Understanding Premenstrual Dysphoric Disorder (PMDD)
If this is the first time you’re hearing about PMDD, you’re not alone. Despite being a serious disorder which affects the livelihoods of many thousands of women, PMDD seldom receives the attention it deserves, and it has been reported that around 90% of women with this disorder do not even receive a diagnosis.
So, what exactly is PMDD?
Premenstrual dysphoric disorder (PMDD) is a mood disorder triggered by the hormonal changes that occur 10-6 days before a woman menstruates. It causes intense mood and behavioural fluctuations which can significantly influence all areas or a woman’s life, including her work-life, academic performance, home responsibilities, involvement in social activities, and her romantic relationships. PMDD may begin any time after a female has had her first menstrual period, but usually starts to appear in a woman’s early twenties.
PMDD often goes hand-in-hand with anxiety and depressive disorders, which can sometimes lead to a misdiagnosis. Other disorders that may mimic PMDD symptomology include endometriosis, polycystic ovarian syndrome (PCOS) and thyroid disorders, and should be acknowledged as differential diagnoses when evaluating for PMDD.
What does PMDD look like?
Symptoms of PMDD can be somatic in nature (e.g. bloating and tender breasts) or may manifest through behavioural and/or mood changes (depressed mood, irritability, anxiety, anger, and increased sensitivity to rejection). Often, women with PMDD experience feelings of hopelessness, anxiety, tension, self-deprecating thoughts, and a sense of being on edge or out of control. Their increased irritability and anger also lead to interpersonal conflict, which can affect their personal and professional relationships. Other common symptoms include insomnia, food cravings, changes to appetite, fatigue, difficulties sustaining concentration, and a decreased interest in activities that the person usually enjoys.
It is important to remember that PMDD and PMS are not the same thing, and that equating the former to the latter can lead PMDD sufferers to feel invalidated, frustrated, and misunderstood. Although there may be some overlaps in symptomology between PMDD and regular PMS (i.e., breast tenderness, joint pain, and bloating), PMDD is a very serious mental disorder which can lead to significant impairment in social functioning and performance at work, school, or university. PMDD, therefore, has the potential to greatly affect women’s health in the workplace and is something that should receive more attention in the corporate sphere.
PMDD is considered a disorder that is highly co-morbid, as 30-70% of women with PMDD have a history of other mood disorders. That is why many health professionals sometimes struggle to distinguish PMDD from other reproductive or psychiatric disorders. One way of telling whether a woman might have PMDD is to establish whether her symptoms are continuous or cyclical. This can be done by carefully tracking her menstrual periods, keeping a diary of all mood fluctuations and other symptoms throughout the month, and looking for common patterns each month. With PMDD, symptoms typically begin a week before menses and start to improve at the onset of menstruation. If symptoms are minimal or absent after menstruation, and typically follow the same pattern every 28 days, this is an indication that the symptoms are cyclical rather than permanent.
What causes PMDD?
Research indicates that PMDD affects between 1.3% and 8% of women globally. Some probable causes of this mood disorder include genetics, psychosocial factors, and a central nervous system which is highly sensitive to reproductive hormones. It has also been suggested that a history of child abuse can be a predictor of PMDD. Research suggests that PMDD likely develops from an underlying genetic sensitivity to rapid fluctuations of the hormones estrogen and progesterone at the start of each pre-menstrual phase. The hormonal changes are believed to influence serotonin transmitters in the body, which leads to an imbalance in the mood-boosting chemical serotonin.
A treatment that is often suggested for PMMD is the administration of hormonal oral contraceptives. Since “the pill” supresses ovulation, it prevents the natural hormonal fluctuations that would usually come with it. Another possible treatment option for PMDD is anti-depressant medication, particularly selective serotonin re-uptake inhibitors (SRIs). These can either be taken continuously or intermittently (i.e., a week before the usual onset of symptoms). A non-pharma logical treatment that is useful in managing PMDD symptoms is psychotherapy. What must be noted for older women who have already started or gone through menopause, taking hormone replacement therapy can trigger the re-emergence of PMDD symptoms and should therefore be approached with caution.
Some good news
Although PMDD pays a visit every month for ten days, it doesn’t last forever. When a woman enters menopause in her late forties to early sixties, she stops menstruating, which means no more monthly hormonal fluctuations and no more PMDD. Sometimes, PMDD symptoms may worsen as a woman approaches menopause, but symptoms usually disappear completely once menopause has ended. Women with PMDD who receive a full hysterectomy (the surgical removal of the uterus, cervix, ovaries, and fallopian tubes) will also cease to experience symptoms of the disorder. The other good news is that women with PMDD don’t have to wait for menopause or opt for surgery in order to know what it’s like to live free from PMDD: those who fall pregnant enjoy a symptom-free nine months before the birth of their baby, along with an additional nine to eighteen month breastfeeding period where they will also be symptom-free (depending on when their menstrual cycle returns).
PMDD can be challenging to live with, especially when a woman has not yet received a diagnosis or has been misdiagnosed with something else. In such cases, women living with PMDD can experience significant frustration and may even come to feel hopeless, anxious, or confused. As with all mental disorders, however, the first step toward a healthier and happier life is to get a correct diagnosis, so that symptoms and their causes may be managed appropriately. By spreading awareness of PMDD, many women will have a better chance at receiving a correct diagnosis and will thereby be able to receive the right resources and treatment options for it. This can make symptoms a lot more manageable and can improve overall functioning and quality of life. So, ladies, let’s get the conversation started!
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