Okay, we know what you’re thinking: PMS is always nasty, bish. You are, of course, completely correct. But there are some among us – an unlucky few – for whom nasty doesn’t even come close. That time of the month becomes half the month. Crying at adverts while eating a liter of Haagen Dazs Dulce Du Leche and a box of Lindor becomes paranoia, insomnia, and life-changing self-destructive behavior for 14 days straight. It’s so bad that they’ve even given this extreme form of PMS its very own name and acronym. Gang, this is PMDD. And it’s an absolute bish.

Hormonal Hell

If you’re (un)lucky enough to menstruate every 28 days or so, there’s a better than good chance you’ve experienced regular old PMS at some point. You know the sort of thing. Sore breasts, mood swings, sobbing for no reason, an over-reliance on Prosecco cocktails… All the fun stuff that comes with riding that monthly hormonal rollercoaster. Of course, PMS in and of itself can be an absolute nightmare. We can attest to that. PMDD, though, comes with all the usual stuff, just at a gazillion times the strength. In short, it is the hormonal equivalent of a nuclear explosion.

PMDD symptoms

Like PMS, symptoms of Premenstrual Dysphoric Disorder, to give the thing its full title, can start up to two weeks before the first day of bleeding and extend well into your period. And, like PMS, the list of PMDD symptoms is long and varied.

Here’s just a small taster of what patients living with PMDD experience:

• agitation,
• insomnia,
• paranoia,
• anxiety,
• confusion,
• loss of control,
• swollen hands, feet and ankles,
• vision changes,
• infections and
• lowered urine output.

Yep, you actually pee less. Because of periods. But this list barely scratches the surface of the havoc that PMDD can wreak. Not only are there dozens of symptoms, which is bad enough, but their severity is also some next-level hormonal shiz.

Living With PMDD

PMDD patients have reported that their psychological symptoms were so severe that it felt like pressing the self-destruct button on their lives every two weeks. We’ve all had days where we couldn’t get out of bed thanks to PMS. But imagine not being able to get out of bed for two weeks and not giving a good God damn about the consequences – job, family, friends, nothing.

Others, though, experience a very different form of self-destruction. The kind where you get so smashed that you quit your job, divorce your partner, and buy an alpaca farm in Alaska. Either way, your life as you knew it is over. And now imagine that happens every two weeks. That’s how bad PMDD can get.

How PMDD can make you a danger to yourself

In fact, symptoms that stop you from functioning on a daily basis are one of the diagnostic criteria for PMDD. Unfortunately, though, it can get so much worse than alpacas. And this is one of the reasons the medical community is taking notice. Depression, lack of control, and general nihilism can lead to thoughts of suicide. That’s on the extreme end, admittedly, but when you live half your life in an extreme state, it’s hardly a big jump. And the suicide ideation concerns healthcare types so much that they’ve added PMDD to the go-to manual for mental health conditions, the DSM5.

Forewarned Is Forearmed

The snappily titled Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM5), only contains officially recognized mental health issues. So, for a period-related female-only condition to be included in the most recent edition is big. Really big. But it also underscores just how serious – and common – PMDD really is. That said, of course, big change can take eons to trickle down to the front lines.

Also, and wouldn’t you know it, PMDD can take years to diagnose. So, how can you tell if you’ve got PMS or PMDD? What can you do to get diagnosed? And what treatment exists to help? We’re glad you asked…

PMDD diagnosis

For a start, before any medical type will even look at PMDD as a possible diagnosis, certain conditions have to be met, and others ruled out. That starts with confirmation that you’re suffering from at least five of the symptoms we mentioned earlier during each cycle for up to 12 months.

And in order to do that, you have to keep a detailed record of how you feel and what’s going on physically. Which means you’ll have to suffer the paranoia, anxiety, and shoes that don’t fit for the better part of a year to satisfy to get in the vicinity of a diagnosis. There’ll be mental health evaluations and pelvic exams, to rule out any related causes. You’ll also need to disprove this thing they like to call PME (Premenstrual Exacerbation). They love an acronym, don’t they?

PME: Periods Make Everything worse, well nearly…

Now, at Hormona, we love to learn to new stuff and PME was new a one for us. What is PME? Beautifully named, most likely by someone who’s never had a period, Premenstrual Exacerbation is something you’ve probably already experienced. It happens when the hormonal changes make a pre-existing condition worse or interfere with the efficacy of medication.

We can already hear you screaming. Because, and this is one of the reasons Hormona exists in the first place, PMS makes everything worse. And that lack of hormonal understanding is the very basis of our business. We digress. You basically have to satisfy your physician that, say, PMS isn’t getting in the way of your Graves treatment and increasing the symptoms. Which, and pay attention UK Endocrinologists, actually happens.

What causes PMDD?

Not that we’re casting aspersions here, but you won’t be surprised to learn that, despite the new recognition of PMDD symptoms, no one really knows what causes it. In a nutshell, medicine’s best guess is that patients have an atypical reaction to fluctuating hormones.

This atypical reaction, in turn, causes a drop in serotonin levels, which leads to mood swings and narrow blood vessels. Yup. And that’s backed up by a very serious American medical institution whose blushes we’ll spare. For now. But that’ll give you some idea why a PMDD diagnosis could be years in the making.

Hiding in plain sight

Regular Hormonas will most likely have already guessed some of the other reasons a PMDD diagnosis can take so long. It’s categorized as an Endocrine mood disorder, which means it can sometimes be mistaken for Graves, Hashimoto’s, Anxiety disorders, or just depression. None of which really cover it. And that lack of knowledge in the general medical community is deeply concerning.

Anyone can develop PMDD. Which means any one of us could be at risk. And that risk increases if you’ve got a family history of PMDD, depression of any kind or if you smoke. But forewarned is forearmed right?

Once you are diagnosed with PMDD

Only once all other causes have been ruled out will you get your PMDD diagnosis. And this is where the good news starts. Just having a diagnosis, knowing there’s actually something wrong, can make a huge difference. And there are some treatments that can be effective. But, they pretty much consist of a mix-and-match bag of the same therapies prescribed for most period-related conditions.

Diet and exercise? Check.

Antidepressants? Check.

The Pill? Yes, but with mixed results.

What about a temporary menopause? Rebooting your hormones just might work. Or there’s always a total hysterectomy. That, without a doubt, will work.  Yes, that was the good news.

Help and Hope

Now that we all know the deal with PMDD, if you recognize anything you’ve read between these paragraphs, please tell someone. No one should ever feel the need to end their life because of hormones. Ever. One of the recommended treatments for PMDD, believe it or not, is talk therapy. Because it works. So tell a friend, your partner, the Samaritans, your dog. Find a PMDD support group. It could change your life.

Keep records of your symptoms where you can, the Hormona app is a great tool for this. And make absolutely sure that if you are taking any medication, it is working properly and at the right levels for you. Of course, diet and exercise are always important. And we love a supplement here, so consider B6, magnesium, and calcium your friends. See a healthcare professional and take everything you know and have learned with you.

But most importantly hold on to the fact that you are not alone. There is help and there is hope.

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