If you’ve normalised extreme sadness as ‘just part of PMS’ but are low-key wondering if there’s more to it, Dr Marshinee Naidoo, a psychiatrist practising at Netcare Akeso Parktown and Netcare Akeso Alberton, enlightens there’s more to the monthly monster.
The rare yet potentially debilitating condition linked to a woman’s monthly menstrual cycle, premenstrual dysphoric disorder (PMDD), is widely misunderstood, often misdiagnosed and a potentially crippling condition. “It’s the monster of premenstrual syndrome (PMS), much worse, to the point where it disrupts women’s lives,” says Dr Marshinee Naidoo.
She further notes that an estimated 75% of women experience premenstrual physical symptoms or mood changes associated with the more commonly known PMS at some point in their lives. “But only 5% of women are believed to suffer PMDD, whose monthly symptoms are more than just annoying or uncomfortable – they affect various aspects of a woman’s life, including family, social, and occupational functioning at work or school,” she adds.
Suppose you’re wondering about the effects of the monthly cycle on your body. In that case, Dr Naidoo says, “I must emphasise that women’s abilities are generally not impaired by their menstrual cycle, but the hormonal changes associated with menstruation affect a minority of women more severely.”
To give you perspective, Dr Naidoo unpacks the debilitating condition.
•PMDD impacts relationships, increases a woman’s risk for suicide and is recognised as a clinical mental health condition. It’s important to clarify that PMDD isn’t ‘just a bad mood’ but a biological process. The latest research shows there’s a biological basis for PMDD and that the disorder is related to the abnormal metabolism of hormones causing mood disruptions.
•Premenstrual dysphoric disorder affects millions of women worldwide and is characterised by physical symptoms of discomfort, affective symptoms including mood and behavioural changes, and cognitive symptoms. These severely impact a woman’s quality of life and begin to develop the week before the menstrual period and ease within several days from the onset of menstruation.
•Hormones influence brain function in men and women, the levels of which fluctuate through women’s different life stages; from the onset of menstruation to the reproductive or childbearing years to changes during and after pregnancy, childbirth and postpartum to menopause. Women with PMDD are unusually sensitive to hormonal changes in oestrogen and progesterone levels that occur through the menstrual cycle, affecting brain chemistry that controls moods, emotions and sense of wellbeing.
•Although each PMDD sufferer’s experience is unique, some women describe feeling as if a ‘switch has been flicked’ to turn them into a different person in the week before their period. Some sufferers describe feeling out of control and responding to events that wouldn’t usually upset them with extremes of anger, tears or even violent behaviour.
• Others may shift from energetic extroverts to becoming withdrawn, unable to function in their daily life and depressed to the point of contemplating or even attempting suicide.
Glamour: How does a medical practitioner reach a diagnosis for it?
Dr Marshinee Naidoo: PPMDD isn’t well understood and is frequently misdiagnosed, mistaken for depression or bipolar disorder or brushed off as being ‘just hormonal’, but it’s a potentially serious condition and women should seek professional help if concerned. To diagnose PMDD, symptoms must’ve occurred in most menstrual cycles over the past year and other more common causes that may present similarly, such as abnormal thyroid function, should be ruled out. Stress and childhood trauma, especially sexual trauma, are risk factors for developing PMDD, as is a family history of anxiety and depression.
G: What are the symptoms?
DMN: To confirm a diagnosis of PMDD, at least five symptoms must be present in the final week before the onset of menstrual bleeding, which must start to improve within a few days and then become minimal or absent in the week afterwards. Diagnosis is usually made by a doctor with experience in women’s health, preferably a psychiatrist. Symptoms include:
• Strong and variable emotional changes, such as mood swings, feeling suddenly sad or tearful or increased sensitivity to situations
•Marked irritability or anger, or increased interpersonal conflicts
•Depressed mood, feelings of hopelessness
•Anxiety or tension
• Lack of interest in usual activities
•Difficulty concentrating
•Lack of energy
•Marked change in appetite, overeating or specific food cravings
“It’s important to note that these symptoms are associated with clinically significant distress and are severe enough that they interfere with work, school, social activities or relationships,” she adds.
G: Is it treatable?
DMN: Psychotherapy, especially cognitive behavioural therapy, offers effective coping strategies. Antidepressants, such as selective serotonin reuptake inhibitors, remedy mood and emotional symptoms, and difficulties with sleeping and concentration. Hormonal treatments such as birth control pills may be recommended to regulate hormone levels and relieve physical aches and pains. There are also surgical treatment options, but these are reserved for severe PMDD in women who have completed families.
How to cope with PMDD
• Lifestyle changes help to improve symptoms, such as dietary adjustments to decrease caffeine and alcohol, and quitting smoking. Eating small, frequent snacks or meals reduces food cravings
• Exercise, sleep hygiene, acupuncture, relaxation techniques such as meditation, yoga and practising mindfulness have all proven to be effective
•Over-the-counter interventions such as vitamin B6, vitamin D, calcium carbonate, evening primrose oil, omega 3, magnesium and others may also help to alleviate symptoms, but it’s advisable to consult a doctor before self-medication
•It’s vital to raise awareness of women’s mental health and the importance of early and effective treatment in minimising risks of more serious mental health problems developing later in life
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