Premenstrual Dysphoric Disorder or PMDD is a disorder that affects people with uteruses, usually within a few weeks before the menstrual period. This disorder is extremely common, affecting some 1 in 12 women of childbearing age and a smaller percentage of intersex people and men. This means that more than one in ten people capable of menstruating experience this disorder. Yet, most of us know very little about it, how it’s treated, or even how to recognize it. That’s further exacerbated by stigma, where many people treat PMDD as a choice, where people might use menstruation as an excuse to behave badly.
While that’s not true and PMDD is based in biological fact, many people go untreated for PMDD because of that stigma. Learning to recognize the symptoms and learning what treatment options are can help.
What is PMDD?
PMDD or Premenstrual Dysphoric Disorder is a more serious form of PMS (premenstrual syndrome). In most cases, people experience emotional and mental symptoms in the week or two weeks preceding the period. Here, you experience the symptoms of PMS plus additional and worse symptoms.
These include physical symptoms of:
- Bloating
- Headaches
- Breast tenderness
Most people who menstruate will experience these symptoms during menstruation. However, if you have PMS or PMDD, you’ll experience them several weeks before the period as well – which may mean nearly constant symptoms.
PMDD also has severe mental symptoms. These include:
- Anxiety
- Depression
- Mood changes
- Suicidal ideation
Mood changes typically include extreme irritability, anxiety, and depression. However, you may experience just one, or experience them in cycles. And, because this is a hormonal issue rather than a behavioral one, it’s usually treated using antidepressants and hormonal birth control.
Symptoms of PMDD
PMDD causes PMS symptoms plus additional mental health problems. Often, it may overlap with risks for other mental health problems as well – which is why many people with premenstrual dysphoric disorder have a diagnosis for a mental health problem such as depression, anxiety, or even bipolar disorder.
However, unlike with those diagnoses, PMDD sufferers have cycles of symptoms that appear and vanish. Because it often starts well before the menstruation cycle, many people never link the two.
- Anger
- Irritability
- Feelings of being overwhelmed
- Feeling tense
- Panic attacks
- Anxiety attacks
- Difficulty concentrating
- Depression
- Suicidal ideation
- Feeling on edge
- Fatigue
- Low energy
- Headaches
- Binge eating
- Sudden changes in appetite
- Insomnia
- Mood swings
For most people, these symptoms start at around the same time as menstruation begins and last until menopause. However, for others, they may kick in during hormonal periods, such as after a pregnancy, after a significant trauma, or after hormonal therapy.
In most cases, it’s caused by menstruation triggering changes to estrogen, progesterone, and serotonin levels in the body, causing those mood swings.
Treatment for PMDD
Premenstrual Dysphoric Disorder is normally treated using a combination of medication and therapy. Because PMDD is a hormonal disorder, it’s impossible to fully treat without medication. For this reason, hormonal birth control is the best treatment option for PMDD. Antidepressants like serotonin reuptake inhibitors are also used to treat PMDD.
Untreated, PMDD can lead to worsening symptoms, depression, and risk of suicide. It also causes emotional distress and may disrupt family, career, and social lives. Someone with an extreme case may have trouble maintaining social and romantic relationships, because partners find them difficult to deal with. This means that treatment is often necessary for quality of life.
To get a diagnosis, you can talk to your doctor, and they will ask you to track symptoms across 1-2 menstrual cycles – at which they will offer a diagnosis and a prescription.
Managing PMDD
As a hormonal disorder, you cannot treat PMDD with therapy. Therefore your therapist or doctor will have to prescribe medication. That can include:
- Sertraline, fluoxetine, or paroxetine HCI or similar SSRI antidepressants
- Hormonal birth control
Secondary therapy options include:
- Cutting back on caffeine
- Introducing B-6 and magnesium supplements
- Taking pain medication to manage cramps
- Learning stress management to improve your control of symptoms
There is no way to treat PMDD without medication. However, you may be able to improve how you deal with symptoms by taking mindfulness, meditation, or similar courses, Many doctors will also ask you to start exercising, because that will improve hormonal regulation in the body – over the period of 3 or more months of regular exercise. However, it still won’t cure or resolve symptoms, it will only help you manage them.
What About Complications
It’s very common that PMDD causes complications, including depression. This depression can be treated, meaning you can go to therapy and get help with it. However, while treatment will help you manage symptoms of depression and potentially recover from it, you’ll likely need to treat the mood swings that come with PMDD to get anywhere with it. In addition, once you start treatment, therapy can give you good tools to better manage mood swings when you do have them.
Complications include:
- Depression
- Anxiety
- Panic attacks
- Trauma
- Low self-esteem
Each of these symptoms can be considered a side-effect of PMDD because PMDD creates the conditions that result in that disorder. However, the disorder is otherwise not related to PMDD, which means it should be treated separately. For this reason, many people with PMDD are recommended into behavioral therapy and treatment despite the fact that it won’t help the direct symptoms of PMDD.
Getting Help
Unfortunately, millions of people experience PMDD. That means struggling with depression, anxiety, mood swings, and irritability two or three weeks out of every month. For many people, that also puts a strain on relationships and constant ups and downs and feeling down can cause side-effects like increased depression and anxiety separate from the PMDD.
PMDD is a hormonal disorder. Therefore, you cannot treat it by improving your lifestyle. However, you can improve how you cope with symptoms and can mitigate those symptoms by exercising, limiting caffeine, and taking other steps for your mental and physical health. And, your doctor will likely prescribe medication to help you with managing the rest.
If you or a loved one needs help with mental health treatment, drug rehab, or alcohol rehab Compassion Recovery Center is here to help. Contact us to ask about our modern and effective treatment programs.
