There’s PMS (Premenstrual Syndrome), there’s PMDD (Premenstrual Dysphoric Disorder), and there’s a big statistic you need to know: 15 percent of all women living with the latter will commit an act of suicide in their lifetime.
Every month, for any given number of days leading up to and during a woman’s menstrual cycle, a very hard-hitting strain of PMS—think “The Hulk” of PMS-ing— brings with it very intense and very real emotional, physical, and mental changes that can be extremely difficult to live with. They make functioning at work and at home nearly impossible at times, and they can put a strain on friendships, family relationships, and life with your romantic partner.
Think you might have it? You’ll have to keep thinking, and follow our guide to self-diagnosis, because even though an estimated 3–8 percent of the female population is living with PMDD, it is not something your therapist, gynecologist, or primary care physician will screen or test you for.
It’s up to you to learn, become aware, track your symptoms, and reach out for medical, social, and therapeutic support in order to make this monthly occurrence as manageable as possible for yourself and those around you.
What is PMDD?
To try and define PMDD, you first need to know what constitutes “normal” PMS, symptoms of which include cramps, mood swings, irritability, fatigue, sensitivity, and headaches.
Take these symptoms, ramp them way up, and there you can begin to understand PMDD.
Prudence Hall, MD, founder of the Hall Center and author of Radiant Again & Forever, says that the severity is the difference. How extreme—and you know yourself best—is your anxiety, depression, anger, or sudden mood swinging?
“Though it may not occur every cycle, PMDD usually hits about seven to 14 days before your period, and the intensity increases as you get closer,” said Dr. Hall. “A woman’s estrogen levels drop in the second half of her cycle, while progesterone levels rise dramatically during this time. The result is feeling lethargic no matter how well you’ve slept.
“When the adrenal glands—the ones responsible for regulating and releasing hormones during your cycle—stay stressed over time, they stop creating healthy and balanced amounts of hormones, and the result is feeling exhausted, depressed, and even having a low sex drive,” she said.
Who is More Vulnerable?
Sometimes PMDD is just a genetic predisposition while in other cases it can develop over time—however, according to Dr. Eliza Bruscato, ob-gyn at Winnie Palmer Hospital for Women & Babies, you’re at higher risk if you have a history of traumatic events, Post Traumatic Stress Disorders (PTSD), or an anxiety disorder.
There is also a higher rate of PMDD among women who suffer from migraines (that makes the author of this article a double-winner). It has also been found that women with Irritable Bowel Syndrome, Chronic Fatigue Syndrome, and women with lower levels of Serotonin in their blood tend to have PMDD.
How do you know if your PMS is actually PMDD?
There are certain physical symptoms that can help you distinguish whether your monthly symptoms are more severe than what’s considered normal. Sarah Noble, DO, a psychiatrist with Einstein Healthcare Network, says that breast tenderness or swelling, joint or muscle pain, weight gain, appetite changes or specific food cravings, headache, severe bloating, severe cramping, or fatigue several cycles out of the year—and this next part is key—that are enough to interfere with work, school, or social activities, can be indicators of PMDD. Other physical symptoms can include a racing heart, sensitivity to light and sound, low energy, joint pain, and back pain.
Your relationships might be impacted around this time every month. You may feel slighted or hurt by family or friends due to increased sensitivity and hyper-vigilance, and you may notice you have less patience for or are getting into more arguments with your romantic partner.
Emails, daily tasks, meetings, social activities, and other aspects of everyday life that normally feel manageable will start to feel scary, overwhelming, or otherwise negative where they would have felt neutral, doable, or even positive. Here are some other symptoms that can be indicative of PMDD:
- Your anxiety levels will spike from time to time and you may experience full-blown panic attacks or shortness of breath.
- You may feel sensitivity to rejection, perceived abandonment, or even thoughts of suicide.
- You may find that you lack interest not only in sex and engaging with your romantic partner, but also in your friendships and social activities or hobbies.
- Your sleep cycle might be majorly disrupted. If you struggle with sleep normally, during this time of the month, insomnia can be a nightmare.
- You could experience a lot of overthinking or rumination, self-deprecating thoughts, a dip in self-confidence, and trouble focusing.
How Do I Track My Symptoms?
Constance A. Young, MD, an ob-gyn at Columbia University Medical Center says to keep a diary of your symptoms—all of the above as well as any other major changes, along with the severity and duration—through your next few cycles.
Dr. Noble also suggests considering other variables, like a new medication or heavier drinking.
There is also an app, MevPMDD (because according to founder Brett Buchert, it really does feel like a battle), where you can check in daily on a sliding scale of dozens of symptoms, write in your self-love journal, keep track of new medications or supplements you may be trying, and find out what your options are for support and treatment.
“The Self-Love Journal is a safe space to write anything related to your journey with PMDD, whether it’s venting thoughts and feelings on hard days, keeping track of any symptom patterns you’re seeing, or writing notes of hope and love to yourself to read on darker days,” Brett said. “It’s a perfect place to keep a self-care and safety plan, gratitude list, list of things you’re learning to love about yourself, and notes from loved ones to remind you of your strength.
What Do I Tell Other People in My Life?
Buchert said that while it’s hard to explain PMDD to others who’ve never experienced it, it’s an important step in receiving the understanding and support we need and deserve from the people in our lives.
