What is PMDD?

WHAT IS PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a chronic and cyclical, reproductive mood disorder. Symptoms of PMDD present 7-14 days before menstruation during the premenstrual or luteal phase of the cycle and usually improve once the menstruation starts. The condition effects up to an estimated 8% of reproductive aged women¹. While PMDD isn’t caused by hormone imbalances, many people with PMDD also have hormonal issues. Research shows that PMDD may be caused by a reaction to the normal fluctuating rise and fall of progesterone and estrogen levels in the brain.²,³ PMDD symptoms often worsen during major reproductive events like first periods, pregnancy, childbirth, miscarriage, and the transition to menopause. About 1 in 20 women experience PMDD during their reproductive years, though many cases go unnoticed or are incorrectly diagnosed. According to a 2020 study it takes an average of 20 years for a woman to receive an accurate diagnosis and treatment forPMDD.⁴

Those of us with PMDD are at a higher risk for self-harming behaviors including suicidal thoughts. People with PMDD face a significantly higher suicide risk – we are 70% more likely to have suicidal thoughts and 34% attempt suicide compared to those without premenstrual conditions.⁵ It is not uncommon for people diagnosed with PMDD to have a history of trauma or depression. In fact, people with a history of trauma are 6.7 times more likely to experience PMDD.⁶

Curious about the differences between PMS and PMDD? Listen to this interview.

GETTING A DIAGNOSIS 

PMDD cannot be diagnosed by blood, urine, imaging, genetic, or saliva testing. It is an elimination kind of diagnosis where first, specific testing must be done to eliminate any underlying conditions that could cause the PMDD-like symptoms.

In order to get a PMDD diagnosis, symptoms and their severity must be tracked for a minimum of 2-3 months. An OBGYN, mental health professional, nurse practitioner, or family physician can diagnose PMDD. Use the Symptom Mapping Kit to monitor your symptom duration and severity.

SYMPTOMS OF PMDD INCLUDE:

• Mood/emotional changes (e.g. mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection)
• Irritability, anger, or increased interpersonal conflict
• Depressed mood, feelings of hopelessness, feeling worthless or guilty
• Anxiety, tension, or feelings of being keyed up or on edge

• Decreased interest in usual activities (e.g., work, school, friends, hobbies)
• Difficulty concentrating, focusing, or thinking; brain fog
• Confusion & overwhelm
• Paranoia & increased negative thoughts about the self
• Changes in appetite, food cravings, overeating, or binge eating
• Hypersomnia (excessive sleepiness) or insomnia (trouble falling or staying asleep)
• Feeling overwhelmed or out of control
• Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating or weight gain
• Suicidal thoughts, self-harming behaviors

A PMDD diagnosis requires the presence of at least five of these symptoms, which occur 7-10 days before your period and subside shortly after menstruation. ⁷

CHOOSING A TREATMENT PLAN

These are the prominent treatment options available through western and integrative medicine. This list is not comprehensive nor is it medical advice. Please do your research and consult with your provider to choose the right option for you.

Western Medicine Treatment Options:

• Antidepressants
• Hormonal Birth Control 

+ Sometimes suggested within western medicine treatment options:

• Mental Health Counseling
• Biofeedback
• Comprehensive Medical Testing
• Vitamin D, Calcium, & Magnesium Supplementation

Integrative Medicine Treatment Options:

• Nutritional Therapy
• Regular exercise
• Sleep Hygiene
• Micronutrient Supplementation
• Stress Management
• Comprehensive Medical Testing
• Targeted Supplementation
• Interpersonal Relationship Tools
• Communication Training
• Menstrual Health Education
• Trauma Informed Therapies
• Hypnosis
• Mind-Body Therapies
• Cycle Syncing
• Endocrine Disrupting Chemical Exposure Reduction
• Relaxation Response Training
• Acupuncture
• Botanical Medicine
• Building a System of Collaborative Care
• & many more modalities & protocols!

Interested in learning how to reduce and better manage premenstrual symptoms through an integrative approach? Check out my program PMDD Rehab where I guide you step by step through the process.

