What is Pre-Menstrual Dysphoric Disorder?


What is Pre-Menstrual Dysphoric Disorder?
(Trigger warning: Suicide section)

What is PMDD?

Pre-Menstrual Dysphoric Disorder (PMDD), is a hormonal mood disorder which causes disabling psychological and physical symptoms. It is a cyclic condition which onsets between the ovulation and menstrual period (1-2 weeks) before each period. It effects about 3-8% of menstruating women and is often self-diagnosed. It is found to disrupt women’s social, personal and work lives. There is no cure but there are treatment options.


 [Image 1]

History and Classification of PMDD

PMDD was identified relatively recently (1994), and was only added to the Diagnostic and Statistical Manual of Mental Disorders in 2013, and to WHO’s International Classification of Disease index in 2010 [1].

The AIFC summarised PMDD from the 2007 UNS Health Care Newsroom as [2]:

“Women who have PMDD were found to have variants in the oestrogen receptor alpha gene catechol-O-methyl transferase) which is responsible for regulating proper function of the prefrontal cortex, an area of the brain that controls moods. PMDD has been found to predominately lower a woman’s serotonin levels, a neurotransmitter connected with learning, sleep and mood. The tests proved that PMDD is an endocrine mood related disorder causing severe symptoms surpassing the harshest psychosomatic symptoms of PMS.”

In Australia, PMDD is recognised by the Therapeutic Goods Association, but is SSIR treatments are not reimbursed by the Pharmaceutical Benefits Scheme. (Wikipedia)


[Image 2]

Symptoms

PMDD is a form of PMS. Although, everyone’s experience of PMDD is different, common symptoms include [3]:

-          Depression with feelings of hopelessness and despair
-          Suicidal thoughts
-          Uncontrollable Crying fits
-          Social Withdrawal
-          Insomnia
-          Longer periods of sleep due to heavy fatigue
-          Loss of interest/energy for usual activities
-          Difficulty concentrating – confusion
-          Appetite changes – overeating, food cravings, weight gain
-          Headaches & migraines that can last for days
-          Extreme irritability
-          Uncontrollable anger or rage
-          Physical symptoms, swelling, breast tenderness, soreness of joints, abdominal bloating

Burden

These psychological and physical symptoms have been found to regularly disrupt social and work lives. Inability to perform regular work and social activities, places further social, economic and emotional burden on individuals.  

Yamada & Kamagata (2017) conducted self-report task to calculate the mean loss in Quality Adjusted Life Years for PMDD sufferers. The self-report task asked PMDD sufferers to measure their mobility, self-care, usual activities, pain/discomfort and anxiety/depression on a 3-point scale. They calculated the expected mean loss in QALY as 0.14 years. Although, the methodology of this study uses subjective self-reporting measures of comfort, it still shows an average loss QALYs showing the need for further awareness and research. [4]


[Image 3]


Treatment

Unfortunately, there is no cure. But there are forms of treatment/management:

Medical

Selective Serotonin Reuptake Inhibitors (SSRIs) – Are the first line medication in America (Contraceptive pills are first-line in Australia). They are only taken during symptoms. Relief is often felt in 1-2 days. [5]

Contraceptive Pills  Suppress ovulation by controlling sex hormone fluctuations during the luteal phase. Lowers levels of estrogen. These often have some side effects e.g. migraines. (Wikipedia)

                                                                                                                                 
   [Image 7]

Psychotherapy
Cognitive Behavioural therapy – This has been found to help some in dealing with the condition, others have said it has not helped at all. Suggested to work alongside medication.

Surgery
Hysterectomy – Removal of the ovaries and uterus have an immediate cure on the condition as the hormones are no longer being produced by the organs. It is often followed by low dose estrogen therapy. It can also prevent future issues with endometriosis or Polycystic Ovarain Syndrome, which is common for PMDD patients [NB: Unable to have children post-surgery]

Non-medical/surgical
NB: Although it is not suggested to only take-up only non-medical treatments, some alternative therapies are found to help, alongside the use of medication/therapy. These may include:
Reduce caffeine consumption - Coffee, tea, energy drinks and other caffeine based foods should be reduced/eliminated from diets [6].
Alcohol consumption - Reduce/eliminate
Regular Exercise – Increased dopamine along with social aspect and feelings of accomplishment (Although many argue that it is difficult enough getting out of bed during an episode, let alone go for a run)
Pregnancy – Although this is not used as a treatment, symptoms are found to disappear during this time as there are no periods. But, PMDD women have higher chances of post-partum depression.


