If you're someone who has periods or has ever been around someone with periods (so basically most of humanity), you've probably heard of PMS or premenstrual syndrome—the combination of symptoms that most menstruators get about a week or so before their period. Mood swings, irritability, trouble sleeping, and food cravings are among the highest on the list of complaints, and while regular PMS can be enough to affect daily life for some, Premenstrual Dysphoric Disorder (PMDD) is a much more severe form of this.
What is PMDD?
PMDD refers to the physical and affective symptoms that occur during the luteal phase of the menstrual cycle, which begins after ovulation and continues until your bleed starts. For most, this is about two weeks, and for those with PMDD, it can cause these days to be completely debilitating.
Both PMDD and PMS may cause symptoms from abdominal and breast pain to mood issues. PMDD is typically defined by having at least five symptoms during most menstrual cycles that relate to severe mood changes and physical symptoms which interfere with life's normal activities. In PMDD, symptoms are more extreme than with PMS and can include:
- Physical symptoms—cramps, body discomfort, headaches
- Behavioral symptoms—problems sleeping, changes in appetite
- Mental and emotional symptoms—feeling very anxious, angry, and depressed. It's reported that those with PMDD can have suicidal thoughts during this time, only to feel like a dense fog has been lifted on day two or three of their period.
What causes it?
There is no definitive answer as of yet, but research suggests that, as opposed to being a hormonal imbalance, PMDD is actually due to increased sensitivity to the normal hormonal fluctuations that occur during the monthly menstrual cycle, possibly due to inherited genetic variations. Symptoms appear to worsen when progesterone levels rise after ovulation, which seems counterintuitive, given progesterone metabolites have a somewhat calming effect.
What can be done?
PMDD affects at least 5.5% of people with periods (i.e., more than 1 in 20). Antidepressants and birth control are commonly prescribed as treatment, but changes in diet and lifestyle can also be effective. Nutritional support, certain supplements, and herbs may reduce symptoms, as can regular exercise, cutting back on caffeine, avoiding alcohol, and stopping smoking. Avoiding stressful and emotional triggers, getting enough sleep, emotional support, therapy, and using relaxation techniques, such as mindfulness, meditation, and yoga, also may help.
For further reading, see our blog post here.
CITATIONS
Del Río JP, Alliende MI, Molina N, Serrano FG, Molina S, Vigil P. Steroid Hormones and Their Action in Women's Brains: The Importance of Hormonal Balance. Front Public Health. 2018 May 23;6:141. doi: 10.3389/fpubh.2018.00141. PMID: 29876339; PMCID: PMC5974145.
International Association for Premenstrual Disorders
Hopkins Medicine