My Hormonology

Does your premenstrual phase seem more difficult than what you see other women go through? Does irritability, anger, depression, anxiety or physical pain you experience interfere with everyday life?

You may have premenstrual dysphoric disorder (PMDD), which is a severe form of premenstrual syndrome (PMS). And you’re not alone. It’s estimated that up to 8% of cycling women have this condition. And, if you’re one of them, then you know just how debilitating it can be.

PMDD symptoms

Think you may have PMDD, but aren’t sure? Here are the signs to look for:

In the one or two weeks leading up to your period do you regularly get….

  • Extreme mood swings
  • Depressed, suicidal or think about self-harm
  • Suddenly and intensely angry
  • Anxiety that makes regular daily activities more difficult
  • Intense pain, cramping or aches
  • Severe insomnia

If you said “yes” to one or more of these symptoms–and these symptoms ease up after your period arrives–you could have PMDD.

PMDD is in your genes

Many–but not all–women experience premenstrual symptoms as a result of two estrogen dips in the second half of their cycle. However, PMDD is different because of the severe reaction women with the condition have to hormone fluctuations.

Now a National Institutes of Health study reveals that the reason for the difference between PMS and PMDD comes down to genetics: Turns out, PMDD sufferers have an anomaly in their gene activity that triggers more sensitivity to estrogen and progesterone, which leads to more intense premenstrual symptoms.

“This is a big moment for women’s health, because it establishes that women with PMDD have an intrinsic difference in their molecular apparatus for response to sex hormones – not just emotional behaviors they should be able to voluntarily control,” study co-author David Goldman, M.D. stated in a news release.

Hopefully, knowing that PMDD is driven by a difference in your body’s makeup can help you feel validated that what you’re experiencing isn’t just “bad PMS”–it’s a medical condition.

What are the next steps to take?

If you suspect you have PMDD, make an appointment with your gynecologist and discuss this with her or him. Only a qualified medical doctor can get you the appropriate diagnostic tests and interpret the results accurately to rule out other conditions and confirm a PMDD diagnosis. A gynecologist is preferred since she or he is likely to have more experience with this condition than a general practitioner.

From there, you have treatment options.

Pharmaceutical approach: Some doctors may suggest taking antidepressants or hormone birth control. Antidepressants work by leveling out your mood and hormone birth control reduces hormone fluctuations that are causing PMDD symptoms. In a 2016 study in the journal Clinical Neuropharmacology, a review of 49 studies examining these options on PMDD prove they both work effectively.

Holistic approach: If you want to try a drug-free treatment first or you want to complement your pharmaceutical treatment with additional proven interventions, there are several avenues to explore…

Cognitive behavioral therapy: This is a short-term (often about six months) round of sessions with a therapist trained to help you identify and cope with PMDD symptoms. This gives you tools you can use to help keep your emotions more balanced, sleep more soundly and deal with other PMDD issues.

Nutritional therapy: A registered dietitian (R.D.) can suggest the kinds of foods and beverages that create more emotional balance, reduce pain and improve sleep. She or he may also recommend certain supplements, such as chromium, which balances blood sugar and was shown to improve PMDD symptoms in a 2013 study in the Journal of Dietary Supplements.

Naturopathic treatment: A naturopathic doctor (N.D.) is medical practitioner who specializes in natural remedies (which is not the same as a naturopath who does not undergo the same medical training). An N.D. may not have the qualifications to administor or interpret all necessary test results, so seeing a medical doctor first is preferred. But, if you’re more comfortable with natural treatments, including supplements, acupuncture and other similar approaches, this would be a good fit for you.

Destressing: Stress has been shown again and again to exacerbate premenstrual symptoms of all intensities because of the cascade of changes stress creates in the brain. Try to find a stress-reducing practice you enjoy–be it yoga, meditation or t’ai chi–and do it regularly.

I recommend trying all of these approaches to find the right treatment or combination of treatments that work for you.

And, if you’re thinking of putting off getting diagnostic tests and investigating treatments because it’s too much of a hassle, consider this: A 2017 study found that women with PMDD who go untreated spend the equivalent of three years of their lives suffering with symptoms–and longer if they don’t give birth since it means going through even more monthly cycles.

Spread the word about PMDD

Most girls and women are still unfamiliar with PMDD, which means those struggling with difficult symptoms may not realize they have a medical condition that can be helped with treatment. Or, worse, their symptoms are dismissed by family members, friends or co-workers who tell them to just get over it, which just adds to their suffering.

If you recognize that a girl or woman you know has one or more of these symptoms, I encourage you to speak up and share this information about PMDD with her. This one revelation that someone’s emotional or physical pain is due to a medical condition with proven treatments can give her the hope she needs to get help.

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My Hormonology