If you thought PMS was bad, we’re introducing it’s more aggressive cousin - PMDD (Premenstrual Dysphoric Disorder). The research differs between studies, but a 2012 review showed it affects between two to five per cent of women of reproductive age. Some studies suggest it could be closer to 15%, depending on the criteria.
To call PMDD a very severe form of PMS is a bit of an understatement, but it’s still probably the best way to describe it. PMDD is “a very severe depression that occurs cyclically every four or five weeks,” explains Jayashri Kulkarni, a Professor of Psychiatry at Monash University who works in women's mental health.
Of course, there's more to it than that – and as with many women's health issues there are more questions than concrete, studied answers. But we want to raise the profile of PMDD, and that starts with making sure more people can identify it.
The 11 symptoms of PMDD are generally agreed to be experiencing any of the following symptoms in a way that impacts your life. If you experience five or more of these in a way that impacts your life, you might meet the diagnostic criteria for PMDD:
Often people find the mental symptoms of PMDD the most troubling. These can include cyclical bouts of extreme depression that can interfere with day to day life. PMDD causes severe irritability, anxiety, and low mood that usually occurs a week or two before your period.
It is these psychological symptoms of anxiety and suicidal thoughts that distinguish PMDD as a rarer and much more severe hormonal condition than normal PMS. The fact that 15% of women with PMDD attempt suicide gives us insight into how severe the depression is.
Normally, the mental symptoms of PMDD will ease once your period starts but the mood swings, anger, and conflict that they cause can develop issues in relationships and general wellbeing. For this reason, many women opt to take medication to settle the symptoms and avoid them interfering with their life.
PMDD's physical symptoms, like fatigue and migraines, are often misdiagnosed. They're very similar to PMS symptoms, and because of this can often go unnoticed or, at the very least, not appreciated for what they really are. Women with PMDD will often show symptoms at quite an extreme level, which goes some way towards ensuring a correct diagnosis.
Fatigue and a change in appetite are the two main physical symptoms that people experience, however some women also experience physical side effects like nausea, heart palpitations, dizziness, and fainting. These are essentially side effects of anxiety and tend to fluctuate at different stages of the menstrual cycle.
PMDD is related to hormonal changes that happen naturally in the body as a result of the menstrual cycle, however researchers are yet to figure out why it affects 5% of the female population.
The exact cause of PMDD isn’t known, although we do know that it has a heritability of around 30-80%. This means that women with a family history of PMS or PMDD are at a higher risk of developing the disorder.
If you think that you might have PMDD, the best thing to do is speak to your doctor and get a diagnosis. This way, you’ll be able to discover your options and find out if medication may be able to ease your symptoms.
Many women combat the physical symptoms of PMDD with painkillers like ibuprofen, naproxen, or aspirin. However, tackling the mental symptoms can be more of a challenge.
Medication can really help women with PMDD, with antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors) often being prescribed to ease the mental burden of the disorder. Oral contraceptives that contain drospirenone (such as Yasmin) have also been approved for the treatment of PMDD.