It's Like PMS, But Much Worse: Meet Premenstrual Dysphoric Disorder (PMDD)

With nearly half the women of reproductive age around the world experiencing Premenstrual Syndrome, its short form, 'PMS', has become a pop culture reference and the stuff of millions of jokes and memes. But there's nothing remotely funny about "PMDD", or Premenstrual Dysphoric Disorder, a far more severe form of PMS that can leave a woman in serious physical and mental distress.

There's a very long list of symptoms through which PMDD manifests itself. They range from nausea, vomiting, and body aches to acne, vision changes, and fainting spells, going all the way to depression and paranoia. These or other symptoms appear in the week before menstrual bleeding starts and they disappear a few days after the periods.

The cause of PMDD isn't exactly known; the general medical view is that the body has an abnormal reaction to the normal hormonal ups and downs that are part of every woman's menstrual cycle. PMDD is serious enough to make a woman almost lose control of her daily life.

It's vital to be able to read the signs of PMDD — and seek medical help — so that the distress doesn't drag the sufferer into a darker place. According to research, almost 30% of women suffering from PMDD attempt suicide at least once. This is a subject that needs open discussions, but social taboos and ingrained shyness to talk freely about menstruation erect a barrier between women and the knowledge they need.

For instance, a health survey done in Indonesia a few years ago found that one in five girls (20% of the survey respondents) never spoke about menstruation and related issues before she got her first menses.

Key facts

• Nearly 48% of women of reproductive age are affected by PMS worldwide
• Among them, about 20% of women have severe symptoms that disrupt their life
• Globally, around 5-10% of women of reproductive age suffer from PMDD
• A very recent study in Thailand, involving women aged 18-45 years, found that 13% of them had PMDD
• Among the survey respondents, 47.5% suffered from PMS

What is PMDD?

PMDD symptoms are similar to those of PMS, only far more severe, and PMDD comes with many more symptoms compared to PMS.

In PMS, women experience symptoms like low moods, irritability, fluid retention, breast tenderness, and bloating before their period.

In PMDD, women experience extreme sadness, anger, irritability, mood swings, and depression. The mood swings are much faster and more extreme. A woman may cry at the drop of a hat, or feel like yelling and screaming for the slightest of reasons. Her anxiety increases manifold, to the point that she starts feeling nervous all the time.

There's a feeling of fatigue and hopelessness that women experience when hit by PMDD. Nothing seems to shake off their boredom or restlessness. This perhaps explains their slide into suicidal thoughts.

PMDD and the risk of suicide

A very real, well-researched, and daunting aspect of PMDD is its ability to make women harbor suicidal thoughts, make suicidal plans, and attempt suicide.

•  The hormonal upheaval in PMDD-affected women is so violent that they're unable to process or rein in the overwhelming surge of negative emotions. Multiple studies have proven that this inability, in turn, makes them harbor self-destructive thoughts.
• PMDD-affected women are four times more likely than usual to think of suicide, and seven times more likely than usual to attempt suicide.
• The risk of PMDD is linked to genetic factors and psychological co-morbidities. For instance, according to one study, one-third of the women suffering from PMDD, also suffer from a borderline personality disorder. Other than this, environmental factors, past traumas, and smoking are also known to be contributing factors.

Diagnosis of PMDD

There are no particular tests or specific markers to separate PMDD from PMS, so it's easy to confuse PMDD with regular PMS, at the peril of letting the problem spiral out of control.

Therefore, a woman and the people close to her must recognize the symptoms she displays in the late luteal phase (a week before her period starts). They should be able to detect a pattern: whether those same symptoms keep recurring in every menstrual cycle or a lot of cycles.

This pattern is also what a doctor will first examine during the diagnosing phase. The doctor will ask about the severity of the symptoms, and whether or not the behavioral symptoms are also accompanied by physical ones such as insomnia, headaches, joint pains, and food cravings.

The doctor might suggest blood tests or pelvic exams to rule out reproductive disorders, but otherwise, there are no specific tests for PMDD.

Treatment of PMDD

PMDD, while medically categorized as a hormonal (endocrine-related) disorder, has been incorporated into DSM-5 as a mental health problem, due to the emotional and behavioral upheavals it brings along. DSM-5, short for The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is a very important manual used by doctors to categorize and diagnose problems related to mental health.

PMDD treatment incorporates a range of measures, from medication to psychotherapy, and even alternative healing methods. They are as follows:

• Birth control pills: Considering other factors, the doctor may suggest a course of hormonal birth- control pills with a shorter or no interval in the schedule. This prevents ovulation for the duration of the pill treatment, and the absence of ovulation means the absence of periods.
• Anti-depressants: An anti-depressant is a medication that can help regulate the levels of serotonin in a woman's body. Such medications are prescribed if the woman is experiencing severe depression or similar emotional issues. In the longer term, she may even be suggested to undergo Cognitive Behavioural Therapy. According to some studies, this therapy helps the woman recognize and deal with her negative thoughts proactively, thus keeping her from self-harm.
• Surgery: This option is suggested very rarely because it involves oophorectomy (removal of ovaries). While the absence of ovaries would stop PMDD, by stopping menstruation itself, this surgery also means premature menopause and related problems. Hence, it's usually the last- resort.
• Dietary changes:Cutting down on foods with excessive salt, sugar, caffeine, or fats can help reduce the impact of PMDD. Alongside, it helps to incorporate foods rich in pyridoxine aka Vitamin B6 into the diet. These include bananas, soya, oats, and poultry.
• Lifestyle changes: Women should aim to regulate their sleep patterns, do moderate exercise regularly, practice breathing exercises, and consider taking up mindfulness or meditation. Going for walks amid nature, playing a sport, jogging, or swimming can boost neurochemicals, which act as natural anti-depressants. Indulging in a hobby, playing with a pet, journaling thoughts, and listening to music can help alleviate negative emotions when practiced consistently.

Let's talk about PMDD

PMDD is a difficult disorder to live with and is also quite misunderstood in many countries. Since there's a tendency to dismiss PMS as a joke, by extension PMDD is also not taken very seriously, even though it's a very serious syndrome.

Also, in the absence of particular diagnostic tests and specific markers, it can take a long time for women and medical practitioners to separate PMDD from heightened PMS.

Adding to the problem, there's widespread ignorance and social stigma about menstruation in general. Even today, in Asian countries like India, Malaysia, and Indonesia, many socio-religious ideas prevent women from speaking freely about menstruation and related issues. When young women develop symptoms of PMDD, they often have no idea what's happening or, whom to approach for a talk.

It's time to rip the opaque curtain of silence and address these issues with the gravity they deserve.