Premenstrual Dysphoric Disorder (PMDD) is a health problem that affects millions of teen and adult women. It is similar to Premenstrual Syndrome (PMS), but PMDD is more serious. PMDD has many serious health consequences, including irritability, depression, and anxiety. These symptoms typically occur one to two weeks before your period starts and start wearing off two to three days after your period starts.
PMDD is often referred to as “severe PMS” since it causes a range of emotional and physical symptoms. Many women experience symptoms of PMS. You may even have severe PMS symptoms, and simply acknowledge them as “normal” since you do not know how else to feel. With PMDD, the symptoms are harsh and it can have a great impact on your life. It can be difficult to work, go to school, socialize with other people, and form healthy connections. If you think you may be struggling with PMDD, continue to read this blog.
Anchor Therapy is a counseling center in Hoboken, NJ with mental health therapists specialized in helping children, teens, adults, and couples with anxiety, depression, relationship issues, trauma, life transitions, and more. Anchor Therapy is accepting new clients and is now providing in-person sessions and teletherapy sessions to residents of New Jersey, New York, Florida, North Carolina, and Utah.
What is PMDD?
PMDD is a serious form of PMS. While PMS can cause symptoms like bloating, breast tenderness, and headaches a week or two weeks before you begin your period, PMDD can contain PMS symptoms and even more signs.
Along with standard PMS symptoms, you may also experience extreme irritability, anxiety, and depression if you have PMDD. The symptoms of PMDD do improve as you begin your cycle. Normally, within the first few days of your period you will feel like your symptoms have improved. But, that does not mean that PMDD does not negatively impact your life, especially the days leading up until your period begins where your symptoms are at an all-time high.
What is PMS?
PMS is a group of symptoms that many women experience between ovulation and period. PMS has a wide range of signs and symptoms, from food cravings and fatigue to mood swings and irritability. It is estimated that 3 out of 4 women experience some form of PMS.
Typically, symptoms of PMS occur in a predictable pattern. However, the emotional and physical changes you experience with PMS can vary from cycle to cycle. PMS can be extremely exhausting; however, please take power in the fact that it does not have to run your life!
Whether you seek the help of a therapist who specializes in women’s issues or make some lifestyle adjustments, you can lessen or manage the signs and symptoms of PMS.
What causes PMDD?
Medical professionals do not know why some women get PMDD. It is estimated that roughly 10% of women who have periods have PMDD.
You may be more prone to PMDD if you have one or more of the following:
Anxiety
Depression
PMS
Family history of PMS, PMDD, and mood disorders
PMDD occurs during the luteal phase of a woman’s menstrual cycle. The luteal phase is the time between when you ovulate and your period starts. Generally, the luteal phase lasts two weeks, but it can be shorter or longer. During this time, you may experience PMDD symptoms on a daily basis, or for a few days within the luteal phase.
One potential explanation for PMDD symptoms is the decrease of estrogen and progesterone hormones after ovulation and before menstruation.
Together, estrogen and progesterone are associated with:
Mental fog
Irritability
Fatigue
Memory problems
It is also thought that serotonin plays a role in the occurrence of PMDD symptoms. Like hormone levels, serotonin levels change throughout your menstrual cycle. Serotonin is a chemical in your brain that is in control of your hunger, sleep, and assists in managing your moods.
What causes PMS?
Like PMDD, the cause of PMS is unknown.
There are several factors that may contribute to PMS, including:
Depression - Some women with PMS have undiagnosed depression. If you want to know if you have depression, take our depression quiz. (Please note that depression alone does not cause all of the PMS symptoms)
Cyclic changes in hormones - Similar to PMDD, signs and symptoms of PMS can fluctuate in accordance with your menstrual cycle and hormone fluctuations. PMS symptoms disappear with pregnancy and menopause
Chemical changes in the brain - Changes in serotonin (a chemical in the brain responsible for managing your mood) could trigger PMS signs and symptoms. When you do not have enough serotonin, you may experience premenstrual depression, fatigue, food cravings, and sleep issues
What are the symptoms of PMDD?
If you are struggling with PMDD, you may find that you resonate with one or several of the symptoms listed below. However, it is important to remember that everyone’s body is unique. Therefore, you may experience some symptoms that are not included in the list below.
Some emotional experiences you may endure with PMDD include:
Difficulty concentrating
Mood swings
Feeling angry or irritable (Check out our blog “When Is It Time To Seek Anger Management Therapy” to find out if anger counseling is right for you)
Suicidal feelings (feeling suicidal? Help is only a phone call away at the free National Suicide Prevention Lifeline: 988)
Feeling anxious (Read our blog “10 Ways To Self Diagnose An Anxiety Disorder” to find out if you are struggling with an anxiety disorder)
Feeling tense or like you are constantly on edge (Read our blog “Everything You Need To Know About Stress Management Therapy” to see if you can benefit from stress management counseling and to learn effective stress management techniques)
Feeling upset or tearful
Lack of energy
Lack of interest in previously enjoyable activities
Feeling hopeless
Feeling overwhelmed or out of control
Some physical and behavioral experiences you may suffer from encompass the following:
Feeling bloated
Sleep problems (If you struggle with insomnia, check out our blog “How CBT Can Help With Your Insomnia”)
Headaches
Breast tenderness or swelling
Muscle and joint pain
Changes in your appetite (e.g., eating too much, eating too little, having specific food cravings)
Increased anger or conflict with your loved ones
Becoming extremely upset easily
Since PMDD is linked to your menstrual cycle, it is unlikely that you will experience PMDD symptoms if you are pregnant. However, you may find that your PMDD symptoms start again once you start ovulating. Additionally, you may suffer from perinatal and postpartum mental health problems, such as postpartum depression (PPD).
