Premenstrual Dysphoric Disorder (PMDD) is a medical condition that occurs in only 8% of women; it is a severe condition that is connected to hormonal changes during the menstruation cycle.
“Dysphoria” is from the Greek root word “dysphoros”, meaning “difficult to bear”. Another translation is “a state of mental suffering”. In the context of this condition, it means that women are suffering both physically and mentally trying to live with the extreme symptoms that can be chronically debilitating.
There is no diagnostic tool for PMDD and it is important for the woman to seek professional help to rule out other medical conditions such as thyroid dysfunction, gynaecological/pelvic disease or psychiatric problems [i].
The cyclic nature of the symptoms paralleling the menstrual cycle should assist in the correct diagnosis, and having five or more of the following symptoms helps in the diagnosis of PMDD [ii].
PMDD shares symptoms with Premenstrual Syndrome (PMS), but has additional symptoms that make it even more debilitating.
The extreme mood swings of PMDD have a downstream effect on relationships and work performance. Relationships can deteriorate beyond repair as the family is subjected to cyclic patterns of behaviors and emotions that erode family interaction and intimacy; while employment can be affected as the woman’s physical, emotional and cognitive function are negatively impacted, making it difficult to sustain activity or performance during these times.
The shared symptoms of bloating, breast-tenderness, tiredness, joint pain and changes to appetite or sleep are compounded by additional symptoms [iii] such as:
- Feeling sad, hopeless, crying, depressed, suicidal;
- Panic attacks, feeling anxiety, stress and tension; unable to participate;
- Feeling extremely moody, out–of-control, irritable, unable to concentrate, angry, rages.
Getting the Right Support
It is important that women get the right support and are not marginalised or vilified for feeling and behaving as they do.
This medical condition is multi-faceted in that it impacts the psycho-social, environmental and biological aspects of the woman’s life. It can be extremely debilitating and costly to the woman and her family unit in terms of the woman’s ability to function and contribute to the family life, running of the home, financially and relationally. PMDD interferes with a woman’s capacity to care for and interact in consistent and meaningful ways with her children and her partner.
In seeking help, it is most important that the woman – and those around her – accept that the symptoms of this medical condition do not reflect a flaw in her character or psyche. It may be that it is the family who seek help on her behalf or who can be the catalyst for exploring diagnostic and treatment options.
The research recommends treatment through a combination of pharmaceutical and behavioural approaches [iv]. However there is also good evidence that in conjunction with psychological / behavioural therapy, life style changes can help reduce symptoms and improve resilience.
It is useful to journal and gather evidence about symptoms, their severity and duration as this can help in the diagnostic process. Once a diagnosis is established treatment options [v] include:
- Eat healthy foods including whole grains, vegetables (5 serves per day), fruit (2 serves per day), and reduce or remove salt, sugar, alcohol, and coffee (these act as stimulants and retention of fluid).
- Engage in regular aerobic exercise throughout the month.
- Engage sleep supportive techniques such as relaxation, reducing electrical stimulation, regulating bedtime (before 10pm to maximise REM sleep), reducing chemical stimulants before bed (i.e. caffeine), reading and music therapy.
- Hydration is important – drink 2-3 litres of filtered water daily.
- Vitamin supplementation as directed by your health professional – magnesium and calcium are a useful nervous system support.
These can only be prescribed by your doctor. Antidepressants such as selective serotonin reuptake inhibitors (SSRI) in micro doses have been found to help reduce symptoms of irritability and fatigue [vi]. They work by increasing the brain hormone “allopregnanolone” which has a calming effect.
It is important that health care professionals are sensitive to the woman’s perceptions around pharmacology, particularly the use of antidepressants that may hold negative meaning or stigma. A woman is less likely to be willing or compliant if she has these reservations.
A useful reframing would be to see the “homeopathic” dose like a “supplement” that boosts her own hormonal uptake, thereby reducing symptoms. If she were anaemic she would probably be okay about taking an iron supplement and this is no different. A risk versus benefits approach may be useful to engage the woman’s reservations and willingness to trial antidepressants.
Other medications which may be of some benefit include: analgesia to reduce pain symptoms, the mini-pill to suppress ovulation, or a specific diuretic called spironolactone to reduce excess fluid.
Alternative Therapies [vii]
In controlled trials, these alternative therapies showed varying degrees of usefulness:
- Relaxation techniques elicit the relaxation response, which has a physiological and psychological effect. It is recommended that these are utilised twice daily.
- Coping skills training.
- Light Therapy – full spectrum fluoro lamps affect serotonin levels.
Counselling and Cognitive Therapy [viii]
Cognitive Behavioural Therapy (CBT) is a process of guided support to challenge unhelpful thinking. It aims to retrain the individual to replace unhealthy thoughts that influence behaviour, with more helpful thoughts and activities. CBT may be used in conjunction with antidepressants over a period of weeks to gain insight and retraining in positive behaviours.
If you suffer from PMDD or much of the above sounds all-too-familiar to you, feel free to make an appointment with me so we can look at how best to manage your symptoms.
Author: Julie Fickel, RN, PG Cert Health Science, PG Diploma Midwifery.
Julie Fickel is a midwife with a passion for supporting women and their partners.
With over 20 years in family health, Julie has developed skills around communication and supporting individuals and their families to cope with change, grief and loss; fostering resilience during times of crisis or distress and more recently trauma therapy. She worked for Lifeline as a telephone counsellor, and group trainer for 3 years, as well as facilitated women’s recovery ministry groups while studying pastoral care.
Julie has extensive experience in counselling couples in pregnancy, parenting and partnering. She has a special interest in perinatal women’s issues with additional training at Griffith University to provide counselling for pregnancy, parenting support, perinatal mental health (depression and anxiety), and perinatal trauma.
Please note: Julie Fickel is currently not practising
[ii] Vigod SN. Understanding and treating premenstrual dysphoric disorder: an update for the women’s health practitioner. Obstet Gynecol Clin North Am. 2009;36:907-924, xii. [PubMed]
[v] A.D.A.M. Medical Encyclopedia. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004461/
[vi] Premenstrual syndrome and premenstrual dysphoric disorder. pmmd.pdf Monash. http://womenshealth.med.monash.edu.au