PMDD, How much do you know about it?

A Conversation on Health 

You might be more acquainted with Premenstrual Syndrome (PMS), as it affects a considerable number of menstruating women—up to 75%, in fact. Symptoms such as mood swings, tender breasts, food cravings, fatigue, irritability, and depression are commonly experienced by many. However, a more severe form of PMS known as Premenstrual Dysphoric Disorder (PMDD) affects up to 20% of women. PMDD leads to significant emotional and physical symptoms during the week or two before menstruation, greatly impacting family and social relationships, as well as overall quality of life.

The precise cause of PMDD remains elusive. It could stem from an abnormal response to the typical hormone fluctuations that occur during each menstrual cycle. PMS, seems to be triggered by a sensitivity to the changing levels of oestrogen and progesterone, which may affect brain chemicals like serotonin, known to impact mood significantly. It's not clear why some women develop PMS or PMDD and others do not, researchers speculate that certain individuals may be more sensitive to hormonal changes than others.

Understanding the Luteal Phase.

PMDD occurs during the luteal phase of your menstrual cycle. This is the time between when you ovulate and when your period starts. Progesterone and oestrogen decline around days 22–24 of the menstrual cycle. This decline often triggers symptoms akin to premenstrual syndrome (PMS), with heightened irritability, negative mood, and potential skin issues, particularly notable in the latter part of the phase.

While any woman can develop PMDD, the following may be at increased risk:

• Women with a family history of PMS or PMDD  
• Women with a personal or family history of depression, postpartum depression, or other mood disorders

The Symptoms

The severity of PMDD symptoms can significantly impair women's ability to function at home, work, and in relationships. PMS and PMDD collectively encompass up to 150 physical and behavioural symptoms. Below are the most common ones:

Psychological symptoms: 

Lack of control 

Insomnia

Anger 

Depression

Difficulty in concentrating 

Anxiety

Confusion

Paranoia

Poor self image

Emotional sensitivity

Gastrointestinal symptoms:

Nausea

Bloating

Constipation

Abdominal cramps 

Vomiting 

Fluid retention:

Swelling of ankles, hands and feet

Periodic weight gain

Skin problems

Acne

Skin inflammation 

Additional symptoms include respiratory issues, eye infections, changes in vision, reduced coordination, decreased libido, hot flashes, intense menstrual pain, and alterations in appetite.

Challenges in Diagnosing PMDD

Unfortunately, diagnosing the condition in the UK is akin to other women's health issues. A recent study conducted by Oxford University, analysing global data, revealed that approximately 1.6% of girls and women, totalling around 31 million individuals, met the stringent diagnostic criteria for the condition.

The diagnosis process appears to be challenging and time-consuming. Researchers attribute this difficulty to various social and cultural biases surrounding the illness. Additionally, the study highlighted a lack of training on Premenstrual Dysphoric Disorder (PMDD) for psychiatrists and medical students, reflecting a broader trend in women's health education.

Dr. Reilly, from the Department of Psychiatry at Oxford University and the National Female Hormone Clinic, emphasised the urgent need for enhanced awareness and training among healthcare professionals regarding this debilitating yet treatable condition. Such improvements would enable patients to access effective, evidence-based management and support.

How can symptoms be alleviated?

1. Dietary adjustments: Increase intake of protein and carbohydrates while reducing sugar, salt, caffeine, and alcohol consumption.
2. Regular exercise regimen.
3. Stress management techniques.
4. Consider taking vitamin supplements like B6, calcium, and magnesium.
5. Anti-inflammatory medications may provide relief.
6. Selective serotonin reuptake inhibitors (SSRIs) can be effective.
7. Birth control pills may also help regulate symptoms.

Although  diagnosing and managing PMDD presents challenges due to societal and cultural biases as well as  inadequate medical training, there are various strategies individuals can employ to alleviate symptoms. From dietary adjustments to medication options, a comprehensive approach involving lifestyle changes and medical interventions can significantly improve quality of life for those affected by PMDD. 

I believe that heightened awareness and comprehension are essential to guarantee prompt diagnosis and efficient management of this frequently neglected condition.

As I conclude, know that you are not alone on this path to better health and wellness. Your journey is unique but together we form a community of strength and support.

Let’s thrive together,

Cristina x