What is PMDD?
PMS does not have the power to destroy or take lives, but PMDD absolutely does. Brie Moore, Founder
PMDD affects an estimated 1 in 20 women and assigned female at birth (AFAB) individuals of reproductive age. PMDD causes a range of symptoms including depression, anxiety, mood swings, anger, thoughts of suicide, fatigue, difficulties with concentration, and sleep issues. These symptoms can directly impact an individual's relationships, work and overall quality of life. This is not a ‘hormonal mood disorder.’ PMDD is directly connected to the menstrual cycle and is a severe negative response in the brain to the natural rise and fall of hormones oestrogen and progesterone.
Sometimes these symptoms mimic generalised anxiety disorder and major depressive disorder, however the key difference is PMDD is cyclical.
What is PME?
PME is known as Premenstrual Exacerbation, which is when PMDD and another mental health disorder coexist. For example, if an individual has generalised anxiety disorder and PMDD, the individual will experience an exacerbation of the anxiety disorder symptoms, due to the PMDD. This means that women and AFAB individuals may experience symptoms throughout the whole menstrual cycle, which do not necessarily subside upon menstruation. PME is not known as an official ‘diagnosis,’ and is used to explain the experience of an exacerbation of symptoms caused by PMDD.
Difference between PMS and PMDD
PMDD
- Symptoms appear in a cyclical nature
- Symptoms negatively impact the quality of life for the individual eg. increased frustration in relationships which may damage relationships
PMS
- Some overlapping symptoms, however not extreme and do not negatively impact the quality of life for the individual
- No required number of symptoms for the disorder
- Experienced by many individuals and varies in regards to the combination of symptoms
Diagnosis for PMDD
In accordance with the DSM, to be diagnosed with PMDD, a minimum of five symptoms must be present before the start of menses, improve within days after menses, and be absent in the week post-menses. It is a cycle.
1. One ore more must be experienced 1
- Mood Swings (Tearful or suddenly sad, increased sensitivity to rejection)
- Irritability, anger or increased interpersonal conflicts
- Depressed mood, hopelessness or self deprecating thoughts
- Anxiety, tension, feeling keyed up or on edge
2. One or more must be present 1
- Decreased interest in activities of work, school, friends, additional hobbies
- Difficulty concentrating
- Easily fatigued and has a lack of energy
- Overeating or specific cravings
- Hypersomnia or insomnia
- Feeling overwhelmed or out of control
- Physical symptoms including breast tenderness/swelling, joint/muscle pain, sensation of bloating or weight gain.
For some individuals experiences of suicide ideation occur during this time.
Most of the symptoms above must be met within the course of a year.1
The symptoms interfere with daily life of the individual eg. social activities or lack of productivity at work.
It is not merely exacerbated with the experience of another disorder such as major depressive disorder, panic disorder or personality disorder. 1
Symptoms are not due to substance abuse or another medical condition. 1
How to get a diagnosis
Diagnosis can be made by the daily recordings of two co-current cycles, or if noticed throughout the course of a year. 1
Speaking with a GP or psychologist to help you make informed decisions regarding the disorder.
At PMDA, we understand that there are still many clinicians who are not privy to, lack education and understanding of this disorder. This is why we are here to advocate and support you.
Causes of PMDD
PMDD is understood to be the brain’s negative reaction to a normal hormonal fluctuation within the brain to the hormone, allopregnanolone which is a main metabolite for progesterone. Allopregnanolone generally allows individuals to feel calm, however in individuals with PMDD it shows an adverse effect and increased emotional dysregulation. 3 4
Although an under-researched disorder, PMDD's cause can be from a multitude of factors:
Genetic: Heritability has been shown in studies within families. However, premenstrual symptoms have been demonstrated across 30% to 80%.
Environment: Factors which have been associated with PMDD include changes in stress, seasonal, interpersonal trauma and cultural aspects associated with female sexual behaviour.
Women who use oral contraceptives have been said to have less premenstrual symptoms than those who do not. 2
- Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. New England Journal of Medicine. 1998 Jan 22; 338(4): 209-216.
- Black, D. W., & Jon E. Grant, M. (2014). DSM-5 guidebook: The essential companion to the diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Pub.
- Comasco E, Hahn A, Ganger S, et al. Emotional fronto-cingulate cortex activation and brain derived neurotrophic factor polymorphism in premenstrual dysphoric disorder. Hum Brain Mapp. 2014;35(9):4450-4458.
- Girdler SS, Straneva PA, Light KC, et al. Allopregnanolone levels and reactivity to mental stress in premenstrual dysphoric disorder. Biol Psychiatry. 2001;49(9):788-797.
