For people who menstruate, the hormonal shifts caused by their period can extend well beyond just the 5 to 7 days spent bleeding. The average menstrual cycle takes 29 days to complete, meaning people spend the majority of the month moving through the phases of menstruation. The four phases include menstruation (when you actually shed the lining of the uterus and bleed), the follicular phase (when estrogen levels rise and the ovaries produce a mature follicle), ovulation (when the egg is released), and the final luteal phase (when progesterone is released or stopped depending on pregnancy).
Needless to say, there’s a lot going on in the body to make your period happen. During the time before menstruation, many people experience premenstrual symptoms (PMS) — like irritability, fatigue, and changes in sleep. But some may also experience premenstrual dysphoric disorder (PMDD), a severe form of PMS. PMDD can disrupt a person’s quality of life, and in some cases, cause depression and suicidal thoughts.
Only a medical profession can diagnose you with PMDD and come up with an appropriate treatment plan, but severe PMS symptoms could be a sign of PMDD.
What Is PMDD?
Mayo Clinic defines PMDD as a “a severe, sometimes disabling extension of premenstrual syndrome (PMS)”. Both PMS and PMDD have physical and emotional symptoms that appear 7 to 10 days before menstruation starts, but PMDD is much more severe in its impact on your life, relationships, and wellbeing.
- Bloating, breast tenderness, fatigue, sleep and eating changes (all symptoms of PMS)
- Depression and/or suicidal thoughts
- Anxiety and/or panic attacks
- Mood swings (including irritability or anger)
- Food cravings or binge eating
Symptoms tend to resolve a few days after bleeding starts, says Cleveland Clinic.
What Causes PMDD?
While the cause of PMDD isn’t yet certain, Mayo Clinic says hormonal changes during the cycle may play a role. Underlying depression and anxiety are also common throughlines of both PMS and PMDD, and it’s possible the hormonal changes during the menstrual cycle may worsen mood disorders. Cleveland Clinic also states that serotonin (the brain chemical that helps regulate mood, sleep, digestion, and sexual desire) may play a role in PMDD, as serotonin levels also fluxuate during the menstrual cycle.
How Is PMDD Diagnosed?
As far as PMDD is typically diagnosed, Johns Hopkins Medicine explains that there aren’t many diagnostic tests and screenings for this condition. In other words, when seeking answers for what’s causing your irritability, there isn’t one stand-alone PMDD test that your doctor can give you. Before a conclusion is drawn, the organization also notes, at least five PMDD symptoms (like those listed above) must be present over the course of a year and during most period cycles.
According to the U.S. National Library of Medicine’s MedlinePlus, there might be certain tests given, like thyroid testing and a pelvic exam, to rule out other potential issues behind your symptoms.
As mentioned above, PMDD is greatly associated with several emotional symptoms — many of which are very serious and should not be ignored. A few examples include anxiety, moodiness, depression, crying spells, and suicidal thoughts.
When trying to find the root cause of your feelings, your doctor may also discuss your mental health history and screen for mood disorders. In fact, according to the UNC School of Medicine, around 40 percent of people who think they have PMDD and are searching for treatment for the condition actually have an underlying mood disorder that’s exacerbated or worsened by PMS. When you have PMDD, the institution says, the emotional and mood-related symptoms should go away when your period starts.
How Is PMDD Treated?
Your treatment plan will depend on you as an individual, your symptoms, and your official diagnosis. Again, only you and your doctor should make these decisions together.
However, according to an article by the Mayo Clinic, treating PMDD is typically aimed at minimizing or preventing the associated symptoms. A variety of different methods may be used, including birth control, lifestyle changes, dietary and nutritional changes, herbal remedies, and antidepressants.
The Cleveland Clinic notes that speaking with a mental health professional may also be helpful in managing this condition. Once you’ve found the right treatment plan, the U.S. National Library of Medicine’s MedlinePlus notes, your symptoms can become more manageable.
Any and every question is worth bringing up to your doctor, so if you feel any emotional or physical changes, be sure to speak with a healthcare or mental health professional.
If you or someone you know is struggling with depression, the National Alliance on Mental Illness has resources available including a helpline at 1-800-950-NAMI (6424). You can also dial 988, the nation’s new mental health crisis hotline.