If you are a new mom and you find yourself struggling mentally, check out our blogs: “How Therapy Can Alleviate Mom Guilt” and “Your Guide To Self-Care As A Parent.” At Anchor Therapy, we have a team of dedicated therapists for PPD and postpartum anxiety who can help you feel like your best self again.
What are the symptoms of PMS?
The list of signs and symptoms of PMS is lengthy since every woman’s body is unique. What PMS looks like for you may not be the same experience your friend has for instance. Most women experience a few symptoms.
Emotional and behavioral signs and symptoms of PMS include:
Anxiety or tension
Crying spells
Social withdrawal (Check out our blog “6 Helpful Tips For Living With Social Anxiety”)
Poor concentration
Change in libido
Mood swings
Irritability or anger
Appetite changes (including food cravings)
Trouble falling asleep (e.g., insomnia)
Physical signs and symptoms of PMS include:
Fatigue
Headaches
Breast tenderness
Alcohol intolerance
Acne flare-ups
Upset stomach
Abdominal bloating
Joint and muscle pain
Weight gain related to fluid retention
For some people, the signs and symptoms of PMS alone can be great enough to affect their daily life. While symptom severity varies, the signs and symptoms of PMS typically go away within four days after the start of the menstrual period for the majority of women.
If you find that your symptoms are disabling, you may have PMDD. If you have not been successful in managing your symptoms on your own, it is highly recommended you seek the help of a mental health counselor who specializes in women’s issues to learn more about effective PMDD treatments.
I think I may have PMDD. How do I get a diagnosis?
If you are interested in getting a PMDD diagnosis, you should visit your doctor’s office. If doing this, you should expect to answer questions to help your doctor understand your symptoms and the severity of your issue.
Your doctor may:
Ask you about your lifestyle - Lifestyle factors can include how often you consume alcohol, if you smoke, how active you are, etc.
Give you a physical examination and some blood tests - This helps your doctor rule out other medical conditions
Ask you about your medical history - Your doctor may ask if you have any history of mental health problems (including family history)
Ask you to keep a detailed record of your PMS/PMDD symptoms for at least two months - It can be helpful to keep a journal log of your symptoms before you visit your doctor initially so you can get a jumpstart on your recovery and PMDD management. If you do not have a symptoms journal before visiting your doctor, that is okay too! This will help your doctor see if your symptoms have a pattern. Your doctor may decide that it is best for you to keep a journal or they may provide you with a daily questionnaire to fill out
When you are asked to keep a journal or fill our daily questionnaire sheets, getting a PMDD diagnosis can feel like a painfully slow process. It can be frustrating as you await treatment. Therefore, it may be helpful to practice some self-care in the meantime.
What can I do to help myself during my PMDD journey?
Luckily, there are many things you can do to reduce the impact of PMDD on your life. Different things work for different people, so it may take some trial and error to find the perfect healthy coping strategy for you.
While you are exploring new stress management techniques, try not to put too much pressure on yourself. Practicing self-care should benefit you in the long-run, not make you feel more stressed out. If something feels overwhelming or like it is not possible now, come back to that activity at a later date.
You can try to do the following to alleviate PMDD signs and symptoms:
Talk to a PMDD mental health counselor
Finding a subjective person you can confide in and trust with your most personal health moments can be scary, and that is where a mental health counselor comes into play. A therapist for PMDD will listen to you and provide helpful strategies so you can manage your PMDD instead of your PMDD managing you.
Anything related to reproductive health can feel private or taboo, but it is a normal part of life, and something that PMDD therapists are trained in. When you find the words and courage to seek external help, that is the first step in feeling better.
If you are trans or non-binary, you may find that talking about periods can bring up especially difficult feelings regarding the gender you were assigned at birth. You may be worried that it will lead people to misgender you. A LGBTQIA+ therapist can help you work through these emotions.
2. Try peer support
There are many peer support groups that may help you navigate your feelings surrounding PMDD while, at the same time, recognizing that you are not alone in your mental health difficulties. Peer support groups bring together people from all different walks of life who have had similar experiences as you which you may find helpful.
3. Create a self-care routine
Finding time to engage in self-care can feel hard, especially when your PMDD signs and symptoms leave you feeling low on self-esteem and depleted of energy. Therefore, it may be helpful to create a set self-care routine that you engage in regularly. For example, you may assign Sundays as your “self-care day.” Maybe this is a day where you do not check work emails, have a bubble bath, and do a face mask. The great thing about self-care is that you can customize it to your needs!
You can also create a self-care box. The box can include things that bring you joy and will cheer you up when you are feeling down. For instance, you can include your favorite book, notes of encouragement, and so on.
Overall, it can be hard to live with PMDD. It can take a toll on you both mentally and physically. If you are struggling, it is important to know your symptoms so you can receive a proper diagnosis. You may find it helpful to work with a PMDD therapist so you can talk through your symptoms and find healthy coping skills that work for you, including peer support and a designated self-care routine.
Victoria Scala
is the Social Media Manager and Intake Coordinator at Anchor Therapy in Hoboken, New Jersey. She is a graduate of the Honors College of Rutgers University-Newark and is currently studying Clinical Mental Health Counseling at the graduate level. As a Social Media Manager at Anchor Therapy, Victoria is committed to producing content for and managing the office’s social media presence and blog.
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