PSA: PMDD is not the same as PMS. Ok, that was quite a lot of acronyms in one sentence, but the point is important. Whilst many people suffer from PMS a few days before their period, for people living with PMDD, it’s a horrific experience and one they need proper support for. But so little is still understood about the condition and so many people are still suffering in silence. Here we’ll break down all you need to know on PMDD and the impact it can have on mental health.
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) which affects 5-10% of menstruating people. It is a combination of debilitating emotional and physical symptoms which occur during the week or two before your period. Now PMS is never fun to deal with, but PMD is a whole other level. It can make it hard for you to work, cause you to pull away from your friends and can also trigger serious mental health issues. This is why it is so important to get a diagnosis and find effective ways to manage and reduce symptoms.
What causes PMDD?
PMDD is classified as an endocrine disorder so it’s all about your hormones. Unfortunately, research into the exact cause of PMDD is still ongoing - and we are a long way off from understanding it completely.
Most doctors agree that it’s all about hypersensitivity to the usual hormonal changes we go through in our menstrual cycle - which could be genetic. After ovulation, our estrogen levels get lower and this can also mean our serotonin (our happy hormones!) gets lower too. This is part of the reason we experience PMS but in people with PMDD, the serotonin seriously plummets.
There is additional research which suggests that PMDD could be triggered by trauma or extreme stress. Further research is still being carried out to explore exactly how and why this may happen.
What are the symptoms of PMDD?
PMDD symptoms vary from person to person, both in type and intensity. No one’s menstrual cycle is the same and so it is not surprising that our emotional reactions to our cycle differ too.
However, many people experience a combination of quite extreme emotional, physical and behavioral symptoms such as:
- Mood swings
- Feeling upset
- Feeling angry or irritable
- Severe anxiety and overwhelm
- Severe depression
- Suicidal feelings
- Breast engorgement and tenderness
- Muscle and joint pain
- Headaches and migraines
- Lethargy and lack of energy
- Panic attacks
- Food cravings or binging
- Lack of interest in relationships/ hobbies
- Disrupted sleep routine
- Trouble focusing and thinking
Obviously, some of these symptoms go hand in hand with PMS, but it really comes down to the severity of them. Suicidal thoughts and severe panic attacks are not normal just before your period - and are definitely a sign that something is wrong and you should ask for help.
Also, remember that PMDD will only usually affect you the week or so before your period. If you are experiencing these symptoms throughout the test of the month, there could be something deeper going on with your mental health and you should also speak to your doctor.
How do you diagnose PMDD?
Unfortunately, it can sometimes take a while to get a diagnosis for a number of reasons. PMDD is not well known or talked about enough ( another period-related taboo from the patriarchy…) and even some medical professionals struggle to recognise it. Also any issues to do with our periods - from PMS to pain - are so often normalized that some doctors (not the good ones, of which there are many!) can even be quite dismissive when you come to speak to them.
In addition to this, the symptoms are cyclical and come and go with your menstrual cycle, so it can be hard to notice the pattern and remember exactly what you were experiencing a few weeks later.
If you think you may have PMDD, there are a few things you can do to help you understand your symptoms better and advocate for yourself when you go to the doctors.
- Keep a record of your symptoms over time. This could be in a period tracking app or simply written down in a journal. If possible keep records for at least 3 months so that you can recognise patterns and triggers that make things worse.
- Take PMDD symptoms and treatment guidelines with you to your appointment. Check out the below guides from trusted sources that can give you a comprehensive list.
- National Institute for Health and Care Excellence (NICE)
- National Association for Premenstrual Syndrome (NAPS)
- Royal College of Obstetricians & Gynecologists (RCOG)
- Ask your GP to refer you to either a gynecologist or a mental health specialist. They may have a better understanding of PMDD and also treatment options.
Can PMDD be cured?
PMDD, unfortunately, has no cure, but with the right support, symptoms can be managed so you can have a happier, healthier cycle!
Your doctor might suggest taking antidepressants for certain phases of your cycle and sometimes hormonal contraception might also be recommended to hijack your natural cycle. Whilst medication like this might sound a bit scary - don’t be afraid to try them out if you are really struggling with your mental health.
However, there are some more holistic things you can do to help ease and manage your symptoms. Self-care is really important when it comes to our mental wellbeing:
Get to know your cycle - If you know that in your luteal phase (generally two weeks before your period) you could be struggling with low energy levels and negative feelings, plan your diary around that. Don’t take on anything that could cause more stress but aso make sure that you don’t completely cut yourself off from people. Maybe book in some low key meetups with friends who understand what you’re going through or invite them round for a cozy night in!
Prioritize rest and relaxation - PMDD can play havoc with your sleep pattern, but getting enough rest is essential for good mental health. Take naps if you need to, take yourself to bed early and try to give yourself the freedom to have a lie in if you need it. Aside from sleep this might be a good time to try relaxation practices like meditation or yoga.
Nourish your body - This goes for movement and food! When feeling down it can be so tempting to want to curl up on the sofa with a tub of ice cream (and that’s ok sometimes!) but also try to give your body the nourishment it needs to boost its serotonin and energy levels. Get moving if you can, and try to include foods on your plate that are high in omega 3 & 6 and low in sugar. This will regulate your blood sugar levels, keeping your energy level stable, as well as helping to stabilize your mood.
Think about supplements - Supplements can be a great way to support a healthy diet and give you even more nutrients that can help tackle PMDD. There are some small studies to indicate that Agnus Castus, Red Clover and St John’s Wort could all be helpful in reducing PMDD symptoms.
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