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Understanding PMDD: A Deeper Look Into Premenstrual Dysphoric Disorder

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Authored by Mandy Kryzsiak, MSS Candidate and The Understory Group Intern





For many individuals who menstruate, the days leading up to their period can be challenging. While it's common to experience some mood swings, bloating, and fatigue, some people experience a much more severe set of symptoms. This condition is known as Premenstrual Dysphoric Disorder (PMDD), a more extreme form of premenstrual syndrome (PMS) that affects about 5-8% of those with menstruating cycles. But what exactly is PMDD, and how can it be managed? 

What is PMDD? 

PMDD is a severe, often debilitating mood disorder that occurs in the luteal phase of the menstrual cycle, which is typically the two weeks before a period starts. Unlike PMS, which involves symptoms like irritability, fatigue, and bloating, PMDD presents with more extreme symptoms that can significantly impact daily life.

Symptoms of PMDD include:- 

Mood Swings: Severe irritability, anger, and even feelings of despair. 

Depression: Persistent sadness, hopelessness, and a lack of interest in activities once enjoyed . 

Anxiety: Intense feelings of worry or panic. 

Fatigue: A sense of constant exhaustion that makes daily tasks difficult. 

Sleep Disturbances: Insomnia or excessive sleeping. 

Physical Symptoms: Breast tenderness, joint or muscle pain, headaches, and bloating. Cognitive Symptoms: Trouble concentrating, memory problems, or brain fog. 

PMDD is often mistaken for other mood disorders like depression or anxiety, but the key difference is that it is directly linked to the menstrual cycle. The symptoms usually resolve after menstruation begins, though for some, they can linger for several days. 

Causes of PMDD 

The exact cause of PMDD remains unclear, but it is believed to be a complex interaction of hormonal changes, genetics, and brain chemistry. Here are some contributing factors: 

Hormonal Fluctuations: PMDD is thought to be driven by changes in estrogen and progesterone levels during the second half of the menstrual cycle. These fluctuations can influence neurotransmitters in the brain, particularly serotonin, which regulates mood. 

Genetic Predisposition: Studies suggest that people with a family history of PMDD or mood disorders may be more likely to experience it. 

Lifestyle and Stress: Chronic stress, poor sleep, lack of physical activity, and unhealthy eating habits can exacerbate the symptoms of PMDD. 

Diagnosing PMDD 

Diagnosing PMDD can be tricky because its symptoms overlap with other mental health disorders and medical conditions. A thorough evaluation by a healthcare provider is essential, which may include tracking symptoms over several menstrual cycles. This tracking often includes noting mood changes, physical symptoms, and the timing of these symptoms in relation to the menstrual cycle.

A diagnosis of PMDD is typically made when a person experiences at least five of the key symptoms (with at least one being a mood-related symptom) during the luteal phase, and these symptoms significantly interfere with daily life. 

Managing PMDD 

While there is no one-size-fits-all approach to managing PMDD, a combination of lifestyle changes, medications, and therapeutic interventions can help alleviate the symptoms. Here are some effective strategies: 

Living with PMDD 

Living with PMDD can be challenging, but with the right treatment plan and coping strategies, many individuals find ways to manage their symptoms and lead fulfilling lives. It’s essential to acknowledge the severity of PMDD and seek professional help when necessary. Educating family members, friends, and coworkers about the disorder can also foster understanding and support during difficult times. 


In Closing

PMDD is a serious, often condition that can affect many aspects of life, but with the right combination of treatments and lifestyle changes, those who experience it can manage their symptoms and live well. Be proactive, and remember that you're not alone on this journey.

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Natalie Adey, LSW, and Emily Evans, LSW, are licensed social workers and provisionally licensed therapists who practice under the clinical supervision of Gina Stango, LCSW, and Kelly Corbitt, LCSW, respectively.

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