Identifying and Managing Premenstrual Dysphoric Disorder (PMDD)

While most people have heard of (and may even experience) PMS, not many people are aware of a correlating disorder: premenstrual dysphoric disorder (PMDD). PMDD is not commonly talked about, but 8% of people who menstruate experience it. This disorder can be difficult to identify, but even more difficult to handle when it goes undiagnosed. To help you identify and manage your symptoms, we’re going over what PMDD is, how it is different than PMS, and what can cause it. If you think you may have PMDD, we also provide you with ways that you can treat it.  

What is PMS? 

Before discussing PMDD, let’s first talk about PMS. PMS stands for premenstrual syndrome. It is a very common condition that most people who menstruate experience. PMS comes with both physical and mental symptoms around 7-10 days before their period starts. Physical symptoms of PMS can include cramps, bloating, back pain, tender breasts, fatigue, or headaches. Mental symptoms may consist of minor irritability or slight mood changes. Overall, PMS symptoms are usually mild and don’t prevent people from working, interacting, or living their lives. 

What is Premenstrual Dysphoric Disorder? 

PMDD is considered a severe form of PMS and the symptoms that come along with it. During the same time that one may experience PMS, they’ll experience cases of severe anxiety, depression, irritability, mood swings, and even suicidal thoughts.  

Whereas someone may experience these cases on a minor scale with PMS, symptoms of PMDD can be debilitating during those two weeks someone experiences them. People with PMDD find it hard or impossible to go to work or school. They may begin getting into arguments with loved ones. It is difficult to live their lives due to new or worsening mental health symptoms.  

However, with PMDD, once the person starts their period, it is like a switch is flipped. The specific conditions brought on by PMDD are alleviated. Existing mental health conditions are in their normal state, and those without them regularly feel more like themselves again.  

What causes PMDD? 

People who have PMDD are thought to have different sensitivities to the hormones their body is exposed to during PMS, such as progesterone and estrogen. It isn’t that someone with PMDD necessarily has more hormones, just that their body reacts differently to them. Because it is a reaction-based cause, there aren’t any specific tests that determine if someone has PMDD. There is also no known reason why some people react differently to these hormones.  

All these factors make it hard to diagnose PMDD. Unfortunately, many doctors who aren’t well-versed in women’s health or mental health might dismiss PMDD as regular PMS. If you feel like you may have PMDD, we recommend keeping a symptom tracker to track your mood in correlation with your menstrual cycle. If you are experiencing a significant change in your mood between the two weeks before your period starts and when your period does start, then you may have PMDD. 

Have you heard of reproductive psychiatry before? Learn more about it here. 

How do I treat Premenstrual Dysphoric Disorder? 

Once given a diagnosis of PMDD, there are a wide variety of treatments. There isn’t a one-size-fits-all solution as people have different symptoms and their bodies and brains require custom treatment plans. Your doctor will work with you to consider your medical and mental health history. Knowing your history can help guide them in making the best possible treatment plan for your unique needs.  

While treatment plans vary, the first step is often to prescribe a low dose of an antidepressant to be taken within two weeks before your menstrual cycle starts. These medications alter your progesterone hormone levels and change the way your body reacts to them up until your period starts. If you aren’t able to take antidepressants or alter your current medication plan, your doctor may recommend nutritional supplements or hormonal contraceptives, in addition to diet and exercise. 

Having a psychiatrist, psychiatric nurse practitioner, or OBGYN could be helpful. Working with a therapist can help you navigate your symptoms and condition. Also, you can keep up the symptom tracker that you used to help figure out if you have PMDD to help plan your life around your symptoms. For example, you can plan things such as movie nights to can help distract you but not overwork you while feeling the impact of PMDD.  

If you feel like you may have PMDD, know that it isn’t just in your head. You may be experiencing something treatable. Know that there is a solution and a way to get help. If you’re struggling with PMDD, or a condition you believe is related to your reproductive health, we can give you the support you deserve. We have an entire program dedicated to reproductive psychiatry. Connect with us today and get started on your path to relief.  

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