Premenstrual Dysphoric Disorder (PMDD)

9 Apr

The menstrual cycle is a remarkable piece of nature, deserving of respect. Every month (roughly, for most females* in reproductive years) a cascade of hormones increase and decrease in turn, with changes happening in the ovaries, uterus, and perhaps less often recognised, the brain. There are many symptoms that can accompany the cycle, including bloating, breast swelling or pain, headaches, bowel changes, skin changes and for some women mood changes. These are common and are often labelled as PMS (premenstrual syndrome).

A more extreme version of PMS is premenstrual dysthymic disorder (PMDD), which is experienced by up to 8% of women. This is when there are severe, cyclical, debilitating mood or psychological symptoms that impact activities, functioning and/or relationships.

Women who experience PMDD find the symptoms start in the luteal phase of the cycle (the week or two before a period) and then within a few days of the period starting, when estrogen and progesterone levels drop, it can be like a switch has flicked and they feel like their normal selves again. This monthly rollercoaster is exhausting and can have a significantly negative impact on a woman’s life. On a serious note, women with PMDD are at a higher risk of suicide than those without PMDD, thus, it must be taken seriously.1

The causes are not fully known, but it is thought that some women are more sensitive to the fluctuation of their natural hormones. Hormones reach every part of our body including our brains where they interact with neurotransmitters which influence mood. Many women notice that in the perimenopausal stage PMDD can worsen, and it is sometimes worse in women with ADHD or those who have experienced childhood trauma. Often PMDD runs in families.

There are no tests to diagnose PMDD. Tracking your cycle and when symptoms occur is key to recognising if you have this condition, and then seeking help. There are lots of ways to manage the condition.

Firstly, like most health conditions, let’s look at how lifestyle changes can help.

Regular exercise or movement increases the happy hormones in the brain, particularly aerobic exercise (brisk walking, running, swimming or cycling).
Of course, sleep is important but sometimes PMDD affects sleep so this can be tricky to manage.
Dietary changes such as reducing caffeine and alcohol and sticking to a healthy diet that avoids fluctuations in blood glucose levels may help.
Strategies to lower stress levels, such as yoga, spending time in nature, breathing exercises and meditation can help to control mood. CBT (or cognitive behavioural therapy) has evidence to support effectiveness for some women with this condition.

For many women with more severe symptoms though, medical treatments may be sought.

There are a few different options when managing PMDD medically and sometimes finding the right treatment for each individual can take trial and error. Levelling out the fluctuations in monthly hormones by providing a stable continuous dose of hormones with the oral contraceptive pill (combined or certain progesterone only pills) can be a game changer. Hormones may also be targeted by using MHT (menopausal hormone treatment).

Another target can be at the neurotransmitters in the brain where certain antidepressants given in the second half of the cycle can be helpful. Continuous rather than cyclical antidepressants are also often prescribed. Most women with PMDD can benefit from these simple treatment options. In extremely rare cases more complex treatments such as GnRH analogues to turn off ovarian function or even surgery may be required.