What Is PMDD? Symptoms, Signs & Treatment Of The Devastating Yet Frequently Undiagnosed Disorder
As written by a woman who suffers from it.
Unsplash If you've never heard of Premenstrual Dysphoric Disorder before, you may now be asking yourself, "What on Earth is PMDD?"
As it turns out, approximately "five percent of women of childbearing age" suffer from PMDD, and I happen to be one of that select group of the lucky, lucky ones who get to experience the symptoms, signs and array of treatments firsthand.
To understand PMDD, you first need to understand PMS, which I assume you already know stands for premenstrual syndrome, but just to be sure we're all on the same page, I wrote it out for you, too.
PMS is said to be experienced by more than 90 percent of women, and is an umbrella term for the group of symptoms that strike women during the time in their menstrual cycle that falls after ovulation and prior to the onset of their period. Symptoms of PMS may include bloating, fatigue, irritability, cramps, increased hunger, brain fog, an air of general ickiness — you know, all of the fun parts of being born in the body of a woman.
Typically, while these symptoms can be quite painful and unpleasant, there's nothing about them that an Advil, some diet coke, a little chocolate and good long sulk in bed watching pretty much anything on Bravo until the bleeding begins can't cure.
In comparison, PMDD is like PMS's husband's secret first wife who he keeps locked in the attic because she is nuts, and the last thing he wants to do is let her be seen in public.
Imagine the typical symptoms of PMS, but multiplied by a power of at least 20. They may include the following:
- Lasting irritability or anger that may affect other people
- Feelings of sadness or despair, or even thoughts of suicide
- Feelings of tension or anxiety
- Panic attacks
- Mood swings or crying often
- Lack of interest in daily activities and relationships
- Trouble thinking or focusing
- Tiredness or low energy
- Food cravings or binge eating
- Trouble sleeping
- Feeling out of control
- Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain
They are so extreme and utterly all-consuming they can actually make it feel as though your life is no longer within your own control. It's like someone is feeding you crazy pills for a week.
And I should know, because I've got it.
I was first diagnosed with PMDD in my early 20s. The time just before my period had always been difficult, to say the least. I would throw up (sometimes out of both ends of my body), and I would get so depressed that the idea of wandering in front of fast-moving train sometimes seemed like the sweet, sweet release I so desperately needed. Then my period would come, and POOF! — I'd be magically returned to my former state as normal human.
I didn't really think much of it. As a depressed and anxious person anyway, I figured this was just my version of normal. Once a month, for the rest of my life, or at least until menopause, I would have to talk myself down from the edge, and that was just what it meant to be a woman.
It was only after I casually mentioned the issue to both my therapist and my OB/GYN and saw each of their eyes widen like saucers that I realized that perhaps something was horribly, horribly wrong.
They both broached the subject of PMDD, and while I was initially skeptical, it did in fact sound like what I experienced.
As explained by the Mayo Clinic:
"Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling extension of premenstrual syndrome (PMS). Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships."
The causes are currently unknown, but it seems to be more common in women who also have anxiety and/or mood disorders, so some think PMDD could be the hormonal changes caused by a woman's cycle worsening symptoms of those conditions.
As far as treatment is concerned, some doctors suggest that women who are already on medication to regulate their mood — including selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem, others) and sertraline (Zoloft) — increase their regular dosage during this period of time.
Others say that taking nutritional supplements, such as calcium, Vitamin B-6, magnesium and L-tryptophan, can be helpful, while other believe herbal remedies like chasteberry "may possibly reduce irritability, mood swings, breast tenderness, swelling, cramps and food cravings associated with PMDD, but more research is needed."
It's important to note, as does the Mayo Clinic, that "the Food and Drug Administration doesn't regulate herbal supplements, so talk with your doctor before trying one."
Finally, some women report that regular exercise, cutting back on caffeine, avoiding alcohol, stopping smoking (if you do), getting enough sleep and relaxation techniques such as mindfulness, meditation and yoga have reduced the severity of their symptoms.
In some radical cases, there are women who make the decision to have a hysterectomy (removal of the uterus), bilateral oophorectomy (removal of both ovaries), or both.
I'm not there yet, but if things keep going the way they're going, I'm 100 percent not ruling it out. However, these are serious surgical procedures that come with their own set of health risks.
According to Rebecca Kolp, MD, an OB/GYN at Massachusetts General Hospital in Boston:
"The problem with something like that is that you're trading the symptoms of PMDD for all the symptoms of menopause... [Ovary removal] would really be a last resort for [PMDD treatment]."
In my own case, I personally feel the gastrointestinal effects of my medication in a pretty hard core way, so I haven't wanted to mess around with my own dose.
Instead, I started keeping a calendar. Some women obsessively track their period and their ovulation cycle: I track the time of the month where I am the most likely to feel like a failure, like my life isn't going anywhere, like I'm the fattest, ugliest person on earth, the time of the month where even breathing can be painful.
I get alerts approximately two days before my mood cycle is about to swing, and just knowing that it's coming helps. It doesn't cure my PMDD, but it does makes managing it easier, because I understand that the tears and the despair I am going through are the result of an hormonal shift, rather than anything I have or haven't done.
My doctor also suggested I switch to birth control pills with a lower dose of estrogen, and I took her up on. The switch definitely made my symptoms more manageable. Now instead of wanting to take my own life, I only feel pretty miserable, and frankly, given how incredibly despondent I used to feel, I'll take that as a win.
The most important thing to know if you are a woman living with PMDD is that you aren't some hyper-sensitive weirdo or freak.
It's something real happening inside of your body, and perhaps the best thing you can do for both your mental and physical health, as well as your overall happiness, is to talk about it, manage your symptoms, and try to go just a little bit easier on yourself.
Sure, tampon ads show you sporty women who love running marathons during "that time of the month," but if you are a woman suffering from PMDD, getting out of bed might be your own private marathon.
And you know what? That's totally fine.
Please remember that there are several options if you or someone you know needs help dealing with an immediate crisis. Call 911 if you think a family member may harm themselves or others.
The National Suicide Prevention Lifeline is available 24/7 at 1-800-273-TALK (8255).
Rebecca Jane Stokes is a sex, humor and lifestyle writer living in Brooklyn, New York with her cat, Batman. She hosts the sex, love, and dating advice show, Becca After Dark on YourTango's Facebook Page every Tuesday and Thursday at 10:15 pm Eastern. For more of her work, check out her Tumblr.