All you need to know about: Premenstrual Dysphoric Disorder

For some women who menstruate, the week leading up to their period can be a rollercoaster ride with premenstrual syndrome or PMS causing a range of physical and emotional discomforts, from headaches and exhaustion to irritability and anxiety. Now, picture these symptoms dialled up to a point where day-to-day functioning seems impossible. This is the reality of those living with premenstrual dysphoric disorder (PMDD).

PMDD is essentially a severe form of PMS, and menstruation can be an overwhelmingly debilitating experience for those with the condition. According to a 2008 study in The Lancet, about 5-8% of women suffer from severe premenstrual syndrome, and it can significantly affect their personal, social, and professional lives.

This chronic disorder, a recognised mental health condition, therefore, cannot be dismissed as just something that happens during ‘that time of the month’ and requires proper diagnosis and treatment. Here’s everything you need to know about PMDD.

What are the symptoms of PMDD?

PMDD symptoms usually set in a week, or sometimes even two, before menses — that is, during the late luteal phase — and subside a few days into the period.

The condition results in drastic changes in mood, accompanied by certain physical manifestations. Those with PMDD may experience deep feelings of sadness, hopelessness, self-criticism, or even thoughts of self-harm. Stress and anxiety may be frequent, with a constant sense of being on edge or the inability to relax. Anxiety or panic attacks may also occur.

Irritability or anger can become intense, often leading to conflicts with others. Concentration can become difficult, and a persistent lack of energy or fatigue is common in the days leading up to the period.

Appetite changes may also occur, including overeating or intense cravings for specific foods, and sleep disturbances — such as excessive sleep (hypersomnia) or trouble falling asleep (insomnia) — are typical.

PMDD may result in a general lack of interest in activities that usually bring joy, like hobbies or socialising, and those with the condition may feel overwhelmed or like they are losing control.

This is further exacerbated by physical symptoms such as breast tenderness or swelling, bloating, headaches, joint or muscle pain, and weight gain.

Causes and diagnosis

Most research suggests that while the causes of PMDD are unclear, it may stem from hormonal changes during the menstrual period, especially decreased levels of serotonin, a hormone that affects one’s mood.

For a PMDD diagnosis, a person should experience at least some of the aforementioned symptoms with such severity that it interferes with their social, professional, sexual, or academic functioning.

The symptoms should also be linked to their menstrual cycle and not just be a result of other physical or mental health conditions, such as depressive or personality disorders or thyroid disease, endometriosis or menopause, although they may overlap with these conditions.

A person experiencing such symptoms must consult a healthcare professional for a diagnosis. A Premenstrual Symptom Screening Tool, which is essentially a questionnaire used to diagnose PMDD, may give the healthcare professional a better understanding of the individual’s condition.

Research also suggests there are some risk factors involved in the development of PMDD, namely smoking, obesity, traumatic events like abuse, genetics, and pre-existing mental health conditions. Some studies have found a possible link between ADHD and PMDD; people with ADHD tend to experience severe symptoms in the weeks leading up to their period. However, more research is needed in this regard.

What are some of the treatment options?

Though evidence is limited, exercise, dietary changes (cutting down on caffeine and certain foods), and stress management (yoga, breathing exercises, etc.) are recommended ways to alleviate PMDD symptoms. In some cases, Serotonin Reuptake Inhibitors (SRIs) are prescribed, as they have been shown to effectively treat severe mood and physical symptoms of PMDD.

Hormonal therapies and oral contraceptive pills are some of the other recommended treatments. Vitamin B-6 and calcium and magnesium supplements may also help ease symptoms.

[Assistance for overcoming suicidal thoughts is available on the State’s health helpline 104, Tele-MANAS 14416 and SNEHA’s suicide prevention helpline – 044 24640050 or from any of the numbers in this link]