For many women, their menstrual cycle can become a nightmare due to altered hormone levels and that may cause Premenstrual Dysphoric Disorder (PMDD), a mood disorder characterised by significant low mood levels in the luteal (second) phase of the menstrual cycle. This may severely affect their general and mental well-being.
Unlike Premenstrual Syndrome, which is characterised by mild mood changes, breast tenderness and craving for carbohydrates, resolve with the onset of the menstrual period,” explains Dr Vythilingum, a psychiatrist based at Akeso Psychiatric Clinic in Kenilworth, Cape Town. PMDD It occurs in the second half of the menstrual cycle and the mood changes
Common symptoms include depressed mood, anxiety and panic attacks, marked Irritability, feelings of being overwhelmed, difficulty concentrating, fatigue and even suicidal thoughts. Women with PMDD are not ‘weak’, nor do they have ‘unstable personalities’. PMDD is not all in your head. – it is a diagnosable medical illness that can and should be treated by a medical professional.
During the menstrual cycle (see graph) there is a gradual rise in oestrogen that peaks just before ovulation and falls at the time of ovulation. After ovulation, oestrogen rises again, but to lower levels than normal. The dominant hormone at this time is progesterone, which peaks just before you get your period, when both hormone levels fall. It is this second half of the cycle, called the luteal phase, when women with PMDD experience symptoms.
Women often ask if PMDD is caused by altered hormone levels or whether there is test that they can do determine their hormone levels. The reality is that women with PMDD have hormone levels that are within the normal range – there is no difference in the levels of oestrogen and progesterone between women with and without PMDD. Researchers reckon that women with PMDD have either an altered sensitivity to normal levels of progesterone, or alternatively, that their bodies break down progesterone in ways that lead to increased anxiety and low mood.
Researchers have also started to unravel some of the genetics of PMDD. It is not a directly inherited disorder – in other words if your mum had it, it doesn’t mean that you will get PMDD, but is it is heritable. Women with PMDD are 56% more likely to have family members who also have PMDD. This tells us that there must be genetic mechanisms linked to the disorder.
Earlier this year, researchers from the NIMH showed dysregulation in a gene complex that controls, among other things, response to oestrogen and progesterone.
The diagnosis of PMDD is made on clinical grounds, based on careful evaluation of your symptoms. You may be asked to keep a diary of your mood and menstrual cycles. No specific blood or hormone tests are done to make the diagnosis.
During most of her menstrual cycles in the past year, a woman needs to have marked depressed mood, anxiety or irritability, as well as changes in appetite, sleep and energy that affect normal functioning and/or cause severe distress. These symptoms must be present most of the time in the last week of the luteal phase, must remit with the onset of menstruation and must be completely absent within a week of the onset of the menstrual period.
Impact on daily life
One of the most difficult things about PMDD is its intermittent nature. “Because you become well with your period, you, and those around wonder what is happening, is this all in your mind? The intense mood swings and irritability are very difficult for partners and family to cope with, and can make women who suffer from PMDD feel helpless and guilty. PMDD can lead to marriage problems and also work issues.
The most important thing partners and families can do is understand and support. PMDD is not their loved one’s fault. It is a medical illness. That said, it does have an impact on them, and as part of the healing process the whole family may need a space to talk about their feelings.
PMDD is best treated through a combination of approaches – medication, psychological and lifestyle changes, Dr Vythilingum points out.
Lifestyle change is one of the biggest parts of managing PMDD and the most important part of lifestyle change is self-care. As women, taking care of ourselves is last on the list – if it even gets onto the list.
Self-care is recognising that just like your car cannot run on an empty tank, neither can you. Self-care means taking the time out to make your needs are attended to as well.
So if you have PMDD you should ensure that you get regular aerobic exercise because it helps your mood and fatigue. Self-care means doing things you enjoy because it decreases your stress and will help decrease your PMDD symptoms. Self-care means taking time every day to do deep breathing and practice your relaxation techniques. And self-care means reaching to your friends, family and partner for support during ‘that’ time of the month when you feel overwhelmed.
Supplements such as vitamin B6, calcium, magnesium supplements, and Omega 3 fatty acids have all been shown to be useful as adjunctive treatments for PMDD. Before starting any supplement, though, you should discuss this with your doctor.
Psychotherapy and Pharmacotherapy (Medication)
Many women with PMDD find that Cognitive Behavioural Therapy (CBT) is an effective treatment for their mood and anxiety symptoms. Relaxation techniques and stress management techniques either alone or as part of CBT are also very useful.
Medication used for the management of PMDD usually falls into two broad categories – antidepressants and hormonal therapies. These methods must be sought out though in conjunction with your doctor’s advice and preferably also your therapist.
The good news, however, is that PMDD is a treatable mood disorder and that “most women with appropriate treatment, recover completely,” concludes Dr Vythilingum.