Everything You Need To Know About Premenstrual Dysphoric Disorder

If you’re feeling abnormally blue and bogged down with brain fog, you might wonder why you’re experiencing these issues just a few times out of the month. Unsurprisingly, it could be cycle-related.

By Gwen Farrell4 min read
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I’m pretty easygoing, extroverted, and normally very bubbly, but within the last few months, I’ve been experiencing unexplained episodes of anger, depression, fatigue, anxiety, and hopelessness that are very much out of the norm for me. There are some days when all I can notice are the horrible things that are happening around us, and all I can do is focus on those issues. It’s disheartening and even makes me wonder if life is worth living sometimes. But within a few hours, I’ll be right back to my normal, cheerful self.

Like any woman worth her salt, I took it upon myself to do some research. Lo and behold, I was scrolling through Reels when I found one from Dr. Patrick Flynn. He was describing a relatively new condition – so new it was only added to the DSM in 2013 – called premenstrual dysphoric disorder (PMDD). As he hit on each and every symptom, I had a lightbulb moment. Since I’ve been documenting these hardships and bad mental health days, I was able to go back and notice a pattern: All of these days fell before my period, but because I don’t normally experience PMS, I wasn’t attributing these symptoms of PMDD to anything cycle-related.

If any of this sounds familiar, it’s very possible that premenstrual dysphoric disorder could be responsible for your pre-period woes as well. Here’s everything you need to know about PMDD.

What Is Premenstrual Dysphoric Disorder?

PMDD affects around 5 to 10% of women and is characterized by mood swings, depression, anxiety, irritability, fatigue or insomnia, food cravings, a downturn in energy, panic attacks, paranoia, and suicidal ideation – all experienced usually a week to 10 days before the onset of a period.

Premenstrual dysphoric disorder, as a diagnosis, is still in its infancy. It’s a relatively new diagnosis, and most healthcare professionals describe it as a “more severe form of PMS.” It’s also usually designated as the psychiatric side of PMS, due to the mental issues women most often experience with PMDD. Whereas we might experience bloating and cramps with PMS, we’re more likely to experience more negative impacts on our mental health with PMDD.

As is the case with PMS, the cause of PMDD can be attributed to severe fluctuations in hormone regulation.

Previous mental health issues or perhaps undiagnosed conditions like depression make a woman more susceptible to PMDD. But as is the case with PMS, the cause of PMDD can be attributed to severe fluctuations in hormone regulation. PMDD is usually diagnosed through a physical exam and through taking a hormone panel. It’s also critical to document or journal the days or phases you feel symptoms to better grasp if you’re suffering from PMDD or another condition.

Treating PMDD

If you’ve been diagnosed with PMDD or suspect that you have it, the next step is finding a way to treat your symptoms. You may not suffer from depression or anxiety every day of the month, but the hopelessness and despair you feel during bouts of PMDD are probably motivating you to seek relief, in whatever form.

The unfortunate thing about PMDD, seeing as it's a relatively new diagnosis in the medical profession, is that researching treatment online will yield only two results: prescriptions for hormonal birth control or for selective serotonin reuptake inhibitors, known as SSRIs. 

But as we know by now, women deserve better than either one or both of these solutions. For one thing, hormonal birth control could be preventing you from examining what could be a more serious condition by masking your symptoms, and in addition to that, taking this route could spell even more trouble with its side effects, especially the mental toll it often takes on women. Once again, hormonal birth control is billed as the solution to an issue that might actually make that condition worse, not better.

We also know that antidepressants are being prescribed now more than ever, at an alarming rate, but mentally, we don’t seem to be getting any better. Also, why should we feel we have to accept this kind of “solution” if we’re only experiencing mental health issues a few days (or even less) per month rather than every moment of every day? In both of these cases, it feels like PMDD treatment isn’t being taken seriously. And once again, suffering women are being given quick-fix, problematic suggestions instead of effective advice.

On the bright side, there is a subreddit on r/AskWomen about treatment for PMDD, and from the anecdotal evidence alone, there are a number of holistic, natural options that aren’t SSRIs or hormonal birth control to look into. As with any hormonal dysregulation or chemical imbalance, supplements are key. Many attribute the cessation of their symptoms to magnesium, calcium, and vitamins C and D. Others suggest evening primrose oil and liver supporting herbs. One swears by a gluten free diet. Another said a commitment to stress management completely changed her life. And there you have it – effective treatment that we deserve, with no harsh side effects or artificial hormones needed.

Could There Be Benefits?

It’s hard to see any advantages to being wracked with crippling anxiety, fatigue, or depression, even if it’s a day or two out of the month. But it’s important to remember that with any symptoms that are inherently cycle-related, it’s all about communication.

Symptoms are signals. Our body is trying to talk to us, even in PMDD. 

That communication at times might feel one-way. Our body is trying to tell us something, but we have no idea what it is, and we’re too tired, too depressed, or even too frightened to try to ascertain what that could be. Because the facets of PMDD are intrinsically related to our mind, it’s crucial to know that these feelings and emotions are in no way symptomatic of some failing on our part, though it often feels like it. It’s just our body sending us a signal that not everything is as it should be.

Becoming body-literate (i.e., recognizing that our body sends us signals each and every day and learning to tap into those signals to figure out what it needs) is a marathon, not a sprint, and it’s a skill that can be learned. There won’t be one cure-all for every single ailment related to PMDD or even PMS. But it is possible to feel better, if only we take the time to learn what works for us.

Every female body and more specifically, every female cycle, is different from the next, and a “simple” fix of birth control or antidepressants is not necessarily the answer to all those messages. A hormonal or chemical imbalance is not a problem to be covered up, but one to be uncovered, especially when there’s clearly a larger issue to get to the heart of. That issue might be progesterone or estrogen dominance, or escalation of those hormones at certain times during our cycle. Or, we could be severely lacking in both those categories. It could be polycystic ovarian syndrome or endometriosis, and there is no quick or simple fix to taking care of those issues.

Symptoms are signals, not necessarily chronic physical or mental illness, and if there’s one advantage to PMDD, it’s knowing that, in actuality, our body is trying to talk to us. We just have to stop and listen, instead of immediately jumping to solutions which could harm us in the long run.

Closing Thoughts

If you’ve felt at a loss for a long time, you can finally breathe a sigh of relief. You aren’t crazy, and you aren’t lacking in some way as a person. Your hormones are likely the cause of your feelings, and with that in mind, you can move forward.

For me, working out regularly has become essential. I sleep better when I do, and I definitely notice differences on days when I don’t. I also take magnesium and ashwagandha every day, which improves my mood. I continue to journal the days when I’m feeling off or have dysphoric symptoms, so I can learn my body better – and you can too. The brain fog, despair, and depression don’t last forever. Find what works for you, whatever that may look like, and know that there are definite solutions to PMDD.

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