What is PMDD?

Reviewed by: Dr. Nubia Chong

If you're a person with ovaries, you’ve probably heard plenty of jokes about how PMS can make you act crazy. Do you ever notice how no one who has ever had PMS before laughs? That's because we know that PMS is real, and it can suck.

PMS, or premenstrual syndrome, is a term used to describe the cyclical pattern of physical and emotional changes, like mood swings 🎢, aches and pains, and breakouts that only happen in the roughly 14 days before your period called the luteal phase. PMS looks different for everyone– there are over 150 associated symptoms– and the severity of PMS decreases for many as they get older. (It does get better!)

For some, PMS is so severe that it significantly disrupts their day-to-day lives and impacts their mental health, relationships, social life, jobs, and school. This condition, called Premenstrual Dysphoric Disorder (PMDD), causes symptoms that make it difficult to function normally.

Unlike PMS, PMDD requires a diagnosis from a doctor, such as a primary care doctor, OBGYN, or psychiatrist with specialized training in women’s mental health. It’s a severe condition that deserves to be taken seriously, and fortunately there are many effective treatment options and self-care strategies that can help you feel better and manage your symptoms! Let’s dive in further:

What is PMDD:

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of PMS, marked by symptoms severe enough to impact day-to-day functioning. The exact cause of PMDD is still unknown, but it is believed that people with PMDD are highly sensitive to the normal, cyclical hormonal changes to mood-regulating neurotransmitters like serotonin that happen during the luteal phase. (People with anxiety and depression might experience PMS and PMDD more severely, but doctors haven’t been able to strongly correlate this with PMDD, yet.)

PMDD can cause a dizzying array of symptoms, but most commonly fatigue and lack of energy, irritability, depressed mood, and heightened anxiety. PMDD symptoms aren’t a normal part of having a period, and can significantly impact your ability to live your life normally.

If you are experiencing PMDD, you’re not alone. As many as 10% of people with PMS might actually have PMDD! The right doctor for you will take your symptoms seriously, and fight for your right to feel your best 💪


Diagnosing PMDD:

It can take time to get diagnosed with PMDD. Your doctor will first have to rule out other conditions like hypo/hyperthyroidism and anemia through blood work and a physical exam, and might ask you to keep a log of your symptoms over the course of a few months to see if your symptoms are limited to your luteal phase. (The official diagnostic criteria for PMDD can be found here.)

If you think that you have PMDD, you can start by logging your symptoms for 2-3 months to review with your doctor. Having a log of your symptoms can help you build confidence and advocate for yourself as you begin the diagnosis process. The Aavia app can help you track changes to your mood over your hormone cycle, and can be a helpful tool to bring to your doctor!

How to treat PMDD:

There are lots of ways to treat PMDD, and your doctor will review treatment options so you can decide on the best treatment for you. Many doctors suggest lifestyle changes as an important part of treating PMDD. Reducing caffeine and alcohol intake, and prioritizing proteins and carbohydrates in your diet can treat symptoms, as can stress-busting activities like regular moderate exercise, cognitive behavioral therapy (CBT), and mindulness techniques like meditation and breathwork. Supplements like calcium, vitamin B6, magnesium, and L-tryptophan may also be helpful in addressing PMDD symptoms!

When conservative treatments (like lifestyle changes) aren’t enough to treat PMDD symptoms, many people also find relief with a type of medication called Selective Serotonin Reuptake Inhibitors (SSRIs). SSRIs are a class of antidepressant medication that include Zoloft, Prozac, and Lexapro. Depending on the severity and type of symptoms, these medications might be prescribed only during the luteal phase aka the 14-day period after ovulation, offering relief when PMDD symptoms are most severe. It can take time to find the right dosage or treatment plan that works for you, so it’s important to work with a doctor to find the best treatment plan for you.

Working with your doctor, and logging your regular symptoms into the Aavia app can help you understand how your mood and symptoms change over your hormone cycle. You deserve to be taken seriously, and you deserve to feel your best! ☀️

For more resources, check out the sources below, and join the #HormonalisHuman group in Aavia’s secure and anonymous community forum!

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Image credit: Gemma Chua Tran