Symptoms of PMDD
Premenstrual Dysphoric Disorder (PMDD) is an endocrine-based, cyclical mood disorder which affects approximately 5.5% of people assigned female at birth (IAPMD, 2019). It is suspected that PMDD constitutes a cellular disorder in the brain, resulting in severe negative reactions to normal fluctuations in estrogen and progesterone. In the PMDD community, the week leading up to the start of menstruation is known as “hell week,” a time in which mood swings, uncontrollable crying, sensitivity to rejection, irritability, anger, interpersonal conflict, depressed mood, intrusive self-deprecating thoughts, feelings of hopelessness/worthlessness, anxiety, panic attacks, feelings of being keyed up/on edge, fatigue, difficulty concentrating/brain fog, food cravings, insomnia or excessive sleeping, loss of interest in usual activities, feeling overwhelmed and out of control, breast swelling/tenderness, joint or muscle pain, digestive issues and bloating are commonly experienced.
Symptoms can come on very suddenly and take place not only in the premenstrual phase, but also during menstruation, and around the time of ovulation. Many people with PMDD also experience severe menstrual cramps, menstrual migraine, and/or suicidal ideation as a regularly occuring symptoms. Even when symptoms are no longer present, many sufferers of PMDD describe the hardship of rebuilding their lives from the rubble left behind by symptomatic phases. Professional, personal, interpersonal and financial consequences of coping with this condition can be staggering, and many individuals feel they are playing catch up for the rest of the month and losing more than half of their lives to surviving PMDD.
Until PMDD is diagnosed, many individuals struggle to understand why they feel fine some of the time, and cease to function at others. Even once PMDD is diagnosed, it can be maddening knowing you can expect to ride this torturous roller coaster until menopause, constantly struggling to decipher what aspects of your PMDD experience are distortions of reality, and to what degree.
Myths About PMDD
- PMDD is caused by hormone imbalance
- Symptoms occur only the premenstrual (luteal) phase and resolve with the onset of menstruation
- PMDD can be “cured” with lifestyle changes (ex. Diet, exercise, supplements) alone
- PMDD only affects people who identify as women
Treatment for PMDD
Living with PMDD can be extraordinarily isolating. The symptoms of PMDD are inherently disruptive to interpersonal communication, and challenge our ability to socialize regularly. There is already little space to talk openly about psychiatric illnesses in general, much less about those based in the female reproductive cycle. The long history of the hysterization of women, and the continued normalization of female suffering compound the misunderstood nature of this topic. But PMDD awareness is suicide prevention, and gaining support, community and the ability to talk about the impact of one’s cycle is absolutely critical to managing PMDD. The experience of living with this condition can be an experience of increasing powerlessness over our ability to feel okay, an experience which amounts to consistent monthly or even bi-monthly re-traumatization. We may feel as though we are held hostage by our cycle, as though we are waging an endless war and losing our will to keep fighting.
In order to treat PMDD, it is necessary to address the biological, psychological and social triggers and consequences of this disorder. This might include finding a helpful doctor or psychiatrist who can prescribe appropriate evidence-based treatments, improving self-care, setting more realistic expectations, building your schedule around your cycle, learning to advocate for your needs with your partner, friends, family, employer, and/or most importantly, yourself, practicing radical self-compassion, developing coping skills, creating a individualized PMDD support plan, and healing trauma incurred from living with this disorder. Further, many individuals with PMDD have dual diagnoses (ex. PMDD and ADHD, PMDD and PTSD), and addressing those additional challenges is critical.
Therapy is in of itself inadequate to manage some of the biological realities of PMDD. Conversely, medication alone may not be able to engender the experience of acceptance, support and safety which support recovery, address the trauma incurred by the experience of living with PMDD, or provide the coping skills necessary to successfully manage this condition long term. We recommend a combination of therapy and ongoing consultation with your doctor about medication, in unison, to successfully support clients navigating a PMDD diagnosis.
Lindi Larsen-Williams, a student counsellor at LifeRoots Counselling, works with folx who are navigating a PMDD diagnosis.
“As a counselor I am in your corner, ready to meet you where you are, to validate your experience as it is, and to support you in finding grounding, meaning, and direction as you steer your ship through the horrific storm that is PMDD, towards a life that is not only tolerable, but truly worth living.”
She offers online sessions at a fraction of the cost—$60 for individuals or $80 for partners, with appointment openings as early as this week. Lindi offers video sessions to clients throughout Alberta, and offers free 20-minute phone consultations!
Interested to connect with Lindi?
Send her a message or book a consultation or your first session to get started!
Hantsoo, L., & Epperson, C. N. (2015). Premenstrual dysphoric disorder: epidemiology and treatment. Current psychiatry reports, 17(11), 1-9.
International Association for Premenstrual Disorders (2021). What is PMDD? IAPMD. https://iapmd.org/about-pmdd
Nillni, Y. I., Berenz, E. C., Pineles, S. L., Coffey, S. F., & Zvolensky, M. J. (2014). Anxiety sensitivity as a moderator of the association between premenstrual symptoms and posttraumatic stress disorder symptom severity. Psychological Trauma: Theory, Research, Practice, and Policy, 6(2), 167–175.
Pilver, C. E., Levy, B. R., Libby, D. J., & Desai, R. A. (2011). Posttraumatic stress disorder and trauma characteristics are correlates of premenstrual dysphoric disorder. Archives of women’s mental health, 14(5), 383-393.
Takeda, T., Tadakawa, M., Koga, S., Nagase, S., & Yaegashi, N. (2013). Premenstrual symptoms and posttraumatic stress disorder in Japanese high school students 9 months after the great East-Japan earthquake. The Tohoku journal of experimental medicine, 230(3), 151-154.