Do you Have PMDD?
Sometimes PMS can feel absolutely overwhelming, and in these cases we want to consider premenstrual dysphoric disorder as the true cause of the symptoms that you may be experiencing.
What is PMDD & how does it differ from PMS?
Otherwise known as premenstrual dysphoric disorder, PMDD is a collection of mainly emotional and behavioural symptoms which happen before your period, and may negatively impact your quality of life.
PMDD is similar to PMS, but primarily focuses on the number, severity and characteristics of psychological symptoms.
Why does PMDD happen?
We don’t know why PMS occurs, and like most women’s health conditions (ie. endometriosis), we don’t know why PMDD happens. Nevertheless, it’s thought to be due because of hormone sensitivity, especially with progesterone. This is not due to an imbalance of hormones per se, but due to abnormal responses to normal ovarian steroid changes.
Symptoms of PMDD
Diagnostic symptoms for PMDD is found in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, and includes:
One (or more) of the following symptoms must be present:
Mood swings, feeling suddenly sad or tearful, increased sensitivity to rejection
Irritability, anger, or increased conflicts
Depressed mood, feelings of hopelessness, self-deprecating thoughts
Anxiety, tension, feelings of being keyed up/on edge
One (or more) of the following symptoms must be present (in addition to the above symptoms):
Decreased interest in usual activities
Difficulty in concentration
Lethargy, fatigue, lack of energy
Changes in appetite, over eating, specific food cravings
Hypersomnia or insomnia
Feeling overwhelmed or out of control
Physical symptoms such as: breast tenderness, swelling, joint or muscle pain, bloating sensation or weight gain
Diagnosing PMDD is similar to diagnosing PMS. You must be experiencing some of the above symptoms during a specific time in your cycle. Moreover, it actually takes at least 2 months to diagnose PMDD.
Here are the specific criteria:
Symptoms occur after ovulation (aka. if you’re not ovulating, it’s not considered PMS)
At least 5 (of the above) symptoms are present
Symptoms occur in the final week before the start of your period
Symptoms begin to improve within a few days after your period
No symptoms should be experienced by the end of your period and before ovulation
Symptoms must be rated (the best tracker to use is called the Daily Record of Severity of Problems)
Symptoms do not occur because of an underlying issue (see conditions below)
Symptoms must cause significant distress or interfere with work, school, social activities, or relationships with others
Conditions that may worsen PMDD
There are other health conditions that may mimic the symptoms of PMDD. They include:
Persistent depressive disorder
First of all, these symptoms need to be tracked on the DRSP. Secondly, if PMDD is truly the reason for these symptoms, they should be disappearing at or after your period. If they are occurring all month long, then there’s probably an underlying issue that’s not PMDD, and instead these symptoms are being magnified during your period!
That said, these conditions may concurrently occur with PMDD.
Non-Pharmacologic PMS Treatments
Reducing inflammatory foods
Admittedly, this is probably not the treatment you’re most excited about (I get it), but it is a helpful one! Inflammation disrupts communication between hormones, and can affect neurotransmitters.
Start slow, and say “see ya” to dairy first. Once you’ve got that covered, add alcohol to the list too. One of the treatments for PMDD is increasing your calcium intake. Obviously this is tough if you’ve cut out dairy – but you can skill get calcium from leafy greens, sesame seeds, and quality supplements!
Stress often results from an imbalance between demands and resources. For instance, you may have a deadline at work, but no time to complete your tasks. Stress may occur due to a variety of reasons and may be daily hassles, traumatic events, or even be perceived.
Stress has many effects on the body, and it may predict cyclical mood changes, and can arise from past traumatic events, current life stressors, or perceived stressors. With respect to the cycle, stress can specifically worsen PMS symptoms, and increased stress can actually predict more severe symptoms as well. It’s the gift that keeps on giving.
Tackling the topic of stress is a huge issue on it’s own, and certainly requires a spectrum of different treatments, some listed below. However, simple techniques like practicing self care and emotional regulation can be a good start-off point.
