Coping with premenstrual dysphoric disorder

Casting off premenstrual dysphoric disorder (PMDD) into the bucket labeled “women’s issues we all deal with” or dismissing these women’s experiences as “just that time of the month” does a disservice to those whose relationships, career, and quality of life suffer with their condition.

PMDD—the facts

  • PMDD is a severe form of PMS that affects between 8 and 5.8 percent of menstruating women per year.
  • This condition comprises cognitive, physical, and affective symptoms that arise during the luteal phase of the menstrual cycle, which spans from ovulation to the onset of menses.
  • The intensity of these symptoms causes significant distress and interference in their daily lives, negatively affecting their relationships and productivity at home and work.

Diagnosing PMDD

Just like PMS, PMDD symptoms only occur in the luteal phase of the menstrual cycle and resolve within a few days of the onset of menses. But unlike PMS, PMDD is classified as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The DSM-5 requires that specific criteria be met for the diagnosis of PMDD.

If you’re wondering if your PMS is severe enough to be classified as PMDD, a good place to start is by journaling which symptoms you have and when you experience them in relation to your menstrual cycle. Look up the Daily Record of Severity of Problems for a validated tool used to document symptoms and diagnose PMDD.

Consult your health care practitioner

Developing a keen sense of your own body is always valuable, but remember to consult your health care practitioner for an official diagnosis. Bring your symptom journal to your appointment for a discussion about taking next steps.

Lab testing and imaging can be helpful to rule out other potential causes of your symptoms. For instance, migraines, anemia, endometriosis, and hypothyroidism may cause similar symptoms to PMS and PMDD and require different treatment.

Interpersonal relationships

The impairment to interpersonal relationships in the luteal phase for women with PMDD is comparable to the severity experienced by those with clinical depression.

Research has shown that education about the condition can mitigate prejudice against those with PMDD. One trial showed that people who were educated about PMDD perceived sufferers to have more warmth, less depression, and more competence than did those who were not familiar with the condition.

Encouraging your partner, friends, and family to read about PMDD from reputable sources may lead to better understanding of your condition. Open communication may also help lighten the burden and foster empathy. When you’re feeling well, encourage your friends to ask how PMDD affects your life.

Cognitive behavioral therapy has been shown to reduce the burden of PMDD, while addressing stress management and coping styles. Psychoeducational self-help programs have also been shown to assist women in managing mild to moderate PMS.

By Dr. Cassie Irwin, ND