What You Need to Know About Premenstrual Dysphoric Disorder (PMDD)

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Last Updated on February 14, 2023 by Erin

Photo of worried woman standing next to a window. Premenstrual. dysphoric disorder PMDD can cause feelings of anxiety and hopelessness.
Photo by Isabela Drasovean on Unsplash

What exactly is PMDD?

Disclaimer: I am not a medical professional. I am an individual who suffers from premenstrual dysphoric disorder and I am sharing my personal experience as well as information I have learned on my journey. If you think you are suffering from PMDD, you should reach out to your doctor for a diagnosis and treatment plan.

Premenstrual Dysphoric Disorder (PMDD) is a severe and disabling form of premenstrual syndrome (PMS). It is a condition that affects women during the luteal phase of their menstrual cycle, typically 1-2 weeks before the onset of menstruation.

PMDD is characterized by a range of physical, behavioral and psychological symptoms that interfere with daily life. After several months of PMS that included feelings of extreme irritability and hopelessness, I reached out to my OB-GYN. I would seriously start to consider leaving my husband and children behind and running away. I felt like the worst mother and wife in the whole world and thought they deserved better. Then, almost like magic, those thoughts and feelings would disappear the first day of my period. I truly believe if I had not received help, those thoughts would have become even more serious.

The exact cause of PMDD is unknown, but it is believed to be related to hormonal changes and an over-reactivity of the brain to these changes.

PMDD is diagnosed when the symptoms are severe enough to significantly interfere with a woman’s daily life, work, and relationships. It is important to note that PMS and PMDD are not the same thing, and PMDD is a much more severe and debilitating form of PMS. If you think you may have PMDD, it’s important to talk to your doctor for a proper evaluation and treatment options.

How is PMDD diagnosed?

PMDD is diagnosed through a combination of medical history, symptom tracking, and a physical examination. Here are the steps typically involved in diagnosing PMDD:

  1. Medical history: Your doctor will ask about your menstrual cycle, symptoms, and overall health history.
  2. Symptom tracking: You will be asked to keep a record of your symptoms for at least two menstrual cycles to help identify patterns and track the timing and severity of your symptoms.
  3. Physical examination: Your doctor will perform a physical examination to rule out any other medical conditions that may be causing your symptoms.
  4. Diagnostic criteria: PMDD is diagnosed based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). To be diagnosed with PMDD, you must experience at least 5 of the following 11 symptoms:
  • Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
  • Markedly anxious or fearful mood
  • Markedly persistent irritability or anger that affects others
  • Decreased interest in usual activities
  • Subjective difficulty in concentration
  • Fatigue and decreased energy
  • Insomnia or hypersomnia
  • A noticeable change in appetite, overeating, or specific food cravings
  • Feelings of being overwhelmed or out of control
  • Physical symptoms such as breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain

It’s important to note that PMDD symptoms must be related to the menstrual cycle and occur exclusively during the luteal phase (1-2 weeks before menstruation).

The particular symptoms I was experiencing included hopelessness, anxiety, irritability, increased appetite, overwhelm, and extreme breast tenderness that was lasting for weeks. It was awful! Nobody wants to feel that way 1-2 weeks every single month.

What is the treatment for Premenstrual Dysphoric Disorder?

There are several treatment options for PMDD, and the best one for you will depend on the severity of your symptoms and your individual needs. Here are some of the most common treatments for PMDD:

  1. Medications: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to treat PMDD. These drugs help regulate serotonin levels, which can improve mood and reduce symptoms such as anxiety, irritability, and depression.
  2. Hormonal therapy: Hormonal therapy, such as birth control pills or hormonal IUDs, can regulate hormonal fluctuations and reduce PMDD symptoms.
  3. Lifestyle changes: Making changes to your diet, exercise routine, and stress management techniques can also help reduce PMDD symptoms.
  4. Therapy: Talking to a therapist can help you better understand and cope with PMDD. A mental health professional can also provide support and guidance for managing symptoms.
  5. Alternative treatments: Some women find relief from PMDD symptoms through alternative treatments such as acupuncture, massage therapy, or herbal remedies.

It’s important to work with your doctor to find the right treatment plan for you. In some cases, a combination of treatments may be recommended. Additionally, it’s important to continue to track your symptoms and work with your doctor to adjust your treatment plan as needed.

For me personally, my doctor and I decided to opt out of birth control pills and stick to an SSRI that I only take during the luteal phase of my cycle. I track using an app called Kindara. I have also made adjustments to my diet. Intermittent fasting has worked wonders for me for the last few years; however, when I’m struggling with my PMDD symptoms, I feel better when I have breakfast earlier in the day.

Are there risk factors for Premenstrual Dysphoric Disorder?

Some of the risk factors associated with PMDD include:

  1. Family history: Women with a family history of PMDD, depression, or mood disorders may be at a higher risk of developing PMDD.
  2. Hormonal fluctuations: Hormonal changes can trigger PMDD symptoms.
  3. Age: PMDD is most common in women in their late 20s and early 30s.
  4. Life stress: Women who are under a lot of stress, especially chronic stress, may be more likely to develop PMDD.
  5. Substance abuse: Substance abuse and alcoholism may increase the risk of PMDD.
  6. Mental health: Women with depression, anxiety, or other mental health conditions may be more likely to develop PMDD.
  7. History of physical or emotional abuse: Women with a history of physical or emotional abuse are at a higher risk of developing PMDD.

It is important to note that not all women who have these risk factors will develop PMDD, and some women may develop PMDD without having any of these risk factors.

I have a family history of anxiety, although I myself have never formally been diagnosed. My PMDD symptoms began in my mid-30s, when I stopped having children. I had honestly never heard about PMDD up until I started doing some online research about what I was experiencing.

What is the outcome for those who have Premenstrual Dysphoric Disorder?

The prognosis for women with premenstrual dysphoric disorder (PMDD) can be positive with the right treatment and management. With proper care and support, many women with PMDD are able to effectively manage their symptoms and live fulfilling lives.

However, without treatment, PMDD can have a significant impact on a woman’s quality of life, including her relationships, work, and daily activities. Some women with PMDD may also have comorbid conditions, such as depression or anxiety, which can affect their prognosis.

The most effective treatment for PMDD is likely a combination of medication and therapy. Antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs), can be effective in reducing PMDD symptoms. Cognitive-behavioral therapy (CBT) can help women with PMDD to manage their symptoms and improve their overall well-being.

It is important for women with PMDD to work closely with their doctor to find the treatment plan that works best for them, and to seek support from friends, family, or a support group.

With the right care and support, many women with PMDD are able to live fulfilling lives, despite the challenges posed by their condition. I myself am so grateful to finally have a diagnosis and treatment plan. I feel so much better about the future!

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What you need to know about premenstrual dysphoric disorder PMDD. My journey and what I've learned.

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