Written by Mairead Cole.
I’m sure most of us will have heard the phrase ‘I’m PMSsing’, or ‘I’m sorry it’s just my PMS’. We sometimes feel the need to use this excuse when we are tired or snap at someone or simply when we are having a bad day. Yet, what most people don’t know is that the symptoms of premenstrual syndrome (PMS) -which up to 80% of women experience in some form in the second half of their menstrual cycle- can become even more severe in the form of PMDD, which unlike PMS is classified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders (a main manual that doctors use to diagnose mental health problems). In fact, PMDD is the only form of premenstrual disorder which is currently classified as a mental illness and it is estimated that 2-8% of women meet the criteria for it.
So what is PMDD?
Premenstrual dysphoric disorder (PMDD) is a very severe form of PMS; It is a hormone-related mood disorder which can cause emotional and physical symptoms to develop in the two weeks leading up to and including the first few days of your period. Whilst women who live with the disorder often experience PMS-like symptoms, the symptoms of PMDD are much more severe and are at increased risk of depression and suicidal behavior.
One woman who suffers from PMDD described her experience of it to the mental health charity ‘Mind’: “Once a month, I decided to press my own ‘self-destruct’ button and literally let my life (my normally very happy and satisfying life...) implode around me. Then when the dark thoughts lifted and completely cleared, I spent the next 2 weeks trying to pick up the pieces.”
Many of us have experienced PMS symptoms in our lives. Now imagine life with PMDD. The symptoms which interfere with your daily life, work, school, socialising and relationships can manifest both physically and emotionally and can go as far as dangerously affecting your mental health.
So why haven't I heard of it?...
If you hadn’t heard of PMS before, trust me, you aren’t the only one. (I hadn’t either before I started researching it)! Part of the reason for this is because still so little is known about the disorder. PMDD is a suspected cellular disorder in the brain and recent studies have shown that decreasing levels of oestrogen and progesterone hormones after ovulation and before menstruation may trigger symptoms. In other studies, there is a link between PMDD and low levels of serotonin, the chemical in the brain which transmits nerve signals. Certain brain cells that use serotonin also control mood, attention, sleep and pain and so a decrease in serotonin during certain points in the menstrual cycle can also contribute to the symptoms of PMDD.
The uncertainty about PMDD, within the scientific community and outside it, means many women often find it very hard to get a diagnosis. PMDD is very commonly misdiagnosed as other mental health problems such as depression or bipolar disorder because of their shared symptoms and it can take months or even years for the women who suffer from these symptoms to realize that they are linked to their monthly cycle.
What kind of symptoms help to diagnose PMDD?
Like with all mental health disorders, every woman will experience PMDD differently. It is important to remember that the symptoms discussed here are merely a guide not a definitive list. Many women will experience some of these and some may experience none.
- Pain in muscles and joints
- Changes in appetite, craving specific foods or overeating
- Breast tenderness or swelling
- Feeling bloated
- Mood swings
- Feeling anxious or hopeless
- Struggling to concentrate
- Struggling to sleep
- Suicidal thoughts
- Lacking energy
- Uninterested in doing things that you normally enjoy doing
There is no blood or saliva test to diagnose PMDD, so the main way a doctor can diagnose someone with PMDD is by tracking symptoms daily for at least two menstrual cycles, so you record which symptoms you experience and when in your cycle you experience them.
How can I get help?
The first port of call when it comes to getting a diagnosis of PMDD is your doctor. Being open and honest about both your mental and physical symptoms is vital in getting the help you deserve with managing PMDD. Alongside medical advice, daily lifestyle choices can help to relieve some of the symptoms for some women:
- Look after your mental wellbeing: No action is too big or too small when it comes to looking after your mental health and everyone is different so there is no wrong way to look after yourself.
- Talking: One of the most important things is to talk. It is sometimes nearly impossible to articulate how you are feeling, but having someone to listen to you and to show how much they care about you is vital. Sharing experiences can help to break down taboos surrounding both mental health and women’s reproductive health, so we have to get talking.
- Some may find it helpful to talk to a therapist, whilst others may prefer to be surrounded by friends and family.
- Look after your physical wellbeing: There are several lifestyle changes which may help to relieve or decrease the severity of PMDD symptoms. Some find it useful to change their diet, to increase their intake of protein and carbohydrates, whilst decreasing sugar, caffeine and alcohol. Others may look at maintaining regular exercise patterns and managing stress or anxiety through meditation or being out in nature.
The most important thing about PMDD is recognizing the benefits of talking about it with others, whether we do this through talking about our own experiences of it or through education. So, listen up ladies and get talking.