“Instead of going for the textbook definition, try describing PMDD with a metaphor. PMDD is like being allergic to your hormones, PMDD is like the dementors in Harry Potter are hovering over me for two weeks every month—something people without PMDD, especially people without periods, can relate to,” she said. “Then, I always think it’s a good idea to communicate why you’re telling them this.”
To your partner: I need you to know because I need extra love and support from you when I feel like I am breaking inside. I can’t do this on my own anymore.
To your boss: I need you to know not for pity or special privileges, but so that you know I am not a bad worker, I’m just doing what I need to fight through certain days and get my tasks done.
To your friends: I need you to know because sometimes I might cancel plans last minute or get extra irritable over small things. Know that when this happens I probably feel really bad inside. Your acceptance, patience, and friendship will always help.
Also, requests for kitten and puppy GIFs are never too much to ask, nor is the ability to vent.
Then, to top off these statements, add an actionable request so that the person can meet your needs best, like, “if you could pick up the kids when I say it’s a bad PMDD day, that would help me so much.”
What to do for Crucial Self-Care
Noble said that one of the most successful treatments for PMDD is lowering overall life stressors where you can.
“Given that PMDD occurs during reproductive years when women are often raising children or working on careers, this is often a challenging undertaking. One of the things we often have a hard time doing is taking time for our own relaxation or hobbies. Carve out 10 minutes to do deep breathing or 20 minutes for a walk. Get together with your girlfriends once a month to do a hobby together,” she said.
If you have to cancel plans because you physically or mentally will not be able to function or be present, give yourself the allowance for that. Same goes if you need to take a sick day. Just be a total rock star when you’re back to yourself, and don’t flake on your friends ’cause it’s raining or play hookie from work because you stayed up binging Netflix.
What Are My Options for PMDD Treatment?
Buchert explained that there are many treatment options for PMDD including therapy (Dialectical Behavioral Therapy is recommended), lifestyle and diet changes, exercise, mindfulness, and various supplements, but many women find medication is needed and beneficial. She adds that antidepressants (SSRIs) and oral contraceptive pills (OCPs) are the first line of medical treatment.
A woman with PMDD may need to try a few to find which works best for her. Also, if progesterone is low, some women may find relief from progesterone therapy; if levels are normal or high, increasing progesterone may cause symptoms to worsen. Buchert said:
If none of these treatments, or a combination of them, are effective enough, chemical menopause by taking Gonadotropin-releasing hormone analogues (GnRH analogs or GnRH agonists) is the next recommended step. GnRH agonists suppress estrogen production in the ovaries and are helpful for many, but adding back small amounts of estrogen and progesterone may be needed over time. The final medical treatment is surgical menopause, removing the uterus and most often the ovaries to eliminate production of estrogen and progesterone completely. This is a last-resort treatment, as the mental and physical changes associated with early menopause may add additional challenges and health risks. However, some women report complete PMDD remission post-surgery and new symptoms that are much less debilitating than PMDD.
However, the most common treatment plan for PMDD is combining medications with healthy lifestyle habits and changes.
If you suffer from anxiety, your doctor may prescribe Xanax or Valium for you to take as needed during this time of the month, or they may suggest adding an antidepressant to your daily routine.
Vitamins B6, magnesium (400mg), omega 3, Vitamin E, and calcium (500mg) all proved to be effective vitamin supplements for Judi Goldstone, MD, who lives with PMDD herself and has tried a number of different treatments.
“Ten years ago, when I started getting worse and worse PMS, I couldn’t find any doctor to treat me holistically. At that time, my ob-gyn wanted to put me on birth control pills and antidepressants. In addition to those, I’d also recommend consuming more high-protein foods or complex carbs like green vegetables, sweet potatoes, or beans, and applying primrose oil in the evening.”
Nutritionists also recommend leafy greens, and not letting yourself get too hungry—feed your cravings, but try to avoid piling on foods that bloat or are high in sugar, as they can make you feel worse during the crash.
This is why tracking is so important—learning what does and doesn’t soothe our bodies and help our symptoms is a process in life, often through trial and error. But awareness is key, and action is the other component.
Where Can I Find Support for PMDD?
There are online and in-person support groups for PMDD. But, for your personal wellness, you may want to consider seeing a therapist or psychiatrist who specializes in these issues.
Social support is crucial when managing PMDD or any other condition that affects one’s mental health, says Buchert.
“Close relationships with friends and family are a great PMDD defense; however, PMDD might strain these relationships at times. It’s best to help your friends and families understand that you need them on your team to fight this and work together to figure out how they can best support you. A compassionate therapist can also be a great support. Therapy often won’t ‘cure’ PMDD, but having a non-biased, kind person to vent to while also learning coping skills is invaluable,” she said.
Also, she adds, the online support network for PMDD is fantastic: there are support groups on Facebook and active #pmdd communities on Instagram and Twitter.
“The hashtag unlocks a community of beautiful women, fighting like warriors, who are committed to sharing their own experiences to help others. In addition, the Gia Allemand Foundation offers one-to-one peer support with trained peer supporters who are also fighting PMDD and ready to discuss anything from exploring diagnosis and treatment options to learning better skills to cope. This service is offered any time and anywhere over phone, email, text, and chat,” said Buchert.
Once we have all of this awareness about what we’re living with, it becomes a responsibility—to take care of ourselves and try to take care of the people around us as best we can, to honor our feelings and our experiences, and to advocate for ourselves—because nobody is going to do it for us.