Premenstrual Dysphoric Disorder (PMDD): How it differs from Premenstrual Syndrome (PMS)

Tender breasts and bloating. Cramping and back pain. Acne and food cravings. Irritability and headaches. Sensitivity to light and digestive issues. These are just a few of some of the emotional, physical and psychological changes menstruators can experience during their cycle. For some of us, the list of premenstrual symptoms can include even more symptoms which can cause disturbances in our daily lives, routine, or even relationships and occupations. Many menstruators experience at least a few of these symptoms either prior to or during their cycle; approximately 80% of menstruators report experiencing at least one of the symptoms mentioned above when their Aunt Flow comes for a monthly visit .

For most menstruators, their cycle does not substantially affect their daily functioning and is easier to navigate. However, 32% of menstruators “report moderate to severe symptoms” that can seriously inhibit how they function or feel in at least one area in their life. Menstrual symptoms can be worsened by a variety of other cycle related disorders such as endometriosis, uterine fibroids, ovarian cysts, polycystic ovary syndrome, etc. All of which tend to be hard to diagnose, due to a lack of research of the female reproductive system as well as the stigma around period problems. We have discussed some of these menstrual disorders in previous blogs, but I have only researched very few of them (out of many). Matter of fact, I find it hard to believe that I am 27 and still learning/having to do research on how exactly my body works on a monthly basis. Conversation with others surrounding menstruation a long with personal experience has also led me to learn more about Premenstrual Dysphoric Disorder, which is a disorder that is quite debilitating and significantly amplifies regular PMS symptoms. I think sometimes we forget how much of an impact hormones have in our lives.

"PMS is often used in the general population and popular culture in a way to explain or dismiss a woman's volatile mood, depression, anger, or behavior."

What is PMDD?

PMDD is a severe menstrual disorder that actually affects 3-8 percent of all menstruators and causes overall dysphoria, which is a general dissatisfaction with life and even suicidal thoughts. It is also said that 90% of individuals with PMDD have not been diagnosed and will not be in their lifetime. Unfortunately, there are no diagnostic tests for PMDD or PMS and it has to be diagnosed by a health professional by keeping a journal of the severity and frequency of your menstrual symptoms. Mine began in the second month following my first cycle in 4 years, after a Mirena IUD removal. In other words, it came soon after I stopped taking the birth control that was altering the balance between my estrogen and progesterone. The symptoms of PMDD vary depending on the individual but can range from extreme depression and tiredness to extreme mood swings, self-loathing and paranoia. The fact this condition can be overlooked is alarming considering 15% of menstruators with PMDD have attempted suicide and "some young women affected are opting for hysterectomies".

On the other side, although PMDD is considered a cellular genetic malfunction and leads to both physical and psychological symptoms, it has also been known to increase spatial awareness and communication skills. As time goes on, more and more is being revealed about this menstrual disorder which leads professionals to believe that it has a strong genetic component and can be passed on from mothers.

“PMDD is ultimately a cellular genetic malfunction in response to hormone changes, and it should be treated as the serious medical condition that it is,” says Tory Eisenlohr-Moul, who studies women’s mental health at the University of Illinois at Chicago.

What is it Like for Me?

Unfortunately, due to the symptoms surrounding PMDD, I have had to be very transparent with those around me about my experiences and how they may influence my communication or relationship with them. The best way I can describe it, is suddenly being immersed in a dark foggy cloud that causes a melancholic exhaustion about 5-8 days before the start of my cycle. During this time, my self-confidence is diminished considerably, I become paranoid and I have sudden bouts of anger and crying spells that I feel I have no control over. In the past, I have actually found a correlation between the week before my period and conflicts with individuals in my life. There is only one week of the month where I do not experience extreme breast tenderness that affects me when I am getting dressed, trying to sleep, drive, exercise, etc. I find it hard to concentrate at work and especially difficult to retain information. It is also strange because I have never once experienced insomnia but during these 5-7 days of PMDD I experience noticeable insomnia. Weirdly enough, about 1-2 days into my cycle, the symptoms begin to subside and I am left in utter confusion attempting to understand how and why I may have felt or reacted that way. There have only been a couple of months where I have had more mild symptoms of PMDD, but most of the time I become fearful of how I will behave at work and in my relationships every month. I have also learned to limit myself from participating in certain things and schedule them around this time of my cycle. I have found this to be helpful during these times as I become uninterested in activities and emotionally imbalanced or hyper-emotional. Sometimes I feel for my partner, who has to observe these changes at home and knows there is nothing they can do to help. In order to help navigate around some of these symptoms I have found meditation and exercise to be very helpful at least for temporary psychological relief. However, some menstruators choose to go on anti-depression or anti-anxiety medications, make lifestyle changes, take up counselling, have hysterectomies, or take supplements in order to help with manage their PMDD.

As of right now, the best way I can describe it is just how it was explained by menstruators on the International Association for Menstrual Disorders' website,

"One week of hell and three weeks of cleaning up"

Interesting facts about PMDD

• "The disorder was only included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013, after plenty of debate"

• "PMDD is the only form of premenstrual disorder currently classified in the DSM-V"

• "PMDD is so murky partly because women’s health is understudied. Some sceptics are nervous about attaching another label to women that presents them as irrational"

• "PMDD is believed to be heritable as shown in studies on families and twins" and "is a suspected hormone sensitivity disorder in the brain"

• "PMDD is a severe negative reaction to the natural rise and fall of estrogen and progesterone"

• "In 2017, researchers at the National Institutes of Health (NIH) found that women with PMDD are more sensitive to changes in the sex hormones estrogen and progesterone, and they found that this might be due to a molecular mechanism in their genes"

• "Sufferers of PMDD report damaging and impulsive behaviors that may include suddenly leaving a job or a relationship"

• "There is evidence to suggest that women and AFAB," (assigned female at birth) "individuals with PMDD are commonly misdiagnosed with bipolar disorder"

For more information of PMDD as well as resources for sufferers of PMDD, check out the International Association for Menstrual Disorders' website here. Let's all urge each other to talk more openly about menstrual disorders as well as not normalize menstrual disorders as common PMS symptoms.