Vicious cycle: The reality of living with PMDD
Premenstrual dysphoric disorder, more commonly known as PMDD, is the silent condition ruining lives. While many of us have suffered the effects of pre-menstrual syndrome (PMS) and painful periods (dysmenorrhea) over the years, the symptoms tend to be manageable and relatively predictable. PMDD, however, is significantly more intense. In fact, it can have serious repercussions on the physical and mental wellbeing of the sufferer. Now, as more and more share their stories of PMDD, we sought the expertise of Dr. Punam Krishan, a NHS GP and an honorary senior lecturer, who reveals the hard, often overlooked, realities of living with PMDD.
Image courtesy of Anthony Tran via Unsplash
WHAT IS PMDD, AND HOW DOES IT DIFFER TO REGULAR PERIODS?
Premenstrual dysphoric disorder (PMDD) is a more serious version of PMS and affects around 1 in 20 women/AFAB*. Most of us will experience a degree of PMS symptoms and can function with usual daily activities; PMDD, however, is more complex and significantly impacts the quality of life of the sufferer. Starting, on average, at around the time of ovulation and usually ending when a period arrives around two weeks later, and the most common symptoms include severe anxiety and depression.
WHAT CAUSES PMDD?
PMDD is an endocrine disorder, meaning it is due to an imbalance in hormonal regulation. It also has profound psychological symptoms. PMDD can impact negatively on all areas of life—work, relationships, quality of life, so it is essential to speak to your GP early on if you suspect you have symptoms suggestive of PMDD.
WHAT ARE THE SYMPTOMS OF PMDD?
The symptoms vary from person to person but typically mimic depression and generalised anxiety disorder where there are fluctuations in mood, anxiety, restlessness, tearfulness, hopelessness, tiredness, poor concentration, and an inability to enjoy things you usually would relish. There are also physical symptoms where it can range from generalised aches and pains, fatigue, headaches, sleep problems, and gut issues, including bloating and constipation. In extreme cases, for the duration of the menstrual loss, sufferers can even feel it is all too much. PMDD can have a profoundly negative effect on a person’s daily life.
WHO IS MOST LIKELY TO SUFFER FROM PMDD?
PMDD may begin during adolescence, however symptoms are more likely to appear during a patient’s twenties. These symptoms may worsen over time, particularly as we enter the menopause.
HOW IS PMDD DIAGNOSED?
We usually recommend to those who feel they may have PMDD to initially keep a diary or journal, in which they can document how they feel in and around their menstrual cycle. From this information, we can begin looking for patterns in behaviour, emotion, and the impact their menstrual cycle is having on their day- to-day life. We should be able to see the same fluctuations in symptoms, and from this, we can better diagnose whether the patient has PMDD or another underlying mood disorder and suggest treatment accordingly. The diagnosis is mostly based on history taking, rather than relying on tests. This makes it a clinical diagnosis.
WHICH TREATMENT OPTIONS ARE AVAILABLE FOR THOSE WITH PMDD?
Once we have a diagnosis you’ll be in a position where you can plan ahead to when you know symptoms will peak, and ensure you have support available during that time. It’s also beneficial that others around you know what to expect from PMDD and can offer you support when you most need it. There are many ways in which those with PMDD can help alleviate the physical and emotional side effects, but these are often found to be the most effective:
RELAXATION THERAPIES
Ensure you carve out time in your schedule to relax and invest in yourself. Many who suffer from PMDD find yoga and meditation to be integral to combating the side effects. Aromatherapy is also helpful in some cases.
TALKING THERAPIES
Regardless of your condition, counselling and cognitive behavioural therapy have been shown to help in learning how to reframe thoughts around it. At the time when your PMDD symptoms peak, you may find that talking to a professional or those in a PMDD support network will help you feel less isolated and provide you with an outlet to confide in.
DIETARY AND LIFESTYLE CHANGES
While this may not be possible for all PMDD sufferers and will not directly alleviate symptoms, exercise is key to creating a healthier mindset, as well as a healthier body. The endorphins from working out will boost your mood, which those with PMDD find to be essential in the run-up to the challenging weeks that lay ahead. Consuming less caffeine, sugar, salt and alcohol, while eating smaller, more frequent meals can help minimise uncomfortable symptoms that might make you feel worse.
THE PILL
If there are no contraindications and your doctor deems it safe to do so, the oral contraceptive pill can be trialled and may help to regulate and control the hormonal upheaval. This must be discussed with your GP.
ANTIDEPRESSANTS
Antidepressants can be very useful in helping ease the psychological symptoms of PMDD, as they can help to control the mood and increase the energy levels of the person taking them. Again, this course of action must be discussed with your GP.
HORMONE THERAPY
For those with extreme PMDD, hormone therapy may be considered. Past patients have been put on treatments leading to chemical- induced menopause, which simulates what it would be like to a hysterectomy and stops the body from naturally producing progesterone. This course of treatment will have to be discussed at length with your GP and other medical professionals.
If you think you may be suffering from PMDD, contact your GP for support and to discuss a treatment path. If you’d like to learn more about Dr. Punam Krishan and her work, follow her on Instagram @drpunamkrishan.