The Low Down on PMDD

Earlier this month, we dove into more details around premenstrual syndrome, or PMS. And while learning more about what PMS is and how it can be managed, we often forget about its more severe sister, premenstrual dysphoric disorder or PMDD.

PMDD, similar to PMS, is a group of physical and behavioural symptoms that occur in a cyclic and predictable pattern, typically in the two weeks prior to a period. It usually resolves in the few days after a period has started and may not be a significant issue for individuals until ovulation occurs again.

[NOTE: Of course, each person with PMDD is unique and different and symptoms may be a challenge in the “off-stage”.]

The occurrence of PMDD is much less often than PMS; PMS impacts an estimated 50-80% of women, whereas PMDD appears to impact only 3-8% of women with regular menstrual cycles. It’s important to note that we still don’t have enough information about non-binary and trans folks who have menstrual cycles, and how PMDD may impact them. And PMDD doesn’t discriminate between socioeconomic, cultural and ethnic backgrounds.

PMDD is a chronic condition, and like others it requires long-term treatment plans that incorporate self-care and community care measures. With appropriate systems in place, symptoms can be managed to maintain the highest quality of life possible.

Throughout a menstrual cycle, hormone levels fluctuate – this doesn’t appear to differ between women that do and don’t have PMDD, and for women that have PMS. It’s been thought that the changes in the hormones involved with menstruation (estrogen and progesterone) can impact brain chemicals such as serotonin – our “happiness” neurotransmitter. When this neurotransmitter has lower quantities and lower effectiveness in the brain, this can have significant impacts on feelings of depression and anxiety. However, while changes between estrogen and progesterone are similar between PMS and PMDD, it’s been thought that women with PMDD may have a higher sensitivity to these hormonal shifts and as a result experience more significant and intense symptoms than PMS alone.

PMS and PMDD share symptoms of fatigue, bloating, irritability and other mood changes however PMDD may also include feelings of worthlessness, frequent tearfulness, increased anger and aggression, and potential suicidality risk. Both syndromes are deserving of care and support – however, more intensive and specific support is necessary for folks with PMDD to stay safe and healthy at home.

At this time, there is no defined way to diagnose PMDD, aside from specific timing of when symptoms occur and resolve. Blood work isn’t necessary for diagnosis however it may provide other useful information that can be addressed and potentially manage symptoms, such as low iron contributing to anemia and fatigue. A knowledgeable and experienced provider may also ask a person to keep a detailed symptom record for a few menstrual cycles, to identify when symptoms happen.

How is PMDD treated if we don’t know how to diagnose it?

Regular, enjoyable and therapeutic movement may provide benefits in relaxation and pain relief – exercise has some mental health benefits as well, given an increase in endorphins that can occur. It’s important to know that this applies to enjoyable activity, not activity that is excessive and harmful to a person or creates a significant amount of pain and stress to engage in.

Some vitamin supplementation can be considered – the ones studied more frequently are the B vitamins, particularly B6 when it comes to symptom management. B vitamins are heavily involved in brain and neurotransmitter health, and can be depleted during periods of high stress. They may also provide some benefits in PMS symptom management such as cramping and abdominal pain.

Prescription medications may also be considered, particularly for folks experiencing depression and anxiety along with other PMDD symptoms – birth control may be an option in this area as it may confer benefits in regulating hormone cycles but might not work for everyone. It’s also of significant benefit to pair medications (especially those for mental health) with a caring and compassionate counsellor, as both symptoms and coping skills can be managed. And having someone to check in with around mental health concerns can be of huge benefit.

PMDD is not something to be brushed off or ignored – and if you experience it, you are deserving and worthy of supportive care. There are so many new communities on social media and within postal codes that can supplement other care resources!