Author’s note: Within this article, the term ‘women’ is largely used to refer to those assigned female at birth (AFAB) who menstruate. It is acknowledged that not all people who menstruate are women, and not all women menstruate.
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“It must be that time of the month.”
It’s the familiar, trite punchline of countless movies and sitcoms. What typically ensues is the female character in question being spurred into an ‘amusing’ fit of rage.
Most women and individuals assigned female at birth (AFAB) know that, beyond such cliches, the symptoms of premenstrual syndrome (PMS) are far more complex in reality. These include emotional changes such as irritability or crying spells, and physical symptoms including breast tenderness and bloating. Yet what of the 1 to 7 percent of women estimated to suffer from its most severe form?
“Most women experience mild emotional and physical symptoms around a week before their menses starts,” explains Dr Elizabeth Siak, Consultant at KK Women’s and Children’s Hospital Department of Psychological Medine.
“However, premenstrual dysphoric disorder (PMDD) is the most severe form of PMS and is known to be so distressing that it interferes with a woman’s daily functioning.”
What sets PMDD apart from PMS?
“Women with PMDD will suffer from at least five symptoms of PMS which are so intense they disrupt their lives and normal functioning,” reasserts Dr Siak. These could affect everything from work and relationships to school and socialising. Symptoms include:
- Feelings of sadness, hopelessness or worthlessness
- Anxiety
- Unstable mood and frequent crying
- Persistent irritability causing conflict in relationships
- Loss of interest in activities
- Lack of concentration
- Fatigue
- Food cravings or binge eating
- Sleeping too much or too little
- Feeling out of control
- Physical symptoms like breast pain, headaches, joint or muscle aches, bloating and weight gain
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Why do only some women experience PMDD?
“The exact cause of PMDD is unknown,” says Dr Siak. Indeed, there is a large dearth of research on the condition, which was only formally recognised in 2013. It’s a gap reflected across many other aspects of women’s health including endometriosis and menopause.
However, existing studies suggest that PMDD may be linked to our hormones, which fluctuate sharply during a woman’s menstrual cycle. “Hormones affecting the function of neurotransmitters such as serotonin, which influence mood and thinking, may be the cause of this condition,” explains Dr Siak.
It remains unclear why only some women experience PMDD, or what exactly triggers its onset—often years after a woman begins menstruating. Links to genetic and lifestyle factors are being explored, with possible risk factors including obesity, past traumatic experiences, high stress levels, smoking and a high-potassium diet.
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How can PMDD be treated?
“If you experience at least five severe PMS symptoms that affect your ability to function, over at least two to three months, you would benefit from seeking a medical assessment,” Dr Siak advises. This assessment will include a medical history and evaluation of symptoms, also ruling out other conditions.
“It is helpful to keep in mind that some women with depression experience a premenstrual worsening of symptoms,” Dr Siak gently clarifies.
Treatment options for PMDD include lifestyle changes, cognitive behavioural therapy and medications such as selective serotonin reuptake inhibitors (SSRIs). Though they have not been extensively studied in the context of PMDD, Dr Siak points to a number of healthy lifestyle changes which can help to relieve premenstrual symptoms. These include:
- Regular aerobic exercise
- Avoiding alcohol, caffeine, smoking and refined sugars
- Stress reduction techniques such as yoga
- A diet high in: iron from plant-based sources; zinc; thiamine; and riboflavin
- Smaller, more frequent meals based on complex carbohydrates can help to relieve PMS symptoms.
- Taking 100mg of vitamin B6 daily may benefit some women with PMS and PMDD.
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Why is greater awareness of PMDD so crucial?
It is important to know that, if you are struggling with PMDD, you don’t have to suffer in silence. Leaving the condition undiagnosed and untreated can severely reduce quality of life and have devastating consequences. Tragically, PMDD is linked to an increased risk of suicidal thoughts and behaviours, galvanising the need to take this condition seriously.
With the right treatment and support, women with PMDD can see significant improvements to their overall wellbeing.
“Raising awareness about medical conditions such as PMDD is an important step in improving overall public health,” says Dr Siak. “It helps to empower women in taking steps to improve their own health and access timely treatment and support.”
