November 19, 2021

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 affects around 5.5% of menstruating individuals. PMDD is not a hormone imbalance, although many people who suffer from PMDD often also have a hormonal imbalance. PMDD is a reaction to the normal fluctuating rise and fall of progesterone and estrogen levels in the brain. Symptoms of PMDD often intensify during reproductive events throughout the reproductive continuum including menarche (the first menstrual cycle), pregnancy, birth, miscarriage, and perimenopause. It is estimated that 1 in 20 menstruators are suffering from PMDD but 90% are misdiagnosed or undiagnosed leading me to believe that many more are struggling with debilitating premenstrual symptoms than the statistic estimates^.1 It takes an average of 12 years and 6.15 physician visits before individuals with PMDD get an accurate diagnosis.²

Individuals who experience PMDD are considered at a higher risk for self-harming behaviors including suicidal ideation. People with PMDD are 70% more likely to experience SI than those without a premenstrual condition and 34% of individuals with PMDD attempt suicide.³ 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.

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 ideation, 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.⁴

CHOOSING A TREATMENT PLAN

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

Allopathic Treatment Options:

Antidepressants
Hormonal Birth Control

+ Sometimes suggested within allopathic 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.

Taking an integrative treatment approach can drastically reduce PMDD symptom presentation but requires more support & more personal responsibility than taking medication. Sometimes we require medication initially in order to get our head above water far enough to commit to lifestyle & diet medicine protocols & that is certainly ok. 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. It is also critical to have a system in place for adequately monitoring your symptom presentation with any treatment protocol to accurately measure its efficacy. Remember you know your body better than any physician or practitioner ever can and you get to choose the treatment option that is right for you at each stage.

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 & 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 chat with you about your symptoms and am happy to support you through any stage of your PMDD experience. If you need a sounding board for choosing a treatment option, finding a provider, or getting a diagnosis please don’t hesitate to reach out.

Think you may be experiencing PMDD but you’re not quite sure.

Written by: Jes Hagan IMHC, Period Educator, & FAM Instructor