I'm lying in bed sobbing uncontrollably after another night of no sleep and a day of insane brain fogginess that made it hard to focus on work. And this isn't the first time I've been through this. In fact, it’s a feeling I experience every single month just before my period comes. Then, like clockwork, five-ish days before my flow, I start to develop overwhelming anxiety with bouts of hopelessness, insomnia, intense cravings and difficulty concentrating. This obviously isn't easy to manage while working full-time and raising a 3-year-old.
For a while, I just wrote it off as typical PMS. But the symptoms were way worse in the past year than they ever had been before. It often feels debilitating for an entire week every month, which is 12 weeks a year or three whole months of my life! That's a lot of time to be feeling this horrible. So, I brought it up to my doctor, who diagnosed me with premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS).
It made me feel slightly better knowing that there was something medically going on with me when I learned about this. Sadly, it's another women's health issue that's often overlooked.
“It can be easy for patients and physicians both to explain away symptoms under the guise of ‘it's an off month’ or ‘maybe it's my diet,’ ” says Dr. Catha Fischer, director of fertility preservation at Spring Fertility. “Mental health disorders, especially for women, can be dismissed until you find a provider with expertise in the area that can look at a long history of symptoms and draw a clear conclusion.”
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Luckily, there are ways to relieve the symptoms if you've been diagnosed. And while I'm personally still working on a solution that works for me, I thought it was important to shed some light on the condition in case other women feel the same. Here is everything you need to know about PMDD.
What is PMDD?
PMDD is a physical and mental change that occurs in the days leading up to the onset of menses and can last into the first few days of bleeding. The temporal relationship to menstruation is the key to this diagnosis.
How is it diagnosed?
I started to track my symptoms in the spring of 2020 when I noticed something out of the ordinary. But there is a clinical way doctors suggest you get diagnosed.
“PMDD is a true mental health condition listed in the DSM 5, the catalog of mental health disorders,” says Fischer. “It is a diagnosis that is made over months as we see a pattern of behavioral and physical changes related to menses. Therefore, to meet the diagnosis of PMDD, the relationship to the menstrual cycle must be established in addition to a combination of physical and mental changes that are severe enough to impact day to day quality of life.”
Fischer adds, “These include but are not limited to mood changes [anxiety, depression, agitation], sleep disturbances, bloating and uterine cramping. Over a year, one must have at least five of the symptoms listed to carry the diagnosis.”
What are the treatments?
Treatment can involve birth control pills, antidepressants and changes to diet and exercise. “It may take some time to establish what works best, and often it is a combination of treatments,” says Fischer. “All menstruating individuals should be health advocates for themselves. If something feels off, then keep asking questions until you hear answers.”