Everything you need to know about PMDD

Everyone has down moments from time to time. But what if you experience moods that send shivers down your spine every month? That you can no longer see reality clearly and everything is pitch black? It sounds like a thriller, but it's real, and it's called Premenstrual Dysphoric Disorder (PMDD). PMDD is a severe mood disorder that causes depressive feelings, rage, and more, affecting about one in 20 women.

You might be thinking now, another PMS-like disorder? Think again.

Because if you somewhat recognize yourself in this description, it's important that you read on. PMDD is real, and women with PMDD often need medical attention and are almost always treated with antidepressants or hormones—really, no peanuts.

So no, it's not a PMS-like illness, it's not ‘just’ a part of it, nor is it down to you. And you don't have to fight the battle alone.

How does PMDD occur, and what are the symptoms?

PMDD is difficult to recognize because it is not physical but mainly psychiatric—a psychological disorder. And although PMDD is directly related to the menstrual cycle, it is not due to a hormonal imbalance.

PMDD is a severe negative reaction to the natural rise and fall of estrogen and progesterone.

Here's the thing: your body, in its best version, forms a wonderful balance between all kinds of hormones. That balance makes you feel good and makes everything work as it should.

During your cycle, your hormones change, and that's normal. But some women are sensitive to these fluctuations (and sometimes they fluctuate too much). If this bothers you a lot, then you have PMS. If you suffer from this 10,000 times more, then we are talking about PMDD.

So all women have fluctuating hormones, but women with PMDD are incredibly affected. Why is that?

PMDD is thought to be a disorder at the cellular level, with symptoms worsening over time and sometimes worsening during menstruation, pregnancy, childbirth, miscarriage, and during perimenopause.

PMDD and your cycle

So PMDD is also linked to certain phases in your cycle - you feel good some days and incredibly bad some days. Women mainly suffer from PMDD during the luteal phase (after ovulation, before your period).

On Levenmetpmdd.be, one woman says: ‘I made the link with my menstrual cycle when I got a Fitbit. That was five years ago now. A Fitbit constantly measures your heart rate. On the days I felt bad, my heart rate shot up. As soon as I got my period, my heart rate stayed low again. That was the first time in my life that I made the link between my body itself and how bad things were in my head.’

The symptoms of PMDD

We just said it: one in 20 women experience it, but a diagnosis often takes a long time. Women with PMDD tend to be depressed, anxious, irritable, tense, often struggle with suicidal thoughts. But they often get misdiagnosed, which stagger them even further: bipolar disorder, borderline, or perhaps worst of all: when people tell you that you are acting out.

The only way to diagnose PMDD is to track symptoms for at least two cycles. These are the symptoms of PMDD:

• Mood swings/emotional changes (e.g., sudden sadness or tearfulness, sensitivity to rejection).
• Irritability, anger, or increased inner conflicts.
• Depressed mood, feelings of hopelessness, feeling worthless or guilty.
• Anxiety, tension, or feelings of being worked up or tense.
• Reduced interest in usual activities (e.g., work, school, friends, hobbies).
• Difficulty concentrating, focusing, or thinking; brain fog.
• Fatigue or low energy.
• Changes in appetite, food cravings, overeating, or eating attacks.
• Hypersomnia (excessive sleepiness) or insomnia (difficulty falling asleep or staying asleep).
• Feeling overwhelmed or out of control.
• Physical symptoms such as tender breasts or swelling, joint or muscle pain, bloating, or weight gain.

A diagnosis of PMDD requires the presence of at least five of these symptoms, one of which must be a ‘core emotional symptom’ (one of the first four).

Is there a solution for PMDD?

Unfortunately, there is no one-size-fits-all solution for PMDD, and treatments do not solve the problem but counteract the symptoms.

Women with PMS often benefit from lifestyle changes: sleeping regularly, getting enough exercise, eating a healthy and varied diet, avoiding sugar, caffeine, and alcohol, and not smoking.

In women with PMS, this can often be very helpful, and if you have PMDD, it can help but is often not enough.

Therefore, many women with PMDD are also prescribed antidepressants (often SSRIs), use hormonal contraception, or are artificially menopausal, and receive cognitive-behavioral therapy.

There are several hormonal treatments that can regulate your hormones, making the symptoms of PMDD less severe. So while PMDD cannot be fixed, there are many ways to ease the symptoms and learn to live with this condition.

For many women, the journey to diagnosis, a solution, or living with PMDD is a long one.

What can you continue to do in the meantime?

• Track your cycle and your moods.
• Set clear boundaries and be kind to yourself.
• Allow emotions and keep talking about your mental health.
• Let your environment know what is going on.
• Listen to your body—it doesn't let you know that you need to rest for nothing, for example.
• Keep looking for the right treatments.
• Find fellow sufferers.

And about that last point... at Guud Woman, you are not alone. If you are struggling with PMDD, we are here to help you, so chat with us. We're here to listen to you and give you advice and support. You are never alone.