PMDD (Premenstrual dysphoric disorder) is similar to PMS, but much more severe and often debilitating. It involves mood, cognitive, and physical symptoms caused by the normal variations in estrogen and progesterone levels during the later half of the menstrual cycle leading up to the next period. It can be difficult to get a diagnosis by a health professional, which may be partly due to confusion about whether it is a psychiatric or a hormonal disorder, and likely also because doctors are taught that patients are not trustworthy when it comes to reporting their menstrual symptoms. If you type “medical sexism period pain” into your search bar you’ll find a slew of fairly recent articles from Harvard University, the BBC, the Atlantic and more about doctors not taking menstrual complaints seriously (or womens’ pain in general). A 2020 study that interviewed 17 people with a diagnosis of PMDD found an average of 20 years of living with the condition before being correctly diagnosed, meaning these participants suffered for 20 years before they had access to appropriate treatment.
We’ll believe you
For the record: if you tell us that your symptoms are severe enough to be considered PMDD, we’ll believe you.
There is a popular belief that severe pain and intense emotional distress with periods are “normal”—just a fact of life if you have a uterus and ovaries. We’re here to tell you that menstruation does not actually have to be a horrible physical and emotional experience and that although we need more research on PMDD and more treatment options, there are treatments out there for PMDD that may help you feel better during the most difficult time of your cycle.
Symptoms of PMDD include anxiety, depression, irritability, angry outbursts, confusion and social withdrawal. Physically, some experience abdominal bloating, chest tenderness/swelling, weight gain, swelling of extremities, headaches, or joint/muscle pain. To officially qualify as PMDD, these symptoms would go away after day 4 of the cycle and wouldn’t reappear until at least day 13. It’s not considered PMDD if these symptoms are related to medication (including hormones), drug, or alcohol consumption. In order to be considered PMDD, these symptoms need to be “severe enough to interfere with social, academic, or work performance.”
Symptoms of PMDD include anxiety, depression, irritability, angry outbursts, confusion and social withdrawal. Physically, some experience abdominal bloating, chest tenderness/ swelling, weight gain, swelling of extremities, headaches, or joint/ muscle pain.
If you think that you may have PMDD, we suggest that you:
- Fill out the DRSP (Daily Record of Severity of Problems) for two months – a daily log of specific symptoms often used to diagnose PMDD.
- Reach out to a health professional for support that may help you get through the difficult part of your cycle immediately, i.e. before getting a diagnosis.
The cause of PMDD has been tricky to pin down. Research suggests that PMDD may be the result of heightened brain sensitivity in response to normal hormonal changes, thus affecting chemical signalling in the brain (specifically serotonin activity and GABA receptors). This makes sense if you consider the conventional treatment options that have shown some benefit: both SSRIs (taken either for the full cycle or only during the two weeks leading up to menses) and birth control (specific treatment protocols to affect hormonal balance) have been shown in research to decrease both emotional and physical symptoms of PMDD. Keep in mind there is no one-size-fits-all treatment; some SSRI treatments may work, while others may not and the same thing can be said for oral contraceptives (the birth control pill can even make symptoms worse).
Alternatives to pharmaceutical drugs
Pharmaceutical drugs aren’t the only things you can try to alleviate some of the symptoms of PMDD. There are multiple other options whether or not you choose to take medication. For example, an herb called vitex has been shown to help both physical and psychological symptoms of PMS and PMDD, although research has suggested that when compared to a popular SSRI, the antidepressant was better at treating mood symptoms while vitex did a better job at helping with physical symptoms. (Note that we don’t prescribe herbs; if you want to try herbal medicine we recommend that you seek out an herbalist.)
While there are some studies on PMDD and acupuncture that suggest benefit, there is a need for more research on the topic. In our 10+ years of experience however, acupuncture works well for some people who experience severe PMS or PMDD. We’ve had patients who can tell from their PMS/PMDD symptoms whether or not they’ve had acupuncture that month. For some, regular acupuncture can be the difference between minor PMS and utterly debilitating mood/physical symptoms for the latter half of the cycle.
If you have any questions about how we can support you with PMS or PMDD, please get in touch.
Cerqueira, R., Frey, B., Leclerc, E., & Brietzke E. (2017). Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systemic review. Archives of Women’s Mental Health, 20(6), 713-719. https://doi.org/10.1007/s00737-017-0791-0
Csupor, D., Lantos, T., Hegyi, P., Benkő, R., Viola, R., Gyöngyi, Z., Csécsei, P., Tóth, B., Vasas, A., Márta, K., Rostás, I., Szentesi, A., & Matuz, M. (2019). Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complementary Therapies in Medicine, 47, 102190. https://doi.org/10.1016/j.ctim.2019.08.024
Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American Family Physician, 94(3), 236–240.
Osborn, E., Brooks, J., O’Brien, P. M. S., & Wittkowski, A. (2020). Suicidality in women with Premenstrual Dysphoric Disorder: A systematic literature review. Archives of Women’s Mental Health. https://doi.org/10.1007/s00737-020-01054-8
Rapkin, A. J., Korotkaya, Y., & Taylor, K. C. (2019). Contraception counseling for women with premenstrual dysphoric disorder (PMDD): Current perspectives. Open Access Journal of Contraception, 10, 27–39. https://doi.org/10.2147/OAJC.S183193
Robertson, J. (nd). PMS and PMDD [Webinar]. The Confident Clinician Club. https://theconfidentclinicianclub.com
Lisa and Stef started writing together for the Guelph Community Acupuncture blog, and even though Stef no longer works at GCA, they continue to write about conditions they see in their respective practices, approaches to care, and barriers to accessing treatment.