An integrative approach can greatly reduce PMDD symptoms, but it needs more effort and support than just taking medication. While lifestyle and diet changes can effectively manage PMDD symptoms, some choose to start with medication. Either approach is valid – you get to decide what works best for your situation. There is no judgment in how you chose to treat or manage PMDD. It is just important to have a clear understanding of the side effects, risks, and other options. Tracking your symptoms is key to knowing if treatments are helping and catching negative side effects early. While doctors and practitioners can help, you’re the expert on your body and get to choose which treatments work best for you at different times.

I advocate for each individual’s body autonomy & encourage you to make an informed choice. You never have to accept a treatment option on the spot. You can simply say, “I’d like to think over my options and then I’ll contact you once I make a decision.” Here are a few prompts to help you navigate deciding what treatment option is right for you, right now:

– Is this a root cause treatment?

– Is this a sequential plan, if not what is my plan B?

– Do I need this treatment right now?

– How likely is it to help me and how much?

– What is my long-term strategy?

– What are the risks or side effects? How likely & how dangerous? Is it worth the risk?

– What alternatives could I consider: including watching, waiting, or more natural therapies?

I’m here to help with your PMDD journey – whether you need support finding a doctor, getting diagnosed, or choosing treatments. Feel free to reach out.

Ready to rewrite your PMDD story?

Start by getting informed about your treatment options in both Western medicine and integrative medicine. Remember, knowledge is power, and understanding your options is the first step toward reducing and better managing PMDD symptoms.

Looking for community support?

Join our FREE practitioner-led online community.

Want to go deeper into understanding and healing PMDD?

Join us in PMDD Rehab, where we’ll guide you step by step through a comprehensive approach to reducing and managing your symptoms. In our course, we dive deep into practical strategies for addressing stress, optimizing movement, improving sleep quality, adapting your diet, and so much more.

Citations:

3. Early analyses of the 2018 Global Survey of Premenstrual Disorders (GSPD) by the University of Illinois-Chicago and IAPMD

1. Halbreich U, Borenstein J, Pearlstein T, Kahn LS. The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology. 2003 Aug;28 Suppl 3:1-23. doi: 10.1016/s0306-4530(03)00098-2. PMID: 12892987.  ↩︎
2. Comasco E, Hahn A, Ganger S, et al. Emotional fronto-cingulate cortex activation and brain derived neurotrophic factor polymorphism in premenstrual dysphoric disorder. Hum Brain Mapp. 2014;35(9):4450-4458. ↩︎
3. Girdler SS, Straneva PA, Light KC, et al. Allopregnanolone levels and reactivity to mental stress in premenstrual dysphoric disorder. Biol Psychiatry. 2001;49(9):788-797. ↩︎
4. Osborn E, Wittkowski A, Brooks J, Briggs PE, O’Brien PMS. Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation. BMC Womens Health. 2020 Oct 28;20(1):242. doi: 10.1186/s12905-020-01100-8. PMID: 33115437; PMCID: PMC7594422. ↩︎
5. Eisenlohr-Moul, T., Divine, M., Schmalenberger, K. et al. Prevalence of lifetime self-injurious thoughts and behaviors in a global sample of 599 patients reporting prospectively confirmed diagnosis with premenstrual dysphoric disorder. BMC Psychiatry 22, 199 (2022). https://doi.org/10.1186/s12888-022-03851-0 ↩︎
6. Bertone-Johnson ER, Whitcomb BW, Missmer SA, Manson JE, Hankinson SE, Rich-Edwards JW. Early life emotional, physical, and sexual abuse and the development of premenstrual syndrome: a longitudinal study. J Womens Health (Larchmt). 2014 Sep;23(9):729-39. doi: 10.1089/jwh.2013.4674. Epub 2014 Aug 6. PMID: 25098348; PMCID: PMC4158950. ↩︎
7. Diagnostic and Statistical Manual of Mental Disorders (5th ed.), (2013), American Psychiatric Association. Washington, DC. ↩︎