known as PMDD (Premenstrual Dysphoric Disorder), this condition is estimated to affect somewhere around 1 in 20 menstruators, though, like many health concerns impacting on women, there hasn’t yet been enough study in this field to properly determine key statistics. Unfortunately, many medical practitioners are not yet aware of the existence of the disorder, let alone how to treat it — an extremely disheartening frustration for sufferers to contend with, especially given that PMDD can have devastating implications on an individual’s quality of life; often impeding on one’s general well-being and their basic ability to function.

PMDD is similar to PMS (premenstrual syndrome), but the intensity of the symptoms are significantly more severe and the duration in which these symptoms last is much longer. Distinct from PMS symptoms, which last around 2-3 days, PMDD symptoms typically begin 1-2 weeks before menstruation and continue to loiter for the first few days of one’s period. 

If you suffer from PMDD, you would know how awful and debilitating it can be to experience these symptoms for such a prolonged period of time, especially when we consider this time frame relative to the typical 28-day menstrual cycle. With this in mind, without proper treatment, a person suffering from PMDD might only have relief from their symptoms for up to 50% of their menstruating life.

Some of the symptoms experienced by sufferers of PMDD include crippling depression and anxiety, extreme irritability, trouble sleeping, panic attacks and even suicidal ideation, among many other expressions. These horrific symptoms often cause major disruptions to a person’s relationships with others, as well as their relationship with themselves. Self-worth is often dramatically impacted and so is one’s capacity to work and/or study effectively.  These implications are even more profound when a person with PMDD is misunderstood — particularly in cases where a diagnosis has not been identified. 

With PMDD said to affect up to 5% of people who menstruate, the fact that the condition is still relatively unacknowledged is a major cause for concern. Many sufferers often think that their symptoms are purely psychological (often misdiagnosed with bipolar) without understanding that what they are experiencing is actually due to hormonal changes taking place in their body every month. Women in their 30s are said to be the most susceptible, with symptoms continuing through into menopause. That's a long time to struggle with such a physically and emotionally debilitating disorder.

Specialists are still unsure what exactly causes PMDD and PMS, but there is a definite correlation between symptoms and the changing hormones in the body that occur within the menstrual cycle. Symptoms are also linked to the neurotransmitter serotonin, which levels fluctuate throughout your cycle, as neurotransmitters are affected by hormone levels. PMDD diagnoses are established through a series of sessions with a doctor or specialist. Generally, an individual will need to be experiencing at least five symptoms of PMDD to receive a diagnosis.

So without an obvious understanding of what causes PMDD, how is it treated? Currently there is no gold-standard treatment that works for everyone. Medication-wise, antidepressants (e.g. SSRIs), which alter serotonin levels in the brain may be prescribed. Alternatively, some forms of the contraceptive pill are used as a treatment option, thanks to their ability to diminish the natural hormonal fluctuations experienced throughout the menstrual cycle.

Cognitive Behavioural Therapy (CBT) has proven effective for some people with PMDD in managing their symptoms. Lifestyle changes such as regular exercise, eating a balanced diet and taking certain supplements may also help alleviate certain symptoms. Meditation, mindfulness, yoga and general relaxation techniques may also be recommended to reduce associated stress.

If you are experiencing symptoms that resemble PMDD, consider checking in with your healthcare provider — ideally one who has sound awareness of the disorder so that they can assist you in figuring out a suitable treatment plan. You deserve to feel empowered by your menstrual cycle, not ruled by hormones.

It's time to say ‘good riddance’ to the days of minimising our own reproductive-related suffering. If you're someone affected by any degree of PMS or PMDD symptoms, I hope you find relief soon.