02 Jun Think you have premenstrual dysphoric disorder (PMDD)?
BY GABRIELLE LICHTERMAN
- If your premenstrual symptoms are intense, crop up every menstrual cycle and are severe enough to interfere with everyday life, you may have premenstrual dysphoric disorder.
UPDATED June 2, 2022 (originally published July 5, 2017)—Do your premenstrual days seem much more difficult than what you see others go through during their premenstrual phase? Does your premenstrual phase last longer or start soon after ovulation? Does pre-period irritability, anger, depression, anxiety, physical pain or trouble sleeping interfere with everyday life?
You could have premenstrual dysphoric disorder (PMDD), which is like a severe form of premenstrual syndrome (PMS) that’s estimated to effect up to 8% of anyone with menstrual cycles.
PMDD symptoms to look for
Think you may have PMDD, but aren’t sure? Here are the signs to look for:
In the one to two weeks leading up to your period (the days after ovulation), do you regularly experience…
- Extreme mood swings?
- Depression, suicidal thoughts or the impulse to self-harm?
- Sudden and intense anger?
- 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 also comes with 2 big clues
When trying to figure out if your PMS is really PMDD, there are two important clues to look for: the intensity of your symptoms and the length of time your symptoms persist.
If you have premenstrual symptoms (such as sadness, irritability, aches, lousy sleep, tiredness) that are annoying, but do not interfere with everyday life and pop up primarily during the six days before your period, this is PMS. You could have mild, moderate or even severe symptoms of PMS. But, if you’re still pretty much going on with your life, you do not have suicidal thoughts or actions, and your pain/insomnia/mood issues are manageable, this is still PMS. Another clue: PMS symptoms can vary from cycle to cycle, and you may have PMS symptoms one cycle, but not the next.
If you have premenstrual symptoms that are intense (such as, but not limited to, depression, suicidal thoughts or thoughts of self-harm, uncontrollable anger, unbearable pain, insomnia and/or debilitating fatigue), these symptoms do interfere with everyday life and they impact you anywhere from the day after ovulation through the day before your period, then you likely have PMDD. Another clue: In those with PMDD, symptoms tend to crop up regularly every cycle.
PMDD is in your genes
Many—but not all—of us experience premenstrual symptoms (such as mood changes, anxiety, aches and sleep issues) as a result of two drops in the body’s level of estrogen in the second half of our cycle. However, PMDD is different because of the greater severity and frequency of premenstrual symptoms, which can make it difficult to navigate work, school, relationships and other facets of everyday life.
Unfortunately, because the condition is not yet widely known, many with PMDD assume—or are told by others—that the pre-period problems they experience are all in their imagination or that they are exaggerating their symptoms. But, a study from the National Institutes of Health reveals the truth: PMDD sufferers have an anomaly in their gene activity that triggers more sensitivity to estrogen and progesterone, which leads to more intense premenstrual symptoms.1
“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.2
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 verified medical condition.
How can you treat PMDD?
If you suspect you have PMDD, make an appointment with your gynecologist and discuss this with her or him. Only a qualified healthcare practitioner 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.3
Unfortunately, this does not guarantee that you’ll get successful results yourself since people respond to medications differently. Yet, it does show that at least these treatments have the potential to ease your symptoms since they have been shown to help others. So, they may be worth trying if your doctor recommends them.
Chemical and surgical menopause are additional options for some patients with severe PMDD that does not respond to other treatments.
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-related issues.
Nutrition therapy: A registered dietitian 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.4
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).5 Your N.D. may not have the qualifications to administer 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 that stress triggers in the brain. Try to find a stress-reducing practice you enjoy—be it yoga, meditation or tai 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.
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 patients with PMDD who go untreated spend the equivalent of three years of their lives suffering with symptoms.6
Spread the word about PMDD
Most people 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 see that friends or family you know have one or more of these symptoms, I encourage you to speak up and share this information about PMDD with them. The revelation that someone’s emotional or physical pain is due to a legitimate medical condition with available treatments can give them the hope they need to get help.
For more information
If you want to learn more about PMDD, get information on the latest treatments or connect with others who are challenged by the condition, visit the International Association for Premenstrual Disorders and Vicious Cycle.
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(1) Neelima Dubey, et al., “The ESC/E(Z) complex, an effector of response to ovarian steroids, manifests an intrinsic difference in cells from women with premenstrual dysphoric disorder,” Molecular Psychiatry, January 3, 2017
(3) Gianna Sepede, et al., “Premenstrual Dysphoric Disorder Without Comorbid Psychiatric Conditions: A Systematic Review of Therapeutic Options,” Clinical Neuropharmacology, 39 (2016): 241-261
(4) Kimberly A. Brownley, et al., “Chromium Supplementation for Menstrual Cycle-Related Mood Symptoms,” Journal of Dietary Supplements, 10 (2013): 345-356
(5) American Association of Naturopathic Physicians (Naturopathic.org)
(6) Kazuo Yamada, Eiichiro Kamagata, “Reduction of Quality-Adjusted Life Years (QALYs) in Patients With Premenstrual Dysphoric Disorder (PMDD),” Quality of Life Research, 26 (2017): 3069-3073
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