Emotionally Debilitating Periods? It Might Be PMDD

For a lot of us, periods can mean a few days of cramping, bloating and feeling irritable each month. Menstruation is a normal and necessary part of life that most people learn to adapt to, despite the uncomfortable and sometimes inconvenient PMS symptoms.

But what if your period came with unbearable emotional symptoms month after month, so severe that it became impossible to simply “get on with life”? This is exactly what many of those suffering from premenstrual dysphoric disorder (PMDD) are dealing with - and it can make life feel like an absolute nightmare.

What is PMDD?

Premenstrual dysphoric disorder is a severe, cyclical mood disorder that is linked directly with the hormonal changes that occur during the menstrual cycle. According to the International Association for Premenstrual Disorders (IAPMD), this condition affects an estimated 5-10% of people with periods during their reproductive years.

While as many as 80% of people with periods are affected by PMS symptoms to varying degrees during their menstrual cycle, PMDD is a severe reaction to the natural rise and fall of oestrogen and progesterone that can result in various mood disorders.

These extreme mood changes can significantly impact the quality of life and make it difficult for PMDD sufferers to manage their work, relationships and ability to care for themselves in the days or weeks leading up to their period. Along with emotional symptoms, PMDD can also present physical symptoms similar to those experienced with premenstrual syndrome (PMS).


What Causes PMDD?

The cause of PMDD is not clear; however, it is suspected to be a genetic condition that can be triggered by or associated with reproductive events such as the onset of menstruation, ovulation, pregnancy, birth, miscarriage or menopause.

A genetic study completed by the NIH suggested that those suffering from PMDD have a fundamental difference in their molecular structure that affects their response to sex hormones. As a result, the mood changes experienced by those with PMDD are more than just controllable emotional behaviours.

It is also believed that those with a history of depression, anxiety or trauma may also be more susceptible to developing PMDD.

PMDD Symptoms

Symptoms associated with PMDD will usually begin during the luteal or premenstrual phase of the menstrual cycle, which falls after ovulation and before menstruation begins. The symptoms will usually subside once bleeding begins.

These symptoms can include:

  • Tension, anxiety and panic attacks
  • Feelings of deep sadness, despair and frequent crying episodes
  • Suicidal thoughts
  • Extreme mood swings that can feel ‘out of control’
  • Irritability, anger or rage
  • Fatigue and lack of energy
  • Trouble thinking and focusing
  • Insomnia or sleeplessness
  • Lack of interest in daily tasks or relationships
  • Intense food cravings and binge eating episodes
  • Physical symptoms similar to those experienced with PMS including body aches and pains, bloating, headaches and breast tenderness

How is PMDD Diagnosed?

If you suspect that you may have PMDD, start keeping track of the symptoms you experience throughout the month, for a space of about 2-3 months. Period tracker apps are handy for recording your symptoms and monitoring how these correspond with the different stages and hormonal fluctuations of your cycle - we've created a list of the best period tracker apps here.

When you have a clear record of your symptoms, discuss them with a trusted medical practitioner to obtain and diagnosis and begin a treatment plan.


PMDD Treatment

There is no ‘cure’ for PMDD, but there are treatment options available to manage and prevent symptoms. Effective treatment can be complex and can take some time to navigate with the guidance of a qualified medical professional. It is essential for healthcare providers to approach PMDD with a high level of compassion and perseverance to find the best treatment plan for an individual struggling with the condition.

Antidepressants for PMDD: Antidepressant medication such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed to manage PMDD symptoms and have a response rate of around 60-75% according to IAPMD. Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Citalopram (Celexa) or Escitalopram (Lexapro) are popular choices. They may be prescribed to be taken with the onset of symptoms during the luteal phase (i.e. for two weeks out of the month) or can be taken continuously.

Oral Contraceptive Pill: There are specific birth control pills that may be able to treat PMDD.

Hysterectomy: Complete hysterectomy (including removal of both ovaries) may be required in some cases, but should only be explored after other options have been exhausted. Surgical management of PMDD is irreversible and will mean that you enter menopause immediately after surgery - which has its own implications for your health, wellbeing and ability to carry children. There are medical treatments such as Lupron that can be used to put your body into a (reversible) forced menopause so that you can attempt to predict how your body will respond to hysterectomy.

Vitamins and Supplements for PMDD: Calcium, magnesium, Vitamin B6 and L-tryptophan may help to relieve the milder symptoms of PMS, but have mixed responses when it comes to treating PMDD. Chasteberry (also known as Vitex) is another herbal supplement that may help to reduce physical and emotional symptoms. It is essential to always seek advice from your doctor before starting on any new supplements.

Lifestyle Changes: eating a healthy diet and limiting the intake of salty, sugary or processed foods, caffeine, alcohol and nicotine help to support overall physical and mental wellbeing. Keeping physically active, practising stress management and relaxation techniques such as meditation are also great ways to support your treatment for PMDD.

If you or somebody you know is feeling suicidal due to PMDD or for any other reason, contact Lifeline Australia on 13 11 14.

Thank you, Dominique, for reaching out and encouraging us to share this important information during PMDD Awareness Month.