Symptoms, anecdotes, and treatment: Premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a condition bought on by phases in the menstrual cycle. Dr. Nicky Keay, author of Hormones Health and Human Potential, summarises it as being ‘characterised by the severity of cyclical mental health issues associated with the menstrual cycle.’

In more detail, PMDD can cause mood swings, extreme anxiety, sadness, increased irritability, depression with feelings of hopelessness, and aggressive or angry feelings. As well as emotional, it can cause lifestyle changes and affect sleep, appearance, appetite, and fatigue. The person diagnosed with PMDD is not the only one affected, as struggling to upkeep relationships, psychosexually and psychosocially, is also a symptom.

It affects 5-8% of people who experience periods and are of reproductive age.

Many sufferers don’t realise they have the condition, or even that it exists. With 20-30% of menstruating individuals experiencing side effects around menstruation, PMDD is often thought of as ‘bad PMS’; they are just ‘unlucky’.

When I went to get diagnosed, however, I went to my appointment with the works; medical jargon, diary of symptoms, photos, records of my gym membership being used (there was a no-show for 10 days every fortnight) – I knew. I have kept a general journal for 6 years and it is peppered with phrases like 'feeling demotivated, lethargic, and uninterested in everything' turning into ‘omg feeling so happy again thank god’ like clockwork.

I was diagnosed immediately after showing him my resources and research, along with my accidental symptom diary (something that you are often asked to make anyway.)

I spoke with Ruby Raut, founder, and CEO of WUKA, Environmental Scientist, and listed in the 2019 Top Women in Femtech. Ruby grew up in Nepal, where shame about periods was widespread. The Nepalese word for period translates as 'untouchable'. She and her brand now work to smash taboos and provide innovation on menstrual health.

She explained to me that ‘There is still a stigma around PMDD, as it is not as well-known as PMS and some people may not understand or believe the severity of the symptoms. Additionally, some people dismiss the symptoms as just PMS or exaggerations of normal menstrual symptoms. People must understand that PMDD is not just "bad PMS". Nicky explained to me that women are even sometimes wrongly diagnosed with PMS instead of PMDD.

Treatments for PMDD include medication such as oral contraceptives, antidepressants, selective serotonin reuptake inhibitors (SSRIs) therapy, and other options like Vitamin B6 supplement and light therapy. There are also more lifestyle-aimed treatments like increased exercise, nutrition, stress management or light therapy, but such treatments for depression are often redundant. The thing about depression is it stops you from doing the very things that would alleviate it.
Nicky also told me that a non-hormonal treatment is Chaste Berry, a traditional medicine available as a supplement. I also self-medicated with Primrose Oil supplements after being told by a friend at the pub that they would ‘make you feel less crazy’. This was after a particularly bad week (Diary entry: ‘Felt extremely mentally ill and insane’). 

I explained to the doctor I was an active, creative, sociable, gym goer, and that believe me, I have tried the lifestyle changes.

Being prescribed SSRIs has been life-changing, and I would push anyone who relates to anything here to visit their GP. On a personal level, I would also push people to take the side-effects of blackouts and manic-ness when drinking on them seriously. Seriously.

As someone who is not depressed, it was difficult at first to grapple with the fact that I was taking medication for the condition. Taking a pill in the morning for a week every two hammers home the fact that I should be feeling sad right about now – I was waiting for it, but it never came.

PMDD is a leading cause of absenteeism from work and school, and results in decreased productivity and social isolation. I personally found it difficult to commit to social events, go to work, and find interest or point in things I usually love. 

How much I can now get done when I don’t take a hiatus every two weeks is shcoking me everyday. I'm almost tempted to start a hustle-culture, 5am wakeup, 10k run before dawn type podcast, or maybe not. 

Thank you to Ruby and Nicky for their help with this piece, please check out their work below:

Ruby's Company - WUKA
Nicky's Website
Nicky's Book 'A guide to Understanding for hormones to optimise your health and performance