Around ninety percent of women who have a regular menstrual cycle will experience both physical and emotional changes during their periods. These symptoms can vary in consistency and severity, but for most women, the symptoms will be mild or manageable, and nothing more than an inconvenience that they have to deal with every month.
For some, however, their symptoms can be so significant that they can seriously disrupt their daily lives and be severe enough that they are unable to function as they would normally do, at home or work. Around thirty to eighty percent of women who have symptoms will have a form of PMS (premenstrual syndrome) but PMDD (premenstrual dysphoric disorder) will only affect around three to eight percent of women as it is far less common. Whilst initially the conditions may seem to be the same, as they share many symptoms they are also different in several ways.
Risk factors and causes of PMS and PMDD
Whilst the causes of PMS and PMDD are not fully understood, studies have shown that some women are more sensitive to the hormonal changes in their body during menstruation. Research suggests that this increased sensitivity can be caused by smoking but the evidence for this is weak. It is believed however that women who have experienced childhood trauma, neglect, physical, emotional, or sexual abuse could be at higher risk. This also applies to women who have a serotonin deficiency, the hormone your brain produces that affects your emotions. Having family members with PMDD or mood disorders such as, anxiety or depression could increase your chances of developing it, as can having experienced gender dysphoria.
Symptoms
Symptoms usually occur around seven to ten days before your period commences and can last for the first few days in both PM and PMDD. Whilst symptoms can be similar in both conditions there are some significant differences.
Physical Symptoms
- Changes to your appetite usually include an increased appetite or food cravings, especially carbohydrates or sugary foods
- Swelling or tenderness in the breasts
- Headaches, muscle, and joint aches or pain
- Feeling lethargic or tired
- Changes to your sex drive
- Struggling to concentrate and being forgetful
- Abdominal bloating
- Pain in the pelvis and groin
- Changes to your hair and skin
Psychological Symptoms
- Anxiety or depression
- Feeling irritable, annoyed, or angry
- Withdrawing from social situations
- Being sensitive to rejection or criticism
- Feeling overwhelmed
- Mood swings
- Poor sleep patterns
Additional symptoms of PMDD
Because PMDD is a more severe form of PMS, it causes more significant mood disturbances and reactivity compared to PMS.
- Feeling suddenly sad or tearful
- Severe mood swings
- Anxiety more severe than with PMS
- Increased feelings of depression which can leave you feeling hopeless and even suicidal
Diagnosis of PMS and PMDD
There are no specific tests to diagnose PMS or PMDD. You should contact your doctor to discuss your symptoms, they may ask you to keep a diary of your menstrual cycle and symptoms to help them make a diagnosis. They can also give you a physical examination and refer you for tests depending on your symptoms, to rule out any physical conditions such as endometriosis, fibroids, or ovarian cysts.
Other mental health conditions such as mood disorders including major depression and bipolar can worsen before your menstrual cycle which can mimic symptoms of PMDD. In circumstances where this occurs, it is referred to as PME (premenstrual exacerbation). It’s believed that around forty percent of women who think they might have PMDD and seek treatment actually have PME due to an underlying mood disorder.
Treatments for PMS and PMDD
Once your doctor or gynaecologist has diagnosed PMS or PMDD, they can provide you with a treatment plan based on how severe your symptoms are.
Medication
They can prescribe anti-anxiety or antidepressant medications including selective serotonin reuptake inhibitors (SSRIs). SSRIs are a form of antidepressant that can affect the serotonin in your brain which can help relieve symptoms that affect your mood.
Hormonal
They can also prescribe birth control or contraceptive pills, as they stop you ovulating (producing and releasing an egg) they are likely to help reduce symptoms such as aches and pains. They can also prescribe painkillers that are stronger than over-the-counter medication if required.
Surgical
In extreme cases, some women who have severe PMDD have opted for surgical intervention. This can include a bilateral oophorectomy which involves surgically removing the ovaries, or a hysterectomy which removes the ovaries, fallopian tubes, and uterus. This option is only used in cases where all other treatment options have failed.
Self-Help
There are a variety of different ways you can try to help yourself manage your symptoms of PMS and PMDD.
Lifestyle changes
It can be beneficial to try these changes before trying medication to see if they work for you. Cutting down on your intake of caffeine, sugar, and sodium is believed to be helpful for some people. Reducing the amount of nicotine and alcohol you consume, as well as maintaining a healthy diet and doing aerobic exercise can help both the physical and emotional symptoms.
If you suffer from stress, anxiety, or depression during your menstrual cycle, you could try relaxation exercises and breathing techniques, or mindfulness as well as meditation or yoga.
Nutritional Supplements
Certain supplements and vitamins have been proven to help physical and emotional symptoms including Vitamin B6, Vitamin D, zinc picolinate, calcium and magnesium glycinate, or magnesium citrate supplements. Supplements should not be used in place of a healthy diet and you should check with your doctor as they might not mix well with certain other medications.
Herbal remedies such as vitex agnus-cactus commonly known as chasteberry, gingko biloba, kava kava, black cohosh, and St John’s Wort can help with symptoms such as irritability, anxiety, or depression. This can be an option for some people who may not tolerate antianxiety or antidepressant medications. Remember that like prescribed medication, nutritional and herbal supplements can have side effects, so you should always check with your doctor that the product and dosage are suitable for you.
Psychotherapy and Cognitive Behavioural Therapy
Both therapies have proved successful in helping women who suffer from PMS and PMDD to help them manage their symptoms.
Written by Jan, Jeana, and Wendy at Barnsley Hypnosis & Counselling (UK).
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