Premenstrual dysphoric disorder, or PMDD , is a form of the well-known PMS, or premenstrual syndrome – except that the general symptoms that are noticeable before menstruation in PMDD are much stronger and more persistent. Because of their similarity to depression, it often turns out that normal functioning becomes impossible. Most people familiar with the subject describe PMDD as “a complete life crash”, “PMS multiplied by a million”, or “crazy on a grand scale”. All of this culminates with menstruation. Tadaaam!
It's a normal thing
People who struggle with PMDD often think that it is nothing more than premenstrual syndrome (PMS). They consider it the norm, and in the end they let themselves be convinced that "it's just their nature" or that they are simply overworked. Because, as we know, PMS is common. I have even come across a shocking opinion that PMS is an excuse that menstruators use for reduced productivity! PMS is often the reason for jokes and sarcasm. It's a "typically female" monster that appears, confuses us and disappears. NORMAL.
Nothing could be further from the truth! With pharmacological therapy, you can live a normal life, but before you can start the right treatment, you need to properly diagnose the problem. And that's where the trouble begins. Although there is a classification of PMDD based on the DSM5 (classification of mental disorders), sometimes you have to visit more than one, not two, and not three specialists to find the right one, who won't throw up their hands in a gesture of helplessness, won't say anything about "such feminine beauty" and won't send you away empty-handed. Instead, they will talk about hypersensitivity to progesterone or estrogen and tolerance to the byproduct of metabolizing these hormones. And about why life is a constant struggle to maintain inner peace and balance. Making a diagnosis in the case of PMDD is nothing extraordinary or out of the "standard". Since it is a disease that has already been classified, we are talking about hard, scientific evidence, not about a mysterious affliction of unicorns.
Read also our article:PMS and diet .
Still PMS or already PMDD? Diagnosis
There are several things that distinguish premenstrual dysphoric disorder from premenstrual syndrome. PMDD is estimated to occur much less frequently (in 3% to 5% of menstruating people) than premenstrual syndrome (which affects 50% to 70% of people). PMDD is diagnosed if the difficulties occurred in most menstrual cycles over the past year, while excluding other mental and physical disorders that may be more severe during the luteal phase of the cycle (the last phase of the cycle). Diagnosis involves recognizing at least five of the following symptoms:
- mood swings,
- sensitivity to rejection,
- panic attacks,
- irritability or anger,
- interpersonal conflicts,
- depression,
- depressed mood,
- feeling of tension and anxiety,
- decreased interest in usual activities,
- subjective difficulties in concentrating,
- tiredness or feeling of lack of energy,
- overeating,
- sleep disorders,
- feeling overwhelmed or out of control.
Physical symptoms typical of premenstrual dysphoric disorder include breast tenderness or swelling, joint or muscle pain, feeling bloated, and weight gain.
What causes PMDD?
The magazine "Molecular Psychiatry" reports on the latest discovery by doctors from the American National Institutes of Health (Marrocco, Einhorn, Petty et al., 2020). According to them, people with PMDD have certain genetic predispositions that determine their reactions to stress . Interestingly, very often in people experiencing PMDD, there are no disorders related to hormone levels. The problem lies in the body's response to the attempt to metabolize them. Although the research results do not offer a solution, they may help to lead to it over time.
Not to be confused with depression!
In the case of dysphoric disorder, treatment most often begins with contraceptive therapy . Only if contraceptives prove ineffective or there are contraindications to their use, SSRIs are used , as in the case of depression. The symptoms are very similar, but PMDD ends with the appearance of bleeding, no later than 2 or 3 days after menstruation (however, this is a very individual matter). The SSRIs I mentioned earlier are selective serotonin and dopamine reuptake inhibitors, i.e. drugs that allow these neurotransmitters to stay in our body longer. To be more precise, selective serotonin reuptake inhibitors (SSRIs ) are a group of drugs that inhibit the reabsorption of serotonin by neurons. Why are they called selective? It's simple - they do not affect other neurotransmitters. SSRI therapy has been used for over 20 years, and the method itself is considered uncomplicated and safe.
Holistic approach
Of course, the most reasonable thing to do would be to support pharmacological treatment with psychotherapy, which is an individually tailored form of help . In this way, with the cooperation of several specialists, we would be sure that each person suffering from PMDD is well cared for and – most importantly – that they are not alone. Such comprehensive treatment makes sense and allows for a full return to social life.
But wait, what does therapy actually do? First of all, it helps a person with PMDD find their way in this situation, cope with stress, and organize what is happening around them. Ultimately, it improves the quality of life and restores faith that one can live a normal life even with such a troublesome burden as premenstrual dysphoric disorder.
It's worth talking
Despite the still insufficient amount of research on PMDD, doctors are becoming increasingly aware of the problem. This is an important argument for reporting the symptoms discussed here to your doctor. This is not about "shaming" the bothersome PMS, but about showing how common PMDD is. Without a diagnosis, it will not be possible to effectively treat the symptoms. And by not treating the symptoms, we agree to a life full of pain and discomfort with a mood that regularly and without any control goes downhill.
Therefore, if you experience the aforementioned symptoms during the luteal phase, such as breast tenderness, low mood, fatigue, headaches, or weight gain, do not hesitate to report it to your doctor – even if these are not symptoms that completely prevent you from functioning normally. For the record – if these symptoms appear in another phase of the cycle, it is also worth mentioning. A good doctor will be able to assess whether these are symptoms of PMS or dysphoric disorder.
Jokes aside
I can't swear that I've never said something like an uncle with a mustache at a wedding: "Oh, someone's on their period!" when I saw one of the women I knew taking another pill for a headache, complaining about constantly aching breasts and the extra kilos that had recently only added fuel to the fire. Reluctance, fatigue, extreme emotional states. Stories about taking it out on yourself or your entire family, desperate attempts to release what was happening inside. I nodded in understanding, completely unaware that something like PMDD existed. I didn't know that for many people everyday matters grow into insurmountable obstacles. And saying "relax, it's just your period" is not the best form of help. PMDD is a disease that will not go away on its own, and it cannot be cured with home remedies . Perhaps you can already think of someone who regularly, say, once a month, is not themselves. They carry storm clouds above them, they get into extreme emotions. They get angry, go crazy, only to collapse from exhaustion and succumb to a sense of anxiety, panic, loss of control. These may (but do not have to) be ailments related to PMDD. It is worth dropping this clue in an honest conversation and persuading them to undergo comprehensive tests.
Created at: 06/08/2022
Updated at: 16/08/2022
