PMDD is a hormone related mood disorder that affects some females during the luteal phase of their menstrual cycle (1-2 weeks before menstruation). While PMS is more commonly spoken about, PMDD is more intense, more disruptive and can significantly impact on one’s daily functioning, emotional wellbeing, work performance and relationships. PMS is more a descriptive term and not a formal psychiatric diagnosis.
While PMS involves mild to moderate physical and emotional symptoms that are uncomfortable, PMDD involves severe emotional symptoms that can feel overwhelming and disabling. Mood-related symptoms are the hallmark of PMDD, while PMS includes physical symptoms such as bloating, breast tenderness, headaches and fatigue. While physical symptoms may be present in PMDD, they are not the main cause of distress. PMS is thought to reflect typical responses to hormonal changes, while PMDD is associated with an abnormal sensitivity in the brain to normal hormonal fluctuations. So while PMS is more prevalent, PMDD is more severe, yet less common.
PMDD requires a diagnosis from an adequately trained professional such as a psychologist, psychiatrist or gynaecologist.
The core emotional symptoms must include one of the following:
- marked mood swings (sudden sadness, tearfulness or emotional sensitivity)
- Persistent irritability or anger
- Feelings of sadness, hopelessness or self-critical thoughts
- Intense anxiety
Added to the core symptoms must be some of the following (five or more in total):
- Anhedonia (decreased interest in usually activities)
- Concentration difficulties or brain fog
- Fatigue
- Appetite changes (overeating or cravings)
- Sleep disturbances (either too much or too little)
- Feeling overwhelmed
- Physical symptoms such as breast tenderness, bloating, joint or muscle pain, headaches or weight changes)
To be diagnosed with PMDD symptoms must be occur during the menstrual cycle, be present in the week before menstruation, improve shortly after menstruation begins and cause significant impairment in work, relationships or daily life. What distinguishes PMDD from other mood or anxiety disorders is the link to one’s menstrual cycle.
Importantly, PMDD us not caused by abnormal hormone levels. Rather, it is a result of increased sensitivity to normal hormone fluctuations. The hormonal shifts affect serotonin, which is the neurotransmitter responsible for mood regulation, emotional stability and impulse control. There is evidence to suggest that PMDD may be genetic.
Because PMDD can interfere with important facets of life such as work, studies and relationships, self help strategies are not sufficient – professional help is recommended. Early intervention can improve quality of life. Treatment may include interventions from a psychologist, psychiatrist (if medication is required) and a gynaecologist.
In addition, there are things one can do to improve their quality of life. These include:
- Tracking symptoms to identify patterns and plan around them
- Planning for lighter loads and extra support during the luteal phase
- Eating balanced meals
- Reducing caffeine, alcohol and refined sugars, at least during the luteal phase
- Reducing high intensity work or workouts during the high-symptom days
- Breathwork, meditation or grounding practices
- Good sleep hygiene
- Communicating needs clearly with loved ones
- Setting realistic expectations for difficult days
Bear in mind that PMDD is not a reflection of weakness. It is a medical diagnosis caused by biological factors. PMDD is highly treatable with the appropriate combination of professional intervention and self care.
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