Premenstrual dysphoric disorder (PMDD) –– what is it and how to deal with it?


Premenstrual dysphoric disorder (PMDD) –– what is it and how to deal with it?

Have you heard of premenstrual dysphoric disorder (PMDD)? No, it’s not the same as premenstrual syndrome (PMS). Some say that PMDD is a black sheep in the menstrual family. The bad sister of PMS. We don’t know much about it but those who deal with it have been to hell and back. Others, in turn, try not to demonise PMDD, embracing its presence as being part of them. The part which craves attention uniquely loud and on multiple levels.

Paulina Pomaska

Published: 17.06.2021 6 minreading time

PMDD illustration

Illustration: Jarek Danilenko

Premenstrual dysphoric disorder, a.k.a. PMDD, is a variant of the well-known PMS, i.e. premenstrual syndrome. However, the usual premenstrual symptoms are much stronger and more persistent in the case of PMDD. Due to their resemblance to depression, it sometimes happens that day-to-day functioning becomes impossible. Most people, familiar with the issue, describe PMDD as “a complete life comedown”, “PMS symptoms multiplied by million”, or “a broadscale madness”. PMDD is also referred to as a more severe form of premenstrual syndrome. Don’t forget the menstrual cherry on top. Ta-dah!

It’s normal

People who cope with PMDD often think that it’s just a regular premenstrual syndrome (PMS). They think it’s normal. Finally, they let themselves believe that it’s just how they are or that they’re simply overstrained. ‘Cause obvi – PMS is so common. I even came across a real shocker – PMS is just menstruating people’s excuse for decreased productivity! More often than not, PMS is the subject of jokes and poignancies. Just like that, another “typically womanish” monster, which comes, messes with our heads and disappears. IT’S NORMAL.

Nothing could be further from the truth! Thanks to pharmacotherapy, we can lead a normal life, but before the proper treatment is implemented, we need to be properly diagnosed. This is where the plot thickens. Despite the fact that there is a PMDD classification based on DSM-5 (classification of mental disorders), sometimes you have to bounce off of not one, not two, and not even three specialists to find the one who won’t helplessly throw up their hands at you, saying something like: “it’s just what being a woman means” and sending you away empty-handed. Instead, they’ll explain to you that you might be hypersensitive to estrogen and progesterone and add something about the sensitivity to the by-product of the metabolisation of these hormones. They might even mention that life is a constant battle for keeping the inner peace and balance. Diagnosing PMDD isn’t something unusual or going beyond “the standard”. Since it’s a disorder that’s already classified, we’re talking about hard scientific evidence and not a mysterious disease from a fairytale.

PMS or PMDD? Diagnosis

There are a few things that distinguish premenstrual dysphoric disorder from premenstrual syndrome. It’s estimated that PMDD occurs significantly rarer (in 3 to 5% of menstruating people) than PMS (which affects 50 to 70% of people). PMDD is diagnosed when the ailments occured in the majority of menstrual cycles during the previous year, excluding other mental health or somatic disorders, which, if present, might intensify during the luteal phase (the last phase of the menstrual cycle). The diagnosis relies on the presence of at least five of the following symptoms:

  • mood swings,

  • sensitivity to rejection,

  • panic attacks,

  • irritability or anger,

  • interpersonal conflicts,

  • gloominess,

  • depressive states,

  • tension and anxiety disorder,

  • decreased attention to regular activities,

  • subjective difficulties in focusing on things,

  • weariness or lack of energy,

  • overeating, various food cravings,

  • sleep disorders,

  • feelings of oppression or lack of control.

The specific physical symptoms of PMDD include: breast tenderness and swelling, joint or muscle pain, bloating, and the increase of weight.

