PMDD: Breaking the Silence

Premenstrual Dysphoric Disorder (PMDD) is a  condition characterized by severe mood swings, physical symptoms, and behavioral changes that occur cyclically in the luteal phase of the menstrual cycle, affecting approximately 3-8% of menstruating individuals (Eisenlohr-Moul et al., 2019). While PMDD shares some symptoms with Premenstrual Syndrome (PMS), such as irritability, fatigue, and bloating, it is distinguished by the intensity and duration of these symptoms, which significantly impair daily functioning and quality of life (Marjoribanks et al., 2019). The specifics of PMDD remains complex and multifaceted, involving interactions between hormonal fluctuations, genetic predispositions, neurotransmitter dysregulation, and psychosocial factors. Research suggests that alterations in the sensitivity of the brain’s serotonin receptors during the luteal phase may contribute to the mood disturbances observed in PMDD (Bixo et al., 2017). Variations in the expression of genes involved in serotonin metabolism, such as the serotonin transporter gene (SLC6A4), have been implicated in the pathophysiology of PMDD (Khalaj et al., 2017).

Symptomatically, individuals with PMDD experience a range of psychological and physical manifestations that can significantly impair their daily functioning and quality of life. Mood-related symptoms, including irritability, sadness, anxiety, and mood swings, are the core features of PMDD and often lead to interpersonal conflicts and difficulties in social and occupational domains (Halbreich et al., 2017). Additionally, individuals with PMDD may experience cognitive impairments, such as difficulty concentrating and making decisions, worsening functional impairment during the symptomatic phase of the menstrual cycle (Rapkin et al., 2017). Physical symptoms commonly associated with PMDD include breast tenderness, headaches, joint or muscle pain, and gastrointestinal disturbances, which can further contribute to the overall burden of the disorder (Yonkers et al., 2019).

Diagnosis of PMDD requires careful clinical assessment, including a thorough medical history, symptom monitoring over consecutive menstrual cycles, and ruling out other underlying psychiatric or medical conditions that may mimic PMDD symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for the diagnosis of PMDD, including the presence of at least five mood and physical symptoms that occur in the luteal phase and remit within a few days of menstruation onset, with symptom-free intervals in the follicular phase (American Psychiatric Association, 2013). Validated screening tools, such as the Daily Record of Severity of Problems (DRSP) and Premenstrual Symptoms Screening Tool (PSST), can aid in the systematic assessment and monitoring of PMDD symptoms in clinical practice (Endicott et al., 2006).

Management of PMDD typically involves multiple approaches tailored to individual symptom severity and functional impairment. Pharmacological interventions, such as selective serotonin reuptake inhibitors (SSRIs), hormonal contraceptives, and gonadotropin-releasing hormone agonists, are commonly used as first-line treatments to alleviate mood symptoms and regulate menstrual cycles (Freeman et al., 2019). However some remedies can be as simple as a certain type of birth control. Non-pharmacological strategies include therapy, stress reduction techniques, regular physical activity, and dietary modifications, which may also provide other benefits in improving coping skills and enhancing overall well-being in individuals with PMDD (Lustyk et al., 2009). Peer support groups play a crucial role in empowering individuals with PMDD to better understand their condition, identify triggers, and implement effective self-management strategies to lessen symptoms and improve quality of life (Pearlstein et al., 2005).

PMDD crept into my life during my sophomore year of college, leaving me confused and lost. I dealt with feelings of despair, mistaking them for depression, yet hesitated to seek help as these emotions seemed to fade with time, only to resurface cyclically. It wasn’t until later that I realized these struggles were intricately tied to my menstrual cycle. My eating habits swung drastically between overindulgence and deprivation, leaving me bedridden for days on end. I pushed away friends, consumed by a cloud of irritability and despair. Academic failure and disengagement from my extracurricular activities became the norm. It wasn’t until the burden became unbearable that I sought out answers, only to discover the existence of PMDD—a revelation that shed light on years of silent suffering. Even then, getting a diagnosis and treatment proved to be a prolonged journey, due to the lack of awareness surrounding this condition. I share this personal testimony and the cited information above in the hope of raising awareness about PMDD, a silent condition that gave me years of confusion until its weight became too heavy to ignore.