The Battle Against Premenstrual Dysphoric Disorder (PMDD)

Have you ever felt really sad, angry, or tired right before your period? That is called PMS, or premenstrual syndrome, and it is very common. For some people, the feelings are much worse. They may feel so bad that they cannot go to work, school, or even get out of bed. This could be PMDD, premenstrual dysphoric disorder. Premenstrual dysphoric disorder (PMDD) is a type of depression. It affects up to 10% of women, even though many women do not know about it. We spoke to practicing psychiatrist and researcher Dr. Crystal T. Clark to learn more about PMDD.

In simple terms, can you help us understand what is PMDD?

It’s actually quite simple. As part of the monthly menstrual cycle, women’s bodies go through the luteal phase—which is typically 14 days before the period begins. During this time, your estrogen and progesterone hormone levels rise. Many women experience premenstrual syndrome (PMS) because of these hormone fluctuations. But some women are particularly sensitive to their body’s normal hormonal changes which is one of the underlying causes for premenstrual dysphoric disorder.

What are the symptoms it can manifest as?

PMDD can cause emotional symptoms such as moodiness, significant irritability, and sensitivity. Physical symptoms would include bloating and weight gain. And overall, it can lead to increased anxiety and depression in women who already suffer from it.

Especially during the luteal phase, women with PMDD can face significant challenges. They might have difficulty getting out of bed, have a hard time completing daily tasks, and experience impaired judgement and ability to make decisions. Self-esteem can also be impacted by feeling bloated or gaining weight.

And how does one know if they have PMDD?

Many women might not realize they have PMDD. It’s a common misconception that no matter what symptoms you have before your period starts each month, they are just normal, and you just have to deal with them. Women face it as a rite of passage, so to speak. But PMDD is a serious health condition that makes life very difficult for many women. It can onset at any point, including after childbirth. It can also be a risk for postpartum depression or postpartum anxiety.

I’d suggest women track their moods closely all month long for at least 3 months. This information will help a clinician tell if it is PMDD or something else. Also, keep in mind that women with ADHD, bipolar disorder, depression and anxiety can have symptoms that can get worse during the luteal phase, but that is different from PMDD.

If at any point your symptoms are disturbing your life and you cannot work around them, you should get help. Speak up and get help; you do not have to suffer silently.

Any recommendations on how to feel better? I mean, is it even possible?

Surely so! Leading a healthy lifestyle can directly help improve PMDD. Exercise, nutrition and sleep are all important, but remember to consult with your doctor because not all treatments are one size fits all. For starters, leading up to the 14 days before your period, you should pay attention to your diet. Sugar, caffeine and alcohol can all cause hormonal changes that impact PMDD symptoms.

Adding or maintaining exercise is also important during this phase. Supplements such as magnesium, vitamin B6, omega-3, chasteberry, evening primrose oil, and calcium can help as well.