You may think that mood swings, irritability and fatigue are just a part of your monthly cycle, but for a small number of women, this may be a sign of something more serious. Premenstrual dysphoric disorder (PMDD) affects an estimated 3.2 per cent of women worldwide, and its effects can be debilitating. To understand more about the symptoms of PMDD and how it differs from premenstrual syndrome (PMS), we caught up with a doctor who gave the lowdown on everything we need to know.
What is PMDD?
"PMDD (premenstrual dysphoric disorder) is a severe form of premenstrual syndrome (PMS). It is characterised by symptoms which occur in the weeks before your period and then improve after you have your period," explains Dr Masarat Jilani, an NHS GP.
According to The PMDD Project, 824,000 people in the UK have PMDD, and the effects can be so severe that around half of these will self-harm, and around 275,000 will attempt suicide. While it can affect anyone, research shows that women with ADHD are three times more likely to also have PMDD, proving the impact that hormones can have on mental health.
The 11 symptoms of PMDD
PMDD is recognised in the DSM-5, a psychiatric diagnostic manual, and is diagnosed by the presence of at least five of the following symptoms in the week prior to menstruation, which ease or stop when the period begins. "Often these symptoms are very severe and can really impact relationships and overall life," Dr Jilani says. According to the DSM-5, a woman must have at least one of the following symptoms:
- Marked mood lability/mood swings.
- Marked depressed mood, feelings of hopelessness or self-deprecating thoughts.
- Marked irritability or anger, or increased interpersonal conflicts.
- Marked anxiety or tension.
Additionally, there must be further symptoms, reaching a total of five between the two lists:
- Reduced interest in usual activities.
- Difficulty concentrating.
- Lethargy, being easily tired, or having a lack of energy.
- Marked changes in appetite.
- Sleep changes (hypersomnia or insomnia).
- A sense of feeling overwhelmed or out of control.
- Physical symptoms, such as breast tenderness or swelling, joint or muscle pain, bloating, or weight gain.
When to seek help
If you are experiencing these symptoms on a regular basis, it's important to seek help rather than suffer in silence, as Dr Jilani explains: "If you are ever experiencing difficulties with your mood/ mental health and it is affecting your quality of life, your ability to work or your relationships, then you should seek help immediately.
"Unfortunately, because PMDD is both a mental health condition and a condition which affects women, it can be associated with unhelpful stereotypes and stigma, which can prevent women from coming forward. The impact of PMDD on a woman's life is severe and should never be dismissed."
Treatment and management options
Luckily, there are a number of management options available for PMDD. All management options should be tailored to each individual to ensure they get the support they need and their preferences are taken into account.
Lifestyle changes:
Establishing a healthy diet, exercise routine and learning to manage stress can all help counteract the effects of PMDD.
"Options include lifestyle changes such as eating regular meals during the premenstrual period. Guidelines for eating every two to three hours and ensuring the meal is small, balanced and rich in complex carbohydrates such as whole-wheat pasta, brown rice and brown bread, as this can help reduce irritability, fatigue and depressive symptoms. Other key lifestyle measures include maintaining healthy habits around exercise, sleep and minimising stress," the GP says.
Medication:
Meanwhile, medication can also be effective in minimising symptoms. "In terms of medication, there are specific types of combined contraceptive pill (particularly those containing drospirenone) which can be helpful for PMDD. These are often more effective when used back-to-back without the optional break every three weeks. Other medication options include antidepressants, which can be taken continuously during the luteal phase (second half of the menstrual cycle)," Dr Jilani explains.
"If either of these options are not suitable or do not work, then there are other options available, including medication, CBT (cognitive behavioural therapy) and even surgery for severe cases where other options have not helped."
Living with PMDD
If you are experiencing any PMDD symptoms, it may help to keep a log of your symptoms throughout your monthly cycle, including when they start and end. This will provide helpful evidence to share with your GP when you seek help. It may also help to connect with other women who are experiencing PMDD via online communities, such as The PMDD Project.