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My PMS was tolerable until my second child was born and then everything went off the rails. Id be looking forward to plans with others, happy, and then about 10 to 14 days before my flow would start, my mood would turn on a dime. Id be horriblecrying, screaming that ~nobody understands~, just so much emotional pain. Id basically lock myself up in the bedroom for a full day to cry, get angry, and feel sorry for myself. It took three doctors before I finally found one who would listen to me before I was finally diagnosed with PMDD. I took Prozac for three years for it but it made me feel numb, like a zombie and not like myself. So I quit and my family just deals with me now. As Ive gotten closer to menopause the PMDD is not as bad, but can be very unpredictable due to hormonal swings from perimenopause. The worst part now is I feel like my friendships have suffered. I always seem to have episodes around major holidays and events and I end up bumming everyone out if I do show up so I end up staying home a lot.Colleen T., 50, St. Paul, MN
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Like Someone Flicked A Switch: The Premenstrual Disorder That Upturns Womens Lives
Premenstrual dysphoric disorder, only recently recognised, can cripple women emotionally, physically and mentally
For two weeks every month Rachel* would be engulfed in a depression so deep she felt like she was walking through treacle. As a gifted athlete and high achiever academically, it was entirely out of character.
Half the month I was extroverted, firing on all cylinders, Rachel says. Then I would hit ovulation. And at that time I became dysfunctional, shy and withdrawn. Its like I woke up one day and became a completely different person. And from then until I started menstruating I became utterly dysfunctional. Then I would get my period and I would be fine. And this happened again and again and again.
She says these symptoms which doctors have now attributed to premenstrual dysphoric disorder, or PMDD have affected intimate relationships and friendships over the years because she would withdraw socially if she felt the fog of depression closing in: I couldnt stand myself so how could anyone else?
PMDD affects between 3% and 8% of women of reproductive age. Its caused by fluctuations in hormone levels which affect brain chemistry and result in severe mood disturbances, says Prof Jayashri Kulkarni, a psychiatrist and director of the Monash Alfred psychiatry research centre at Monash University in Melbourne.
There are some women who are more sensitive to their hormone fluctuations than others
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Your Serotonin Levels Are Diminished
Strangely enough, the hormonal changes you experience also influence how the chemicals in your brain function. Neurotransmitters in the brain probably have something to do with PMS symptoms, Dr. Dweck says. Research suggests that serotonin drops when your period starts, due to all the hormonal fluctuations. Low amounts of serotonin in the brain are associated with depression, irritability, and intense cravings for carbohydrates, which is pretty much PMSing in a nutshell. In her book , psychiatrist Dr. Julie Holland explains,
Lower estrogen levels cause serotonin levels to drop precipitously a few days before menstruation, which may be the basis of many PMS symptoms. Low levels of serotonin are implicated in depression, panic disorder and obsessive compulsive disorder youre even more physically sensitive to pain than usual, and more emotionally sensitive to criticism. Youre less resilient in the face of stresses and feel sadder, hungrier, and more scared, tearful, and angsty.
On top of all that, as levels of estrogen and serotonin rapidly fall, dopamine and gamma-aminobutyric acid also start to disappear when your period arrives. These are two chemicals that boost your moods, put a pep in your step, and reduce anxiety. Without them, you dont exactly have a recipe for calm, cool, and collected on your hands.
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You Feel Overwhelmed And Out Of Control
Feeling uncontrollably overwhelmed, particularly about routine tasks, is often a symptom of PMDD. “My patients tell me they’re easily discombobulated when they need to get the kids off to school,” said Dr. Currier. “They feel overwhelmed with their typical day-to-day schedule.”
“I’ve even had a couple of patients tell me in tears that the week before their period was when they were most apt to scream atâor even think about hurtingâtheir children,” said Dr. Sulak. “They get to the point where they feel completely out of control.”
How Is Pms Diagnosed
Your doctor will ask you to keep track of your symptoms on a calendar. If your symptoms follow the same pattern each month, you may have PMS.
Your doctor may want to examine you and do some tests to rule out other possible problems. He or she may also want to talk about your eating habits, exercise habits, your work, and your family.
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When To See A Doctor
Individuals who experience depression regularly before or during their period may wish to speak to a doctor. Treatment is available for people with PMS, PMDD, or co-occurring mental health conditions.
If someone is at immediate risk of suicide or serious self-harm, seek emergency help by calling 911 or the local emergency number.
Can Pcos Affect Moods
As I mentioned earlier, women with PCOS are statistically more likely to battle issues with anxiety and depression.
They are at high risk for developing major depression, binge-eating disorder, and generalized anxiety disorder.
While we cant say for sure exactly why this is, some research indicates its due to the insulin resistance thats characteristic of PCOS. Whether this is exactly why or not, incorporating dietary changes that support balanced blood sugar and inflammation are key to getting PCOS in check.
