The first thing to understand is PMDD is NOT PMS. The symptoms of PMDD are unique. They completely detach a women from her normal life and are severely disruptive on her wellbeing, routines, work, social situations and relationships (family/friends). It is a hugely disabling condition. PMDD effects between 2-8% of women. The detailed cause is unknown. PMDD is not a hormonal imbalance, it is caused due to hypersensitivity in the hormonal changes within each menstrual cycle. PMDD symptoms usually arise after ovulation (in the luteal phase) and continue to a few days after the women bleeds-the symptoms can occur anywhere between 3-20 days of a month.
15% of all women with PMDD will attempt an act of suicide. It is so important this condition has awareness and women are supported to avoid such measures to rid them of their suffering.
Most women with PMDD find it difficult to share their symptoms, mainly due to the stigmatism associated with womens' hormones, lack of knowledge of PMDD by others and sadly the embarrassment of what PMDD does to them. They cannot make forward plans, as they don't know how they will feel in a few months, days or even tomorrow.
Many women suffering do not have a GP who is aware of PMDD. They can be ridiculed and sent home with the assumption this is normal 'PMS' or they have another mental illness. These women do not receive the right care and most certainly need to be seen by a specialist gynaecologist.
Symptoms of PMDD
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, feelings of being overwhelmed or out of control
Marked emotional reactivity (eg, feeling suddenly sad or tearful or experiencing increased sensitivity)
Persistent, unexplainable and marked anger or irritability or increased interpersonal conflicts
Decreased interest in usual activities (eg, work, school, friends, and hobbies)
Subjective sense of difficulty in concentrating
Lethargy, easy fatigability, or marked lack of energy
Marked change in appetite, overeating, or specific food cravings
Hypersomnia or insomnia
Suicide idealisation - feeling of unworthy and detaching oneself from life
Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or appetite changes
As a sufferer, you can relate to these symptoms.
As a non-sufferer, these symptoms may not appear to be so life debilitating. Women with PMDD feel as though their body has been taken over for half the month, and the 'good days' are spent catching up on life before entering the PMDD mindset again. Despite the physical symptoms, the emotional thoughts in the brain causes women to act in the most irrational ways.
Treatment for PMDD
Dr Nick Panay, a senior gynaecologist at Chelsea and Westminster Hospital has published a treatment guideline for PMS/PMDD.
Treatment for PMDD women generally continues throughout their reproductive life. Their bodies are put through a huge deal of stress - both physically and emotionally. Physical stress can be due to adjusting to new medication or side effects, some of which can occur suddenly due to a medication no longer having the desired effect. Emotional stress comes from the constant medical appointments, decisions, worry and the PMDD itself.
Women with PMDD will usually go through an array of hormonal interventions, either to help hormonal fluctuations and suppress their cycle. For example oral contraceptives, tailored oestrogen and progesterone medication.
Women who do not tolerant this, usually have GnRH analogies, such as Zoladex, and hormone replacement therapy (HRT).
Zoladex shuts down the natural menstrual cycle, putting the women into a chemical menopause, and HRT is provided to maintain the womans health. Estrogen is needed for preserve bone density and progesterone is needed for preventing tissue build up in the womb. All sorts of HRT is used-different delivery systems and different doses. Its a tireless trial and error to try and get the right match for the women.
Unfortunately, some women also do not tolerate this. The HRT, especially progesterone, can cause PMDD symptoms or other undated side effects. These women are offered an Hysterectomy to rid them of PMDD.
Sadly women as young as 25 years old, are having to resort to having a Hysterectomy, only for them to live a 'normal', balanced and happy life. This is a difficult decision to make, especially if you hope to have a family/children.
Personal stories
The only way to really understand PMDD is to read stories from real women.
Here are some links below:
11 women with PMDD share what it's really like
Laura's brave story with PMDD
The rare menstrual disorder that contributed to Gia Allemand's suicide
Imagine having to choose between your mental health and your fertility
If you yourself are going through PMDD-know you are not alone.
If you know someone suffering with PMDD - be patient, kind and supportive. Know the women herself, not who she is as the PMDD girl.
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