PMDD causes

Molecular Psychiatry magazine reports on the newest findings of doctors from American National Institutes of Health (Marrocco, Einhorn, Petty et al., 2020). According to their research, there are particular genetic predispositions in patients with PMDD, which determine their reactions to stress. What’s interesting, there are very often no disorders related to the hormone levels in people with PMDD. The problem lies in the organism’s reaction to the attempt of metabolising the said hormones. The results don’t offer any solution to this problem — however, they might be a good start and, with time, lead to finding one.

Don’t confuse it with depression!

In case of premenstrual dysphoric disorder (PMDD), the treatment usually begins with the application of birth control medicines. Only after birth control pills prove ineffective or there are some contraindications to the use of these, are the SSRIs applied, just like in case of depression. The symptoms are very similar but PMDD ends when the menses begins, 2 or 3 days of the period onset at the latest (although it’s an individual matter). The above-mentioned SSRIs are the selective serotonin reuptake inhibitors, that is medicines thanks to which this neurotransmitter has a chance of staying in our body for longer. To be more precise, selective serotonin reuptake inhibitors (SSRIs) are a group of medicines that impede the reabsorption of serotonin by the neurons. Why are they called selective? It’s simple – they don’t influence other neurotransmitters. SSRI therapy has been applied for more than 20 years now and the method itself is seen as uncomplicated and safe.

Holistic approach

Obviously, it’d be most reasonable to support pharmacological treatment with psychotherapy, which is a targeted form of help. This way, with the help of a number of experts, we’d be certain that every person with PMDD is taken care of and – what’s most important – is not alone. Such holistic treatment options make sense and allow those affected to fully reintegrate into social life.

Hold on a second, what do you actually get from therapy? Above all, it helps a person with PMDD find themselves in the situation, cope with stress, and organise the madness around them. In the end, it improves the quality of life and restores faith in the possibility of leading a normal life with such a heavy baggage that PMDD definitely is.

Talk it through

Despite the fact that there’s still insufficient research concerning PMDD, doctors become increasingly aware of the issue. It’s a solid argument for reporting the aforementioned symptoms to your healthcare provider. It’s not about “whining” about the cumbersome PMDD but showing how often it affects people. Without proper diagnosis, it’s impossible to implement a proper treatment of the PMDD symptoms. And without the treatment we agree to a life full of pain and discomfort, where our mood regularly swings to and fro.

Which is why, if, in the luteal phase, you notice any of the aforementioned PMDD symptoms, such as breast tenderness, mood swings, fatigue, headaches, or increasing body weight, don’t hesitate and report to your healthcare provider immediately. Even if the symptoms don’t impede your day-to-day functioning entirely. Just to be on the safe side, if the symptoms occur in different phases of the menstrual cycle – it’s also worth consulting them with your healthcare provider. A good doctor will be able to assess if these are the PMS symptoms or the symptoms of PMDD.

Joking aside

I won’t bet dollars to doughnuts that I’ve never deployed a stupid line, the whiskered-uncle type, like: “whoops, someone’s period’s coming!” when I saw that one of my friends was swallowing another painkiller, constantly whining about the tenderness in their breasts or extra kilograms, which only added insult to injury. Reluctance, fatigue, extreme emotional states. Stories about taking it out on oneself or an entire family, desperate attempts to let off steam in relation to what’s going on inside you. I nodded understandingly without realising that something like PMDD even exists. I didn’t know that, for some people, ordinary tasks rise to insurmountable obstacles. And shoving the expression “relax, it’s just period” to their faces was not the best way to help. PMDD is a disorder which won’t disappear on its own and can’t be cured with home remedies. Maybe even now you realise that there is someone around you who regularly, say, once a month, doesn’t act like themselves. Someone who has these dark clouds over their head, someone who’s off-balance once in a while. Maybe you know someone who gets mad or goes crazy and in the next second collapses from fatigue and gives in to the feelings of anxiety, panic, or lack of control. They might (but don’t have to be) symptoms of PMDD. It’s worth mentioning it during a heart-to-heart and convincing someone to get tested.

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