From bloating to cramps to breakouts, most of us are more than familiar with the telltale signs of an upcoming period. In fact, many women experience some level of premenstrual syndrome (PMS) at some point in our life and while the symptoms are unpleasant, they’re usually quite manageable with a couple of paracetamol and a hot water bottle.
But for some women, the lead up to their monthly period is somewhat more of an ordeal. They might experience severe mood swings, sleeping problems, extreme anxiety and physical distress. These women are experiencing premenstrual dysphoric disorder, or PMDD – a relatively common but poorly understood condition that’s not often spoken about.
Here, we ask Dr Houda Ounnas of 25 Harley Street, to tell us everything we need to know about PMDD, from what it actually is, to the symptoms to look out for, to what you can do to help.
WHAT IS PREMENSTRUAL DYSPHORIC DISORDER (PMDD)?
“Almost all women have some mild premenstrual symptoms that signal the imminent arrival of their period every month,” says Dr Ounnas. “For some it’s merely an annoyance, some bloating and mild mood changes.”
However, for others, the symptoms are more significant and fall under the diagnosis of premenstrual syndrome. “About 20% of menstruating women suffer from PMS. Women with PMS have mostly physical symptoms and some minor mood disturbances caused by the changing hormone levels just before the period arrives.”
Sometimes, in about 5% to 8% of menstruating women, there are also debilitating mood changes which come together with the premenstrual physical symptoms. “This is another level up from PMS, and is called premenstrual dysphoric disorder, or PMDD,” explains Dr Ounnas.
According to Dr Ounnas, PMDD is a severe, sometimes disabling extension of PMS. “Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships,” she says.
WHAT ARE THE SYMPTOMS OF PMDD?
In both PMDD and PMS, symptoms usually begin seven to 10 days before your period starts and continue for the first few days that you have your period. The two conditions share some symptoms – bloating, breast tenderness, fatigue, and changes in sleep and eating habits.
However, in PMDD, at least one of these emotional and behavioural symptoms will be present – sadness or hopelessness, anxiety or tension, extreme moodiness or marked irritability or anger.
WHAT CAUSES PMDD?
“The cause of PMDD isn’t clear,” says Dr Ounnas. “Underlying depression and anxiety are common in both PMS and PMDD, so it’s possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders. What is worth noting, is that PMDD is biological and not merely behavioural.”
HOW IS IT TREATED?
Unfortunately, there isn’t a miracle cure for PMDD, and a lot of the treatment is about better understanding your symptoms. “Self-awareness and recognising the disorder and empathising with the self without judgment, is the first step in healing this disorder. Accepting that it is biology and not beating yourself over it as badly behaved, is key,” advises Dr Ounnas. However, Dr Ounnas also recommends a well-balanced diet, regular exercise and cutting back on caffeine and alcohol can all help alleviate symptoms. “It’s also a good idea to try relaxation techniques like meditation and mindfulness, as well as consider counselling.”
Plus, there are certain medicines that can help; “There are two options the antidepressant class of drugs that can help. SSRIs (Selective Seretonin Reuptake Inhibitors) may reduce emotional and sleep symptoms,” she says. The other option is the combined oral contraceptive pill; “it shuts down your fluctuating natural hormones, and replaces them with regular influx of artificial hormones.”
FINAL WORDS OF ADVICE?
“Whilst not dangerous to your health, PMDD can affect your relationships, both personal and at work and is definitely worth being aware of and controlling the symptoms,” advises Dr Ounnas. “If you have a partner, it might be with telling them that you suffer with this condition, just so they are aware in terms of increasing their window of tolerance and patience around you that time of month, when the symptoms are likely to be active.”