Could it be more than 'just PMS'?
Premenstrual symptoms that you shouldn't be told to 'put up with'.
The menstrual cycle is a complex system that can affect everything from energy levels, to motivation, sex drive and mood. We are taught from an early age about PMS and PMT, and to expect some level of mood sensitivity in the week leading up to our period - but what happens when the severity of these symtoms impacts on our ability to function in daily life? Is this something we should consider 'normal'? Are premenstrual symptoms that affect your interpersonal relationships and performance in daily life, something that is just 'part of being a woman'?
For between 5-10% of people who menstruate, premenstrual symptoms are so severe they can cause a monthly 'dysphoria'. Read on to learn the premenstrual sympomology that is NOT considered 'normal'. If you are suffering with these symptoms you should track them alongside your menstrual cycle and seek help from a doctor. There is help and support out there and there are treatments available to help manage this monthly rollercoaster.
Symptoms of Premenstrual Dysphoric Disorder (PMDD) can be physical, but are largely psychological, in nature.
Diagnostic criteria for PMDD (DSM-V)
You may have PMDD if during most of your menstrual cycles during the past year, you have had five (or more) of the following symptoms occur during the final week before the onset of your period, and started to improve within a few days after your period started. At least one of your symptoms should be one of the top 4 symptoms (in bold) listed.
- Marked affective lability (e.g., mood swings; feeling suddenly sad or tearful or increased sensitivity to rejection)
- Marked irritability or anger or increased interpersonal conflicts
- Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
- Marked anxiety, tension, feelings of being "keyed up" or "on edge"
- Decreased interest in usual activities (e.g., work, school, friends, hobbies)
- Subjective sense of difficulty in concentration
- Lethargy, easily fatigued, or marked lack of energy
- Marked change in appetite, overeating, or specific food cravings
- Hypersomnia or insomnia (oversleeping or not being able to sleep)
- A subjective sense of being overwhelmed or out of control
The above list is by no means exhaustive (as many sufferers will tell you). Sensitivity to noise (misophonia), paranoia, wanting to run away from your life, suddenly feeling numb or 'out of love' with your partner (and the list goes on and on), are all common complaints across PMDD support groups.
Symptoms should be minimal or absent in the week after your period. If they are not, then it may be of interest to you to explore PME (Premenstrual Exacerbation). The correct diagnosis is important as treatment may differ. It is important to ensure the disturbance is not an exacerbation of the symptoms of another disorder, such as Major Depressive Disorder, Panic Disorder, Dysthymic Disorder, or a Personality Disorder (although it may be superimposed on any of these disorders).
The symptoms are associated with clinically significant distress or interferences with work, school, usual social activities or relationships with others (e.g. avoidance of social activities, decreased productivity and efficiency at work, school or home).
You need to track your symptoms, as diagnosis ‘should be confirmed by prospective daily ratings during at least two symptomatic cycles’. (The diagnosis may be made provisionally prior to this confirmation.)
It is important to ensure that the symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication or other treatment) or a general medical condition (e.g, hyperthyroidism).
In oral contraceptive users, a diagnosis of Premenstrual Dysphoric Disorder should not be made unless the premenstrual symptoms are reported to be present, and as severe, when they are not taking the oral contraceptive.
To read more about the etiology of PMDD click here.
To learn how to track your cycle for PMDD click here.
How is PMDD Diagnosed?
There is currently no blood, saliva or urine test that can detect PMDD. However thorough blood testing is recommended to rule out other conditions such thyroid issues or hormonal imbalance. If you do have PMDD you can expect your hormone levels to come back measuring within the “normal range”.
PMDD is a sensitivity to hormonal fluctuations and not a hormonal imbalance. (That is not to say you cannot have an imbalance as well as PMDD - but it is not the cause of PMDD).
To ensure you get the correct diagnosis you need to track the symptoms alongside your menstrual cycle through prospective (daily) symptom/cycle tracking. A diagnosis is made by looking at 'historical tracking'. You will need to record your symptoms and the severity of those symptoms over a couple of cycles by using some type of scale. You can track by using an app such as Me v PMDD and/or printing out a paper copy from IAPMD. It is important to note how these symptoms impact your functioning in day-to-day life and relationships.
If you feel you are in a crisis, seek help immediately, you can confirm your symptoms with tracking later.
Your doctor may wish you to be evaluated by a psychiatrist in order to rule out other mental health issues such as generalised anxiety, major depressive disorder, rapid cycling bipolar disorder or PME (Premenstrual Exacerbation of an existing psychiatric disorder). These conditions share many of the same symptoms and so there is a risk of misdiagnosis.
Want help chatting this through? Reach out the IAPMD peer support team who are really helpful. It is free, confidential and run by people who have (or have previously had) a premenstrual disorder - so you will never need to explain it.
Who can make a diagnosis?
This will vary from country to country. Your General Practitioner (GP) is often your first option. If you find that your doctor isn't knowledgeable about PMDD (which sadly isn't uncommon), you can ask to be referred to a specialist gynecologist or endocrinologist, or you could do some research to find a doctor who is experienced in this area - or willing to learn.
PMDD may also be diagnosed by a mental health professional or psychiatrist who should be guided by the definition of PMDD in the DSM-V.
If you are struggling to get help, you really are not alone - we've been there. We know it can be soul destroying, but keep knocking on doors until the right person helps. Read, learn and print official guidance documents and advocate for yourself - or take someone with you that can help you. To locate a health care provider recommended by PMDD patients, take a look at the IAPMD Global Provider Directory to see if someone has been recommended nearby. Don’t panic if no-one is listed yet, it does not mean there is no-one who can help, it just means no patients have recommended anyone yet.
The International Association for Premenstrual Disorders (IAPMD) have resources for health care professionals to help them recognise, diagnose and treat PMDD. This includes treatment guidelines and scientific papers.
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