Throughout the menstrual cycle many folks will experience mood imbalances. As reproductive hormones fluctuate, they can affect mood hormones as well, resulting in some tearful, anxious, and angry days. These typically happen a few days before the menstrual week. But what degree of mood fluctuation is ‘normal’? When is it cause for concern with feelings of anxiety and depression surrounding the cycle? Premenstrual Dysphoric Disorder (PMDD) is a severe mood disorder occurring within the menstrual cycle¹. It is when people experience extreme psychological symptoms such as anxiety, depression, and hopelessness one to two weeks before every period.
Research shows PMDD affects 5-10% of people with periods but due to the condition being under-diagnosed that number could be much higher². PMDD can have an onset at any point in a person’s reproductive years, but the average onset is 26 years old. This disorder is thought to be a sensitivity reaction to hormones in the brain and is suspected to have genetic linkages as well. PMDD shares many characteristics with Major Depressive Disorder (MDD), the key difference being that PMDD occurs cyclically for one to two weeks every month before the menstrual week begins.
What Are the Symptoms of PMDD?
While PMDD is most known for its effect on mental health there are physical symptoms that may accompany it as well. According to the American Psychological Association and John Hopkins Medicine the most common symptoms are³–⁴:
Diminished interest in usual activities
Appetite changes (binges/loss of appetite/cravings)
How is PMDD Diagnosed?
There is currently no definitive blood, saliva, or urine test to confirm a PMDD diagnosis. The only way it is diagnosed is by a provider analyzing symptom tracking over the span of a few months².
It is vital that mood and physical symptoms be tracked daily alongside the menstrual cycle for multiple cycles for a provider to be able to properly analyze and diagnose PMDD. To learn how to track your cycle click here.
How is PMDD Treated?
It’s important to note that PMDD is a serious, chronic condition that often requires long-term treatment. Nobody needs to suffer in silence. There is no one correct treatment for PMDD, and working with your health provider is essential to figuring out what will work or you.
Some treatments options for PMDD are:
Antidepressants: SSRI’s can be extremely helpful for managing some folks’ PMDD and is considered the gold standard of treatment by the American College of Obstetrics and Gynecology⁵. Providers may opt to prescribe it as a daily medication, or as a “take as needed” during symptomatic weeks of the cycle.
Antidepressants have been a controversial treatment route for PMDD as they also have many potential side effects synonymous with the original symptoms of PMDD such as headaches, nausea, loss of concentration/interest. Working with your provider to find an SSRI that does not have adverse reactions on your system is key if you select this treatment option.
Hormonal Birth Control: Hormonal birth control is sometimes used to suppress the menstrual cycle in people with PMDD. Continuously taken oral contraceptives is thought to be an option as it can stop periods from occurring and thus halts the hormonal ebbs and flows that trigger PMDD.
Psychotherapy: Therapy can be helpful for strategizing and implementing healthy coping mechanisms for folks with PMDD. Pharmaceuticals don’t completely mask PMDD symptoms for many, so it can be helpful to be equipped with tools to help in moments of crisis.
Alternative Medicine: Some people with PMDD choose alternative practitioners to help manage symptoms of PMDD such as herbalists, naturopaths, nutritionists, etc.
What Should I Do if I Think I Have PMDD?
Track Your Cycle. To receive a diagnosis and formulate a treatment plan with your doctor you will need multiple cycles of daily mood/symptom tracking data.
Educate Yourself. Read about PMDD to better understand what to expect, and determine possible treatment options to discuss with your health provider.
Talk to Your Health Provider. Bring your cycle tracking information to your doctor and discuss the next steps to take. Write out a list of questions you have for your provider ahead of time, so you don’t forget any.
Seek Support Groups. There are many Facebook PMDD support groups and online forums for those with suspected/diagnosed PMDD to connect and share their stories and coping mechanisms.
If you think you have PMDD, help is out there, contact your health provider to take the next steps toward feeling better. Nobody should have to suffer in silence. You are not alone!
1. Hantsoo, L., & Epperson, C. (2016, June 2). Premenstrual dysphoric disorder: Epidemiology and treatment. Retrieved March 05, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890701/
2. Facts & figures. (2019, March 21). Retrieved March 05, 2021, from https://iapmd.org/facts-and-figures
3. Daw, J. (2002, October). Is pmdd real? Retrieved March 05, 2021, from https://www.apa.org/monitor/oct02/pmdd
4. Premenstrual dysphoric disorder (pmdd). (n.d.). Retrieved March 05, 2021, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd
5. Premenstrual syndrome (pms). (n.d.). Retrieved March 05, 2021, from https://www.acog.org/womens-health/faqs/premenstrual-syndrome