Women experiencing premenstrual dysphoric disorder (PMDD) frequently encounter stigma, face increased health care expenses compared to those with mild to moderate premenstrual syndrome (PMS), and necessitate targeted medical interventions. Individuals suffering from PMDD often report a diminished health-related quality of life and a higher likelihood of suicidal thoughts in contrast to women without PMS.
Labeling PMDD as merely a common women’s issue or trivializing these women’s experiences as “just that time of the month” undermines the challenges faced by those whose relationships, careers, and overall quality of life are adversely affected by the disorder.
PMDD—the facts
- PMDD is a severe variant of PMS that impacts approximately 1.8 to 5.8 percent of menstruating women annually.
- This disorder includes a range of cognitive, physical, and emotional symptoms that emerge during the luteal phase of the menstrual cycle, which occurs between ovulation and the beginning of menstruation.
- The severity of these symptoms can result in considerable distress and disruption in daily life, harming relationships and productivity both at home and at work.
Diagnosing PMDD
Like PMS, PMDD symptoms emerge exclusively during the luteal phase and typically subside within a few days of menstruation. However, PMDD is recognized as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The DSM-5 stipulates that four specific criteria must be fulfilled for a PMDD diagnosis.
PMDD diagnostic criteria
-
Criterion A
At least five of the following 11 symptoms must be present, with a minimum of one from symptoms 1-4:- Depressed mood, feelings of hopelessness, or self-critical thoughts
- Anxiety, tension, or a sense of being "on edge"
- Significant mood swings
- Persistent and intense anger, irritability, or increased conflicts with others
- Loss of interest in usual activities
- Difficulty in maintaining focus
- Fatigue or low energy levels
- Changes in appetite, overeating, or specific food cravings
- Oversleeping or insomnia
- Feelings of being overwhelmed or out of control
- Other physical symptoms such as breast tenderness or swelling, headaches, muscle or joint pain, bloating, or weight gain
-
Criterion B
The severity of symptoms must significantly impact social, sexual, workplace, or academic functions. -
Criterion C
Symptoms must pertain to the menstrual cycle and not be exacerbations of other conditions like major depressive disorder, anxiety, panic disorder, dysthymic disorder, or personality disorders. - Criterion D
Criteria A, B, and C must be validated through daily symptom ratings for a minimum of two consecutive menstrual cycles exhibiting symptoms.
If you suspect your PMS may be severe enough to be classified as PMDD, begin by documenting your symptoms and their timing concerning your menstrual cycle. The Daily Record of Severity of Problems is a validated tool for tracking symptoms and diagnosing PMDD.
Consult your health care practitioner
Becoming attuned to your body’s needs is invaluable, but it’s essential to seek an official diagnosis from your health care provider. Bring your symptom journal to your appointment for a thorough discussion regarding the next steps.
Lab tests and imaging studies may help exclude other potential causes of symptoms. Conditions such as migraines, anemia, endometriosis, and hypothyroidism may present symptoms similar to PMS and PMDD and may require different treatment approaches.
Interpersonal relationships
Women with PMDD experience impairment in their interpersonal relationships during the luteal phase that parallels the severity seen in clinical depression.
Research has indicated that educating people about the condition can reduce prejudices against those with PMDD. One study found that individuals who received education about PMDD perceived those affected as warmer, less depressed, and more competent than those who were unfamiliar with the disorder.
Encouraging your partner, friends, and family to seek information about PMDD from credible sources may foster a better understanding of your condition. Open dialogue can help ease the burden and encourage empathy. When you’re feeling well, invite your friends to inquire about how PMDD affects your life. (See the sidebar for communication tips.)
Gender roles
Navigating the societal expectation that women should be kind, nurturing, and self-sacrificing can be challenging. PMDD can provoke angry outbursts, lead to fatigue that prevents you from fulfilling regular tasks, and result in withdrawal from social engagements, contradicting the ideal image of a woman, wife, or mother!
If you are managing PMDD, you might face criticism from your partner, leading to feelings of guilt and inadequacy. It’s important to practice self-compassion and recognize that these feelings do not truly represent who you are.
Regardless of your involvement in traditional domestic roles, it’s beneficial to communicate with your partner about distributing responsibilities. Intentionally lighten your responsibilities during the luteal phase and take on more during the follicular phase when you feel more like your usual self.
Communication tips
- Request flexibility from HR regarding scheduling, deadlines, and presentations.
- Plan important conversations with your partner for your follicular phase.
- Discuss boundaries with your partner concerning your outbursts.
- Share your needs openly.
- Consider couples therapy to address unmet needs and collaborative solutions.
- Inform your children in advance about needing personal time; refer to it as “grumpy mummy time.”
Mental health resources
- Cognitive behavioral therapy has shown effectiveness in alleviating PMDD’s impact while also addressing stress management and coping strategies.
- Psychoeducational self-help programs are beneficial for women managing mild to moderate PMS.
Natural premenstrual supports
- Calcium
Supplementing with 600 mg, twice a day, has demonstrated superiority over placebo in improving emotional and physical PMDD symptoms. - Chaste tree berry / vitex
Oral administration has proven more effective than placebo for tackling both emotional and physical symptoms of PMDD. - Bright light therapy
Morning and evening light sessions may help alleviate PMDD symptoms. - Magnesium and vitamin B6
Combining these supplements may be more effective than a placebo in reducing PMS symptoms. - Chamomile
An oral extract may work as well as mefenamic acid (an NSAID) for managing physical symptoms of PMS, and is more effective for emotional symptoms. - Geranium
Essential oil utilized in aromatherapy massage may surpass massage alone in alleviating both physical and emotional PMS symptoms. - Lavender
Inhaling lavender essential oil may improve bloating, pain, and emotional PMS symptoms. - Damask rose
Essential oil from this flower, whether applied to the skin or inhaled, has been found to alleviate menstrual headaches, fatigue, and bloating.