Stigma and awareness

There are several reasons for the stigma against PMDD:
-          Pre-existing stigma against mental illnesses
-          Medical sexism (which has long existed in the medical field)
-          It is a newly recognised mental disorder
-          Rare (3-8% of women that have periods)
-          Little existing research and medical acceptance

Some stigmas and myths include:
-          It is not real
-          It is just bad PMS
-          Women just get crazy every month


Suicide and PMDD

For every man that dies by suicide, four women will attempt it.                                                                   – Gia Allemand Foundation

15% of people living with PMDD will attempt an act of suicide in their lifetime [8]. Although data has found that most women do not complete the act, there are still many whom experience self-harm and suicidal ideation each month and deserve to receive access to proper service and support. This starts with public awareness!


[Image 4]


Misdiagnosis

Doctors often misdiagnose people with PMDD. PMDD patients are often initially diagnosed with bipolar disorder or MDD. [7] Hence, are prescribed the wrong medications, resulting in possible side-effects. Panay and Fenton (2015) suggest that it is time for a new approach in addressing PMDD Awareness. They focus on awareness in primary care facilities, as a response to these high rates of misdiagnosis.


April is PMDD Awareness Month! Get involved!

Next week is PMDD Awareness Month, it is time to get involved. The Gia Allemand Foundation is one of (or the only) PMDD specific foundation I have found in my research. They started PMDD Awareness Month as a time to re-blog, share online, and tell friends about in real life because it is expected that many more women suffer from PMDD without their own knowledge. Awareness opens them up to the option that they may have it.

PMDD Awareness is not just a justice to people that suffer PMDD, but is a justice to all people whom are stigmatised for having mental illnesses and all women whom suffer forms of PMS.

What you can do:

-          Draw images, write poems, share stories of and/or for women suffering PMDD (especially if you suffer from it yourself)
-          Share online articles
-          Write open letters/posts to anyone organisation/individual whom does not believe/accept PMDD
-          Donate to local Mental health organisations and/or PMDD specific foundations such as Gia Allemand here


Do you have PMDD?

If you are reading this and it sounds like you may fit some of these descriptions, then it is important that you should know that its ok, people are here for you and its not your fault.

Next you should act on it, by going to the doctors and doing your own research. PMDD is usually self-diagnosed, so I suggest that you suggest the condition to your doctor directly (instead of waiting for them to diagnose you with it), because it is rare, and doctors may often forget, (or maybe not even know) about the condition.


                                                                               [Image 5]

It may take a few months for you to find the right medications/treatments for you. Be patient, you will find the right combination eventually. And tell your family and friends – it is important they know about it so they know to be supportive and when to check up on you. Because they want to be there for you especially in times of need.


Do you know someone with PMDD?

If you know someone that has PMDD, or seem like they may have it. It is important you talk about it with them, take them to the doctors and be with them during every step of the process.

It is important to be empathetic, patient and loving. Know that this time is extremely stressful for them and don’t give up on them, because they usually do want to get better.

It helps to read or watched some articles and videos on women talking about their experiences with PMDD. (I will link some down below).


[Image 6]

Personal Stories and Articles from People with PMDD
Women’s PMDD journey – Here  [9]
PMDD sufferer who got a hysterectomy – Here  [10]
Headspace blog thread - Here  [11]
Gia Allemande Foundation Youtube channel - Here  [12]

Useful numbers
LifeLine 13 11 14
Beyond Blue 1300 22 4636
Sane Australia 1800 187 263
Suicide call back service 1300 659 467
Headspace website http://www.headspace.org.au/

Written by: Patricia Chaar



References
[1] http://apps.who.int/classifications/icd10/browse/2010/en#/IV                                                                           
[4] https://link.springer.com/article/10.1007/s11136-017-1642-1  QALY

Images
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Comments

  1. Premenstrual syndrome (PMS) is a female sexual health condition that is very common among women, usually between 5 and 11 days before menstruation. The symptoms of PMS can be alleviated by having an orgasm, as it releases mood-boosting endorphins.

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