This might seem like a no-brainer, but sleep is critical when it comes to ensuring that our body has recharged. What’s my sleep routine? I aim for 8 hours of sleep, in a cool, dark and quiet room. If I’m using a device before bed, I’ll have it on night mode. And on some nights, I start to wind down with a glass of chamomile and lavender tea.
This often deficient nutrient, is needed in almost 300 of our body’s chemical reactions! It helps to reduce inflammation, stress, and acts as a muscle relaxant. Leafy greens and pumpkin seeds contain magnesium, but often choosing the right form and dose of a supplement will help replenish your stores faster.
This vitamin has mixed reviews when it comes to helping PMS. It also helps reduce inflammation, promotes better detoxification of estrogen, and is needed for the formation of progesterone and neurotransmitters. Too much Vitamin B6 might cause numbness in the fingertips and toes, so be sure to work with a healthcare practitioner when using it.
Chasteberry (Vitex Agnus Castus)
This one of my most beloved herbs. It improves communication between the brain and ovaries, and helps to calm the nervous system. I frequently recommend it to my clients.
CBT & DBT
Cognitive Behavioural Therapy is a form of psychotherapy that treats problems and boosts mood by changing dysfunctional emotions, behaviours, and thoughts. Whereas Dialectical Behavioural Therapy provides you with new skills to manage painful emotions and decrease conflict in relationships.
CBT often addresses the idea of ‘hot thoughts’ (ie. I’m not good enough) in an attempt to observe your response to them as opposed to reacting to these thoughts.
DBT uses techniques like mindfulness and emotional regulation to address some of the symptoms you may be experiencing. For instance if you are feeling anger, emotional regulation will help you identify the feeling you want to change, check the facts (why you are angry – perhaps your partner is not picking up their phone), identify your action urges (send an angry text), and ask your gut if acting on this emotion is effective in this situation (will you get the response that you desire)?
You can even practice opposite reactions to help emotional regulation. For instance, if you are feeling sad the opposite reaction would be to get active (ie. do 20 jumping jacks, go for a walk, etc.).
If you’re a planner, you may want to consider listing your triggers and creating an action plan when they occur. Click here to download the action template.
Now that you’re pretty much an expert when it comes to PMDD, the first thing you should be doing is tracking your symptoms for at least 2 months using the DRSP. There’s also an app called Me v. PMDD, which may also be helpful tracking symptoms. In order to be consistent with tracking your symptoms, consider pairing it with another activity such as brushing your teeth.
If it is PMDD, you can certainly adopt some of the treatment measures listed above. However, be mindful that if you choose to use supplements – it’s best to do so under the supervision of a Naturopathic Doctor. I strive to recommend the highest quality products, ingredient forms, and dosages.
A note on treatment for PMDD, usually trying something for 3-6 is a good way to ascertain if the treatment is good for you. If you’re not noticing any benefit, then don’t be afraid to move onto the next treatment option.
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If You’re in Crisis:
If you are in crisis now please call any of the crisis line numbers listed below or dial the local emergency telephone number (often 911) in your area.
If you need emergency help, please call 911 or visit your local emergency department.
Crisis Service Canada: 1-833-456-4566
Toronto Distress Centre: 416-408-4357
National Suicide Hotline: 1-800-273-TALK
Walsh S, Ismaili E, Naheed B, O’Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician & Gynaecologist. 2015;17(2):99-104. doi:10.1111/tog.12180.
Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Womens Ment Health. 2005;9(1):41-49. doi:10.1007/s00737-005-0103-y.
Nevatte T, O’Brien P, Bäckström T et al. ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health. 2013;16(4):279-291. doi:10.1007/s00737-013-0346-y.
O’Brien P, Bäckström T, Brown C et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011;14(1):13-21. doi:10.1007/s00737-010-0201-3.
Dickerson L, Mazyck P, Hunter M. Premenstrual Syndrome. Am Fam Physician. 2003;67(8):1743-1752.
Ismaili E, Walsh S, O’Brien P et al. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Arch Womens Ment Health. 2016;19(6):953-958. doi:10.1007/s00737-016-0631-7.
Kadian S, O’Brien S. Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders. Menopause Int. 2012;18(2):43-47. doi:10.1258/mi.2012.012017.