What is Premenstrual Dysphoric Disorder (PMDD)?

Premenstrual Dysphoric Disorder, or PMDD, is a severe, sometimes disabling extension of premenstrual syndrome (PMS). Most women experience some PMS symptoms before starting their menstrual cycle every month. PMS symptoms are typically a mild discomfort and do not disrupt most women’s everyday lives. However, for people who suffer from PMDD, these premenstrual symptoms are more severe and often result in harmful impacts on their lives, relationships and mental health.

How is PMDD different from PMS?

PMDD is an extreme form of PMS that occurs in a cyclic, or routine, pattern every month starting one to two weeks before the menstrual cycle begins. The symptoms go away once the cycle starts to flow or within a few days after. PMDD symptoms include:

• Sudden extreme sadness
• Thoughts of suicide or thinking you were better off dead
• Crippling anxiety
• Hopelessness, irritability or irrational anger
• Extreme moodiness
• Epic fatigue
• Physical symptoms often associated with PMS, including breast tenderness, headache, generalized cramping, weight gain, binge eating and bloating.

How is PMDD diagnosed?

PMDD diagnosis is made entirely on the type and timing of symptoms in relation to the menstrual cycle. With PMDD, at least five symptoms must be present during most menstrual cycles. These symptoms need to start the week or two before the menstrual cycle begins, typically within the luteal phase (the time in your cycle after ovulation and before your period arrives), and symptoms must resolve within a few days of starting the cycle. Also, to have a diagnosis of PMDD, at least one out of your five symptoms must be a core mood symptom. Core mood symptoms include irritability or anger, feeling down and depressed, feeling extremely anxious and stressed and avoiding your usual activities. In addition, to meet the criteria for PMDD diagnosis, any one of the following symptoms is needed:

• Difficulty concentrating
• Feeling tired and having a very low energy level
• Binge eating
• Sleeping too much or having trouble falling asleep
• Feeling overwhelmed and out of control
• Physical symptoms, especially breast tenderness, bloating, body aches and weight gain

How can you cope with PMDD?

Here are a few tips to help overcome the physical and mental symptoms of PMDD:

1. Be kind to yourself - First, do not dismiss your low mood and be kind to yourself. People who suffer from PMDD are highly sensitive to the normal changes in reproductive hormones during the two weeks before their menstrual cycle starts. This sensitivity results in changes in brain chemicals, which control mood and well-being simultaneously. Soon after the menstrual cycle begins, the reproductive hormones shift and the changes that occur to the brain resolve at the same time, thus helping you feel better and more like yourself.
2. Track your symptoms - Tracking your symptoms is key to getting the correct diagnosis. Record your symptoms daily for at least two menstrual cycles, making note of the days you are menstruating. There are many ways you can collect this information such as printable trackers, downloading a period tracker app like Me vs. PMDD or even jotting down the info on a piece of paper.
3. Make lifestyle changes - Another major way to manage PMDD symptoms is to make lifestyle changes to improve your overall health and wellness. As with most health and wellness issues, consistently eating nutritious foods, getting regular physical activity and adequate rest is key. Also, finding ways to manage the emotional stress associated with PMDD is essential. This can be done with mind-body techniques like emotional freedom tapping, deep breathing, meditation or yoga.

I think I have PMDD. Now what?

If you suspect you have PMDD, you should schedule an appointment with your healthcare provider and openly discuss your concerns with your family and friends to educate them on what you are going through and strengthen your support system. Your healthcare provider can help you better understand the condition and work toward a diagnosis and a treatment plan to help manage your symptoms and improve your level of functioning. Your healthcare provider can discuss various FDA-approved prescription medication options to help manage PMDD, including birth control pills, antidepressants and injectable Lupron, which is only used in rare cases when symptoms fail to improve with other methods. Unfortunately, PMDD is often misdiagnosed and can take years for women to make the connection between their severe symptoms and menstrual cycle. If this sounds like you or someone you know, you no longer need to suffer alone. As an advanced practice provider specializing in PMDD, I am here to help provide patients with education, support and guidance to better control this cyclic turmoil and improve their quality of life.