Riding The Crimson Wave: What is PMDD?

Did you know that 1 in 20 individuals who menstruate experience highly disruptive hormonal symptoms before their period? Despite this, premenstrual disorders, including Premenstrual Dysphoric Disorder (PMDD), are often overlooked and training in many healthcare professions is far from ubiquitous. Fortunately, the first step to increasing overall awareness is education!

According to The International Association for Premenstrual Disorders (IAPMD), “PMDD is a cyclical hormone-based mood disorder. It is a severe negative reaction in the brain that is directly connected to the natural hormonal fluctuations of the menstrual cycle and is triggered when ovulation occurs.” Related symptoms onset during the luteal phase of the menstrual cycle, generally 1-2 weeks prior to menstruation and subside within a few days of menstruation. While the exact cause is unknown, researchers have established that it is an atypical neurological response to the typical rise and fall of progesterone and estrogen occurring at this point in the cycle. Please note that while PMDD is connected to hormone fluctuations, it is NOT a hormone imbalance.

An individual with PMDD can expect to experience some of the following emotional, cognitive and/or behavioral symptoms: 

• mood swings

• sadness or tearfulness

• increased sensitivity to rejection

• persistent irritability or anger leading to increased interpersonal conflict

• depressed mood

• feelings of hopelessness

• worthlessness

• suicidal ideation and self-harm behaviors

• guil

•  increased anxiety

• feeling on edge

• feeling out of control

• difficulty focusing

• “brain fog”

• decreased impulse control

• fatigue or low energy

• loss of interest

• changes in appetite and/or sleep disturbances

They may also experience physical symptoms, such as bloating, weight gain, cramps, muscle or joint pain, headaches and/or breast tenderness or swelling. And this isn’t even an exhaustive list!

Fortunately, self-screening options are available and the most common diagnostic method is the daily tracking of symptoms over the course of at least two menstrual cycles. Not sure how to organize the data? Try this FREE symptom tracker!

Once diagnosed, typically in partnership with a mental health provider, gynecologist or PCP, treatment options include both ​​non-pharmacological methods, such as exercise, dietary modifications and stress management techniques, and pharmacological methods, such as SSRI medication, birth control, hormone therapy, and ovulation suppression (https://www.ncbi.nlm.nih.gov/books/NBK532307/).

In conclusion, the crucial takeaway from all this is you are not crazy, this is not “normal,” and you are not alone. Now that you know more about PMDD, go forth and spread awareness!

This month Looking Glass Counseling is proud to support LUCE Immigrant Justice Network of MA. LUCE is a coalition of immigrant-led, grassroots organizations who build people power for everyone across Massachusetts. LUCE moves grounded in their principles of justice and equity, with a deep commitment to keeping all of our communities safe through grassroots organizing, information sharing, and mutual aid.

---

Kim Johnson, LMHC, MT-BC, is a licensed mental health counselor (LMHC) and board certified music therapist (MT-BC) who graduated with her master’s from Lesley University in 2017. She has experience with adults and adolescents in group private practice and community mental health settings. The levels of care she has worked in are outpatient, with both individual and group therapy and in partial hospital programs for mental health and substance use disorders. Additionally, she has had intensive training in dialectical behavioral therapy and cognitive processing therapy for PTSD.

Thank you for your interest in our Monday Mental Health Moment. Join our mailing list for a weekly newsletter on various mental health topics, and information about upcoming groups or workshops. We promise no spam!