Pre -Menstrual Dysphoric Disorder aka PMDD, is becoming increasingly common.
This condition has severe symptoms, and they often last for 7-14 days out of a cycle.
It is described as a spectrum of mood and physical symptoms that occur during the luteal phase of the menstrual cycle and it is classified as a psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
Premenstrual syndrome PMS can be challenging and for a few days before a period.It is common for the medical model has normalised PMS, heavy or irregular periods. This needs to be addressed because any irregularities in menstrual bleeding must be seen as a red flag and dealt with accordingly.
It can take decades to get a diagnosis of PMDD or severe PMS, and sometimes only after misdiagnosis for illnesses like anxiety, depression, or bipolar disorder:
Symptoms of PMDD and severe PMS can include:
- mood swings
- feeling down or anxious
- feeling irritable
- feeling bloated – your tummy sticks out more than normal
- headaches or migraines
- breast tenderness or changes
- loss of interest in sex
- changes in skin (like spots or dryness)
- changes in appetite
- tiredness and/or difficulty sleeping / insomnia
- extreme fatigue and sleepiness
- food cravings (that often result in binge eating)
- joint pain
- weight gain
- trouble concentrating
PMDD is a huge risk factor for suicide, with one recent global study suggesting that up to
- 34% of people with PMDD have attempted suicide.
- 51% experience self-harm.
- 87% experience passive suicidal ideation.
Another study found that:
- 17% of subjects reported having lost a job due to PMDD.
- 57% had lost a partner.
- 43% reported problems with parenting.
- Just over 10% of respondents said they felt completely unable to parent during the worst parts of their cycle.
- Women with PMDD often must rearrange their lives and work to accommodate their monthly cycle.
In order for a woman to be officially diagnosed with PMDD, she would need to keep a diary of her symptoms over a few months to determine whether her symptoms appear cyclically.
According to the DSM-5, “at least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) should be present for diagnosis.
- Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts.
- Marked anxiety, tension, feelings of being “keyed up” or “on edge”
- Marked affective lability.
- Persistent and marked anger or irritability or increased interpersonal conflicts.
- Decreased interest in usual activities (eg, work, school, friends, and hobbies).
- Subjective sense of difficulty in concentrating.
- Lethargy, easy fatigability, or marked lack of energy.
- Marked change in appetite, overeating, or specific food cravings.
- Hypersomnia or insomnia.
- A subjective sense of being overwhelmed or out of control.
- Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation
Treatments include:
- SSRI antidepressants to modulate GABA receptors.
- hormonal birth control to shut down ovulation and progesterone.
- HRT.
- In some cases surgical intervention such as a hysterectomy is offered.
However –
- SSRI antidepressants have side effects including may increase the risk of osteoporosis.
- Contraceptive progestin drugs carry their own set of mood side effects.
- Women need ovulation and progesterone for long-term health.
- Contraceptive progestin drugs are bad for mood.
- Contraceptive progestins have been linked with anxiety and depression.
- They are not the same as natural progesterone and can often be why progesterone is demonised in mood conditions.
- Mood symptoms
There is still no clear understanding of what causes premenstrual mood symptoms.
A traditional view is people with PMDD have a neurobiological sensitivity to hormonal changes and are “wired differently”.
However, we work with PMDD as an inflammation, gut, blood sugar and oestrogen / progesterone imbalance.
What are the options for alternative treatments and natural therapy?
- Eat a diet that balances blood sugars to support hormones associated with mood such as ghrelin and leptin.
- Remove food intolerances to reduce inflammation.
- Use Adaptogenic herbs to reduce the impact of stress hormones ensuring that you make enough progesterone for the luteal phase of your cycle
- Work on gut health to reduce oestrogen dominance and supporting your liver with supplements such as N-acetyl-L-cysteine, Calcium-De-Glucarate and DIM (we recommend working with a practitioner to ensure these are safe for you to use)
- Explore how micronized, body identical progesterone can benefit you
- Work with a coach who is experienced with anger work to find a healthy outlet for the emotions.
For further support check out www.pms.org.uk