Let’s Talk About PMDD…

Antonia Jenkinson 18/07/23

Content warning

This article discusses themes of mental health and suicide. Please take care reading.

Mind.org.uk describes premenstrual dysphoric disorder (PMDD) as a severe form of premenstrual syndrome (PMS) but much more intense. It occurs during the luteal phase of the menstrual cycle (between ovulation and the period) and can last up to two weeks. PMDD includes both mental and physical experiences, including, but not limited to, hopelessness, suicidal feelings, exaggerated anxiety, migraines, poor sleep, and joint pain. Up to 8% of people with periods experience PMDD, yet the disorder is still poorly understood and under researched.

The menstrual cycle can affect the brain as hormones fluctuate during the cycle. This has been suggested as one of the main causes of PMDD, however it can be linked to genetic variation, passed down from mother to daughter, and can be influenced by smoking, which can result in increased hormone sensitivity. Trauma and stress can also play a role in PMDD at different parts of life. While it is most commonly described as an endocrine (hormonal) disorder, PMDD is also frequently categorised as a mental health disorder due to its overwhelming impact on a person’s psychology. PMDD can result in periods of extreme depression, difficulty socialising and working, impulsive spending, increased aggression and irritation, feelings of despair, and loss of self-belief. In its most severe forms, PMDD can lead sufferers to making drastic decisions, like ending long term relationships or quitting jobs, and even violence in some judicial cases. It is imperative to recognise that those who suffer from PMDD are not ’being dramatic’, but are instead enduring an extremely difficult mental health condition with little support available.

As the recognition of PMDD grows, so do the questions surrounding it. Many clinicians, according to BBC Future, are cautious to diagnose PMDD in fear of attaching a label of irrationality or violence to the menstrual cycle. The Diagnostic and Statistical Manual of Mental Disorders (DSM) have also shared concerns to BBC Future that PMDD could become pathologized and over medicalised for profit. As a result of caution around research and diagnoses, many people who suffer from PMDD feel forced to take drastic action, like having hysterectomies, voluntary sectioning, and unfortunately in some cases, suicide in order to feel they can maintain stability in their menstrual cycles.

Talking to your GP

The most important step is finding a GP you feel comfortable talking to, and who actively listens to your concerns.

It is highly liy that your GP will ask you to document your symptoms in detail across at least two cycles (two months.) This might be something to consider starting before your first consultation to move the process of diagnosis along faster. As with most other medical conditions, your GP will likely ask you about your medical history, including historic or existing mental health problems, your lifestyle, and may request a physical examination and blood tests. Remember, it is always okay to request a particular GP and medical escort for your comfort if physical examinations are something which causes heightened anxiety.

“I don’t have a GP I feel comfortable talking to.”

It can be extremely frustrating and upsetting for those struggling to get a PMDD diagnosis, as it is a largely unknown condition amongst healthcare professionals, which can lead to valid feelings of dismissal in patients. After experiencing medical dismissal, it can feel isolating and pointless to pursue a diagnosis, however we each have the right to access public services like the NHS in order to make our lives as comfortable, and liveable, as possible. You are worthy of help, and it is possible to find a GP who will support you appropriately through the process of a PMDD diagnosis.

Mind.org.uk suggests that, in these circumstances, the best action is to keep a detailed record of symptoms, recommending the Me v PMDD app which is recognised clinically as a successful way of monitoring symptoms of PMDD. It is possible that in the process of diagnosing PMDD, people with periods can often be misdiagnosed with depression or bipolar disorder, which is why it is so important to keep a detailed log of symptoms.

Mind also suggests taking a copy of the National Institute for Health and Care (NICE) guidelines for PMDD along with you to GP appointments, and even consider taking along an advocate with you. A medical advocate is someone who will help you to understand the care and support for your diagnosis, stand up for your right to medical wellbeing, and help to challenge decisions you feel have been made incorrectly. A medical advocate can be requested through your local council social care services, but can also be applied for through charities such as The Advocacy People, POhWER, and VoiceAbility.

Treatment in the UK

Don’t fear - there are many different solutions in the UK to manage PMDD symptoms.

It is important to note that, as with most other mental health conditions, solutions are not cures, and must be used with adapted changes in lifestyle to be effective. The first, and most common, treatment is being prescribe a higher dosage of progesterone typically in the form of birth control to regulate hormones. Porgesterone and estrogen are often prescribed to people experiencing the menopause, as hormone replacement therapy (HRT) to alleviate emotional stress caused by unbalanced hormone levels. This has been proven to be an effective way of managing the symptoms of PMDD in less severe cases, however many people also have negative experiences with contraception so there are other options available.

If progesterone is not for you, you may be prescribed oestrogen therapy to achieve the same result as progesterone, although there is a possibility of this being a rather long process, as BBC Future suggests that for oestrogen therapy to be effective in relieving symptoms of PMDD, dosage must be frequently measured and altered based on individual biology. You will be monitored closely throughout the process, so you won’t have to do it alone. Although a long course of treatment, oestrogen therapy can be really helpful in building a good rapport with your assigned practitioner, and can also help them to understand your menstrual cycle comprehensively.

So far, in the summer of 2023, a combination of the appropriate antidepressant and occupational therapy is widely regarded as the most effective treatment for PMDD. Your GP will prescribe you with the appropriate antidepressant once they have fully assessed your needs and will suggest referral for occupational therapy treatment available free of charge in the UK. There are also of course other paid private options for all kinds of therapy for those who have funds available. If you are based in Nottingham, you can visit the nottshelpyourself.org.uk website to find free local mental health services. If not, search your local council website for similar services, or contact your GP directly who will point you in the right direction.

This week, we have introduced a referenced blog post which will be updated weekly with our research and statistics from each article.