Une femme souffrant de trouble dysphorique prémenstruel se tient la tête en criant.

Premenstrual Dysphoric Disorder (PMDD) Demystified | Mme L'Ovary

Premenstrual Dysphoric Disorder Demystified

Hello, beautiful soul.

Do you sometimes feel overwhelmed by intense emotions, inexplicable mood swings and a general sense of deep unease before your period?

You're not alone.

If, beyond that, these symptoms prevent you from living your life normally, you may be suffering from what's known as premenstrual dysphoric disorder (PMDD), a neuroendocrine problem that's still not widely known.

In the United States, April is dedicated to raising awareness of premenstrual dysphoric disorder.

We'd like to take this opportunity to shed some light on this condition, which can seriously affect the quality of life of sufferers and their loved ones.

First, understanding premenstrual syndrome (PMS)

Before diving into premenstrual dysphoric disorder, let's make sure we understand what premenstrual syndrome (PMS) is.

PMS, which is thought to affect around 75% of menstruating people, encompasses a range of physical, emotional and behavioral symptoms, the main ones being:

  • Physical symptoms such as abdominal pain or cramps, bloating, breast tenderness, headaches or migraines, increased fatigue, water retention (responsible for that "bloated" feeling), acne or other skin problems;
  • Emotional symptoms such as irritability, anxiety, mood swings, crying spells, mild depression, nervousness or tension;
  • Behavioral symptoms such as difficulty concentrating, changes in appetite, specific food cravings (often junk food), insomnia or excessive sleeping, reduced interest in usual activities.

Of course, this list is not exhaustive.

These symptoms generally occur during the luteal phase of the menstrual cycle, between ovulation and menstruation, but can sometimes begin up to two weeks before day 1 and last until day 6 of the cycle.

They are not necessarily all present during PMS, and may vary in intensity from one menstrual cycle to the next.

The symptoms of PMS, although unpleasant, generally have little or no direct and persistent impact on the lives of those who experience them.

It's on this nuance that everything hinges.

A woman suffering from premenstrual dysphoria frowns.

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (or PMDD) is a severe form of PMS, characterized by a marked intensity of the emotional symptoms usually associated with PMS, which has a significant impact on the lives of those who suffer from it. Here are the main symptoms.

Deep depression

People with premenstrual dysphoric disorder can experience severe depression, which inevitably interferes with their ability to function normally on a daily basis.

This depression can be persistent, leading to feelings of hopelessness, discouragement and despair.

Extreme anxiety

In addition to deep depression, anxiety can be a major symptom of premenstrual dysphoria.

People with this disorder can experience extreme anxiety, which manifests in panic attacks, constant nervousness and generalized apprehension.

Severe mood swings

The mood swings of someone with PMDD are more pronounced and severe than those of someone with PMS.

They can go from one emotional state to another in the blink of an eye, and this can be very destabilizing for both themselves and those around them.

Tensions in relationships

The emotional symptoms of premenstrual dysphoric disorder can put significant strain on personal relationships, including with partners, family, friends and coworkers.

Maintaining healthy relationships can be difficult for sufferers, leading to a profound sense of loneliness that can contribute to emotional distress.

Suicidal thoughts

Finally, suicidal thoughts are unfortunately common among people with premenstrual dysphoric syndrome.

These thoughts can be intrusive and difficult to control, and may even require immediate medical intervention.

Premenstrual Dysphoric Disorder is less common than PMS, but is estimated to affect between 3% and 8% of menstruating individuals.

The important thing to remember is that PMDD differs from PMS in the intensity and severity of the symptoms. Whereas PMS can be difficult but manageable, PMDD is debilitating and causes problems in the sufferer's life.

If you think you may be affected by this condition, we strongly encourage you to consult a healthcare professional, who will undoubtedly give you a full medical examination.

This will enable them to rule out any other medical conditions that could be causing similar symptoms, such as clinical depression, bipolar disorder or a simple hormonal imbalance, before making a diagnosis, if appropriate.

A woman suffering from PMDD is sitting on the floor in a curled-up position and leaning against the bathtub, staring at the floor.

What are the available treatments for PMDD?

When premenstrual dysphoric disorder is diagnosed, several treatment options can be considered, depending on the severity of symptoms and the individual preferences of the person concerned. These may include :

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy is a form of psychotherapy which has proven to be effective in treating the emotional symptoms of premenstrual dysphoria, such as depression, anxiety and suicidal thoughts.

It helps the person to identify and modify negative thought patterns and unhelpful behaviors that play a role in the intensity of symptoms.

Antidepressant drugs

Certain antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) can be prescribed as a treatment to premenstrual depression and anxiety associated with premenstrual dysphoric disorder.

These medications can help regulate neurotransmitters in the brain and reduce the intensity of emotional symptoms.

Hormonal contraceptives

Certain hormonal contraceptives such as combined contraceptive pills or hormonal IUDs can help regulate the hormonal fluctuations responsible for PMDD symptoms.

They can also reduce the severity of mood swings and physical symptoms associated with menstruation.

Nutritional supplements

Certain supplements, notably calcium, magnesium and vitamin B6, have been studied for their potential effectiveness in relieving PMDD symptoms.

We recommend, however, that you seek the advice of a physician before taking any supplement, to ensure its usefulness and compatibility with other medications.

Lifestyle changes

Adopting healthy lifestyle habits can go a long way to alleviating the symptoms of premenstrual dysphoric disorder.

Regular exercise, managing stress through yoga and meditation, eating a balanced diet rich in raw foods (fruits, vegetables and whole grains) and getting enough regular sleep are the most obvious examples.

In fact, whether we suffer from PMDD or not, these are all excellent habits to put in place in order to optimize our quality of life.

It's important that you consult a healthcare professional to discuss all possible options before embarking on a treatment plan. Maybe a combination of different approaches will be the best solution for you.

To facilitate assessment, we encourage you to keep track of your symptoms in a diary, as we tend to forget some once we’re in the doctor's office.

A woman writes down the symptoms of her premenstrual dysphoric disorder in a diary.

Is PMDD associated with other medical conditions?

You may be wondering if PMDD could be associated to other medical conditions like ADHD, endometriosis or polycystic ovary syndrome (PCOS)?

Although research is ongoing at the time of writing, some studies suggest a correlation between PMDD and ADD/ADHD.

Indeed, hormonal fluctuations associated with the menstrual cycle could influence neurotransmitters in the brain, potentially worsening ADHD symptoms in some people who menstruate during the premenstrual phase.

However, the exact nature of this relationship remains to be clarified.

In the case of endometriosis and PCOS, the links are much less clear, and no conclusions have yet been drawn.

Take care of yourself

Although premenstrual dysphoric disorder is not a mental health problem so to speak, its symptoms are unmistakably psychological, and its consequences can be serious, even dramatic.

If you find yourself struggling with suicidal thoughts or need immediate assistance, don't hesitate to call 911.

You're not alone in this struggle, and there are resources and support available to help you through this difficult time.

Don't stay in the dark. You deserve to be heard and supported, and your luteal phase doesn't have to be synonymous with psychological distress every month.

With L'Ove.


Sources :

Premenstrual Dysphoric Disorder (PMDD): Information for Patients and Families : Canada : eMentalHealth.ca

Premenstrual Syndrome - Gynecology and Obstetrics - MSD Manual Professional Edition

Premenstrual syndrome (PMS) - Yourperiod.ca

Premenstrual dysphoric disorder: an unrecognized suffering (in French)