If you are experiencing anxiety and a cluster of the following symptoms, you may want to talk to your doctor about PCOS:
- Heavy menstrual bleeding
Since one of the hallmark traits of PCOS is anovulatory cycles, women can often find themselves low in progesterone and high in testosterone. As Ive explained, both imbalances in progesterone and testosterone can contribute to anxiety.
I would encourage you to check out my PCOS Kit that is designed to support womens natural hormone function to help clear up acne, lose weight, and even get their period back.
I also have a ton of great information on my website specifically to help you ladies struggling with PCOS.
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When It Feels Like Depression But Isnt
If youre experiencing depression symptoms that come and go, have fewer than five symptoms from the list above, or your symptoms are only present for a few days and not 2 full weeks, you might be experiencing depression-like PMS symptoms but not PMDD or PME.
Another possible cause of menstrual depression symptoms may have something to do with your hormonal birth control.
Though
- symptoms often fading a couple of days after the period starts
Diagnosis of PMDD is by experiencing a combination of five or more depression symptoms and PMS symptoms in the week before your period, instead of the full 2 weeks for clinical depression.
In most cases, symptoms will go away or lessen around the start of your period.
For a doctor to diagnose PMDD, they must rule out depression symptoms resulting from an underlying clinical depression or anxiety disorder.
You might want to talk with a healthcare professional if you feel like PMS symptoms are intensifying, mirroring depression symptoms, and interfering with your quality of life.
Your doctor may recommend over-the-counter or prescription pain meds to manage physical pain.
A mental health professional might prescribe antidepressants for PMDD. If you have PME, a mental health professional may adjust your antidepressant dosage if youre treating other mental health conditions that PME intensifies.
In the meantime, you can try some best practices at home.
Causes Of Depression During Periods
Its not known exactly how PMS causes depression, but its probably connected to the hormonal fluctuations that occur during the second half of the menstrual cycle, sensitivity of the central nervous system to reproductive hormones, genetic factors, and psychosocial factors such as stress.
Changes in levels of progesterone and estrogen can affect levels of serotonin. Serotonin is a neurotransmitter that helps regulate appetite, sleep cycle, and mood. Low serotonin levels may lead to feelings of irritability and sadness, unusual food cravings, and trouble sleeping, all of which are symptoms of PMS. In addition to these symptoms and depression while on your period you may also have:
- Sleeping too little or too much
- Eating too little or too much
- Tiredness or fatigue
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Your Symptoms Are Primarily Emotional
PMS includes a whole host of physical symptoms, like breast tenderness or bloating, along with emotional symptoms like mood swings. A mood-related symptom, along with four other severe PMS symptoms, should be included in order for a person to get a diagnosis of PMDD per researchers of a March 2022 Endocrinesarticle.
“When it crosses over to where the symptoms are mostly emotional and are really interfering with your life, that could be PMDD,” Patricia J. Sulak, MD, a professor of obstetrics and gynecology at the Texas A& M Health Science Center College of Medicine and the director of the adolescent sex education program at Scott & White Clinic and Memorial Hospital, in Temple, TX, told Health.
What Are The Complications Of Pmdd
Untreated PMDD can lead to depression and, in severe cases, suicide. The disorder can cause severe emotional distress and negatively affect relationships and careers.
If youre experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 1.800.273.8255. This national network of local crisis centers provides 24/7 free and confidential emotional support to people in suicidal crisis or emotional distress.
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What Are The Causes Of Pmdd
The exact causes are still not fully understood but researchers believe that PMDD is caused by being very sensitive to changes in hormone levels. Recent research suggests that PMDD is associated with increased sensitivity to the normal hormonal changes that occur during your monthly menstrual cycle.
See the International Association for Premenstrual Disorders website for further information on hormones and PMDD.
There is research to suggest other possible causes for PMDD, as well as things that may make your PMDD worse. Some of these possible factors are:
- Genetics. Some research suggests that increased sensitivity to changes in hormone levels may be caused by genetic variations.
- Smoking. Some research suggests that smoking can have an impact on your hormone sensitivity.
- Trauma and stress. Other research has shown that in some cases PMDD may be linked to stressful and traumatic past events, such as emotional or physical abuse. Stress may also make your PMDD symptoms worse.
Understand The Underlying Cause
Its normal to feel a little blue before, during and after menstruation as both estrogen and progesterone take a steep dive during these times.
However, if the feeling is persistent and intense, there could be an underlying hormonal imbalance, especially due to estrogen deficiency.
Check out the following resources:
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Should I See A Doctor
If your symptoms dont improve after lifestyle changes or you think you may have PMDD or PME, its worth following up with your healthcare provider.
If youve been tracking your period and PMS symptoms, bring those along to the appointment if you can.
If you do have PME or PMDD, the first line of treatment for both conditions are antidepressants known as selective serotonin reuptake inhibitors . SSRIs increase serotonin levels in your brain, which may help decrease depression and anxiety.
