Ever felt bloated, grumpy or sad before your period? You might be experiencing PMS or PMDD.
You might be thinking: I’ve heard that PMS is the cause of grumpiness before my period, but what’s PMDD?
Let’s start with PMS. Premenstrual syndrome (PMS) is a collection of physical and emotional symptoms that start a week to a couple days before your period. It can cause physical symptoms, such as fatigue and bloating, as well as emotional symptoms, like mood swings, anxiety, sadness, and irritability. Most period-havers have experienced some kind of PMS in their life before, but for about 3-8% of the population, these symptoms affect their quality of life so much, it can become a significant problem.
That’s where PMDD comes into the picture. Premenstrual dysphoric disorder (PMDD) is one of the ways severe PMS symptoms can manifest. These may include extreme emotional symptoms, like extreme mood swings, heightened emotional sensitivity, and general feelings of unhappiness. Usually this is also in the 1-2 weeks before your period.
There are many ways to manage PMDD; lifestyle modifications, cycle tracking, vitamin supplementation, and therapy can help reduce these effects. If these aren’t enough, medication such as birth control and antidepressants are also often prescribed. Everybody is unique and it may help to see one or more doctors to build a comprehensive image of your options.
Is it PMS, or could it be PMDD?
Most period-havers have experienced some degree of PMS at some point in their life.
Symptoms can include:
- Sense of feeling overwhelmed
- Sensitivity to rejection
As well as physical symptoms like:
- Appetite increases (a perfect excuse for a munch on those chocolates)
- Breast tenderness
- Sleepiness or fatigue throughout the day
- Difficulty sleeping at night
For most people, these symptoms are unpleasant but manageable. However, if you have symptoms that are so severe they significantly impact your quality of life then you may have PMDD.
PMDD usually starts in a person’s twenties, though, less commonly, it can affect people earlier too. The symptoms may also get worse over time, which is why early diagnosis can be important for improving your long-term outcomes.
Some risk factors for PMDD can include:
- A family and/or personal history of a mood or anxiety disorder
- A family history of severe PMS symptoms
- Stress, especially if it’s unmanaged
- Being in your late-twenties to early-thirties
Also, generally, for PMDD, the symptoms begin in the 1-2 weeks before your period, and resolve on the first day of your period. If you have symptoms of a mental or physical health condition throughout your cycle that get worse before your period, this may be premenstrual exacerbation.
Treatments for PMDD
The first-line treatments for PMDD are similar to those for PMS. These can include:
- Tracking symptoms via the YourCycle app. This means you know when you’re likely to experience these symptoms and you can make lifestyle changes in advance to reduce them
- Calcium and/or B-6 supplementation
- Regular exercise
- Focusing on a balanced diet filled with nutritious foods
- Maintaining a regular sleep routine and trying to get to sleep before 11 or 12 each night
- Managing stress through mindfulness or trying to remove the causes of stress in your life
A medication option that may help some people with PMS symptoms as well as PMDD is hormonal birth control. However, for some people, hormonal birth control can make emotional symptoms worse so make sure you talk with one or two doctors to know the full range of possible effects and if this is something that feels right for you to try.
Therapies such as cognitive behavioural therapy (CBT) are commonly used to treat anxiety and depression symptoms, so they may help you learn to manage the emotional symptoms PMDD can cause. Cognitive approaches to treating PMDD can teach you how to interpret and react to your intense emotions so that they’re less disruptive to your sense of wellbeing and to those around you.
Selective serotonin reuptake inhibitors (SSRIs) are the most common type of antidepressant used to reduce the effects of PMDD. The hormonal fluctuations in the second half of your cycle can reduce the amount of serotonin in your brain. SSRIs block the reuptake of serotonin, which pretty much just means that it is likely to increase the amount of serotonin in your brain.
It’s common to take these antidepressants for only the 1-2 weeks leading up to your period, but in other cases, your doctor may recommend you take them daily. Work with your healthcare provider to make a plan that works for you.
There are some hormones you can take that may help with PMDD. However, they can reduce your hormones to menopausal levels (menopause is when your periods stop), so they are associated with side effects like vaginal dryness and hot flashes.
If all else fails, then an option that some people may consider is the surgical removal of the uterus, fallopian tubes, and ovaries with hormonal treatment afterwards. This is best reserved for only the very worst cases of PMDD and is usually offered to people who have had all the biological children they want to, and who find antidepressants unhelpful, or the side effects intolerable. Of course, this is a huge commitment! And it’s generally a last resort method. Still, if nothing else has worked, consider discussing it with your healthcare provider.
PMS is normal. But, if the symptoms impact your quality of life significantly, then rest assured, there are a broad range of ways that can help you reduce these symptoms. Lifestyle factors, supplementation, medication, and more. If you think you might have PMDD, we would recommend tracking your cycle and showing the logs, symptoms and the severity of your symptoms to one or more doctors for a comprehensive discussion of what may be best for you.
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Post by Miranda Bromage