By Maarya Sheikh.

 We all know about PMS. Those 3-4 days before your period can be absolute torture. Feeling crampy, bloated, tired, and irritable even for a few days can disrupt the normal rhythm of your life. But what if your symptoms start more than a week, even two weeks, before your period every month? What if you experience sudden depression, anxiety, and fatigue so severe it impacts your ability to function? If that sounds like you, it may not be regular PMS.

PMDD or premenstrual dysphoric disorder, is sometimes described by sufferers as “PMS on steroids”. It affects almost 10% of women, yet is not a well-known condition. Symptoms including (but not limited to) anxiety, depression, extreme irritability, or fatigue can start 7 days or more before a person’s expected period. Some people even notice these symptoms around their ovulation window, which is why it is sometimes known as “late luteal phase disorder” by doctors. For most sufferers, these symptoms disappear when their period arrives.

Although the symptoms of PMDD are known, its root cause is not. Not everyone who suffers from it has a hormonal imbalance, but rather an unusual reaction to these hormones. There is some debate about whether it begins with the endocrine system, or neurotransmitter systems in the brain. Many doctors often misdiagnose PMDD sufferers with mood disorders such as bipolar disorder. However, unlike these mood disorders, the effects of PMDD coincide with your cycle in mostly predictable ways, and vanish in the weeks during and after your period. 

Women who visit doctors for PMDD symptoms often have their pain dismissed. They may hear things like “it’s only PMS”, and that symptoms like headaches, breast swelling, or back pain are totally normal. For this reason, it is difficult for them to get a correct diagnosis and they can suffer for many years. Living with untreated PMDD can cause problems for the person’s career and personal relationships, and even puts them at higher risk of self-harm and suicide

Getting a diagnosis

If you suspect you are dealing with worse-than-average PMS, here are a few things you can do:

  • Download a period tracker like Clue or Flo to log your mood and physical symptoms. This will help you find the pattern in your cycle.
  • Keep a detailed journal of your mood swings, brain fog or loss of motivation, and self-image. Some people report struggling with normal tasks, feeling “dumber” or more easily overwhelmed, which can often trigger fights in relationships. 
  • If your symptoms start 7 days or more before your period, get referred to an OB/GYN or endocrinologist. You may need to get some blood tests or even an ultrasound to root out conditions like endometriosis or PCOS. 
  • Realize that not all doctors understand PMDD, but stay firm and do not let them dismiss your symptoms. Go with a friend if necessary.

Treatment options

There is no medication or permanent solution for PMDD, but it can be managed with the following treatments:

  • Antidepressants: If your fatigue and depression symptoms are severe, you may be prescribed fluoxetine or sertraline to treat them. 
  • Birth control: OTC birth control pills like Yaz are often used to regulate hormone levels and provide relief for people with PMDD, endometriosis or PCOS.
  • Supplements: Herbal and vitamin supplements have been shown to help reduce the severity of PMDD symptoms. Calcium, Vitamin B6, folic acid, Vitamin D, and magnesium reportedly help manage mood, fatigue, and symptoms like breast pain. Omega 3s, 5-HTP, and Ginkgo Biloba are shown to help with brain function and trouble concentrating. Herbal supplements like Vitex Agnus Castus and Evening Primrose oil are also used to treat hormonal imbalance, although they are not as well-researched. 
  • Exercise: Regular cardio has been shown to help give a boost of energy, channel anxiety and ease some of the physical aches and pains associated with PMDD.
  • Diet and lifestyle: Quitting alcohol and smoking, cutting out caffeine and dairy as well as reducing sodium and sugar has been shown to decrease the severity of symptoms. Eating more protein and tryptophan-rich foods is recommended. 
  • Surgery: Rarely, and often as a last resort, doctors may recommend oophorectomy (removal of ovaries) or hysterectomy for people who cannot find any relief from the above treatments. 

    Your menstrual cycle may make you feel crazy, but you are not alone. Disorders like PMDD are under-researched and deserve greater attention, which is why talking about women’s health has never been more important. Awareness alone can make a big difference for people living with this condition. 


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