How Can I Beat Depression
If you experience anxiety and severe depression before period, know that you are not alone and that there is a biological basis for your condition. Often, women are told that their PMDD symptoms are imaginary, whereas numerous studies and research has clearly proved otherwise. A combination of the following suggested treatments can potentially help manage and ease the severity of your symptoms:
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How To Improve Your Hormone Levels
One of the leading causes of hormonal imbalance followed by mental disorder is physical and psychological stress Today we have become attuned to noticing triggers and traumas that comprise psychological stress, but sometimes physical stress can be more difficult to spot.
Some people live for many years without noticing the effects of physical stress until they begin to experience hair loss, irregular or absent cycles, or rapid ageing, or they develop a mental disorder or an autoimmune disease. Women often suffer from anxiety due to physical stressors such as excessive exercising, strict dieting, poor sleep, and other restrictions. But there are ways to reduce your stress levels with a few easy lifestyle changes.
Signs Of Severe Depression During Period
You may experience severe depression before and during periods due to premenstrual dysphoric disorder . PMDD is similar to PMS, but its severe and sometimes disabling. PMDD can cause extreme mood shifts, which can interfere with your daily life, relationships, and work. Symptoms usually start a week before menstruation and continue a few days after your period begins. Apart from severe depression before and during periods, other symptoms and signs of PMDD are:
- Tension or anxiety
- Feeling out of control or overwhelmed
- Extreme moodiness
- Hopelessness with extremely negative thoughts
- Trouble concentrating
- Binge eating or food cravings
- Lack of interest in relationships and daily activities
- Loss of interest in sex
You may manage depression during your period by making certain lifestyle changes and taking specific medications.
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What Are The 11 Symptoms Of Pmdd
Symptoms of PMDD, both common and rare, include:
- severe fatigue.
- mood changes, including irritability, nervousness, depression, and anxiety.
- crying and emotional sensitivity.
- paranoia and issues with self-image.
- coordination difficulties.
What vitamins should I take for PMDD?
According to the Mayo Clinic, these supplements may be worth a try:
- Calcium. 1,200 milligrams calcium daily can help ease physical and emotional symptoms.
- Magnesium. 360 mg can help ease breast soreness and bloating.
Can hysterectomy cure PMDD?
Removal of the uterus / hysterectomy does not improve PMDD. It is the ovarian cycle that triggers the mood centre of the brain and so if the ovaries are left behind, then the PMS will continue after the hysterectomy.
Most People With Depression Need Treatment To Feel Better
If you think you may have depression, start by making an appointment to see your health care provider. This could be your primary doctor or a health provider who specializes in diagnosing and treating mental health conditions . Certain medications, and some medical conditions, such as viruses or a thyroid disorder, can cause the same symptoms as depression. A health care provider can rule out these possibilities by doing a physical exam, interview, and lab tests. Your health care provider will examine you and talk to you about treatment options and next steps.
Talking to Your Health Care Provider About Your Mental Health
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Tip : Get Up And Get Moving
When youre depressed, just getting out of bed can seem like a daunting task, let alone working out! But exercise is a powerful depression fighterand one of the most important tools for depression recovery.
Studies show that regular exercise can be as effective as antidepressant medication at increasing energy levels and decreasing feelings of fatigue. You dont even have to hit the gym. A 30-minute walk each day will give you a much-needed boost. And if you cant manage 30 minutes, three 10-minute bursts of movement throughout the day are just as effective.
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Can Dehydration Cause Fatigue
If you are feeling fatigued, it could be due to dehydration. Usually, you feel thirsty later than your body senses dehydration, making it hard to catch up on your water intake.
Try these tips to stay hydrated:
- Drink at least two glasses of water an hour before and an hour after vigorous physical activity.
- Sip water during your workout.
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Youre More Susceptible To Pain And Youre Experiencing More Of It
Physical pain is never a pleasant thing to endure. Think about someone who has a splitting headache or a gnarly stomachache. Do you find them to be a joy to be around? Are they smiley and up for anything? No, of course not. Theyre probably easily annoyed by your antics and just want to be left alone. Not only are you dealing with cramps before and during your period, but hormonally, as Dr. Holland explains in, your pain tolerance is at its lowest point during PMS. Not a great time to go to the dentist or get waxed. Its a double whammy.
Dr. Dweck reminds us that being in pain can make people irritable, so dont beat yourself up if youre feeling emotional as youre reaching for the Midol â nobody is happy-go-lucky when theyre experiencing discomfort. Put on an electric blanket and sip on some chamomile tea to relax yourself through the pain.
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“My PMDD manifests in both mental and physical symptoms. From the time I got my period at age 12, I’ve had extreme cramps and heavy bleeding. I’d leak at school through a super maxi pad every class so I’d tie sweatshirts around my waist and have to scrub my clothes when I got home. It was super humiliating. I’d have to take six to eight ibuprofen at a time to deal with cramps, and if I didn’t I’d end up on the floor sweating like I had the flu. Sometimes I’d even throw up. This meant I ended up spending a lot of time sick in bathrooms and knew where every restroom was at all times. Birth control helped manage the PMDD and other issues, but as soon as I was done having kids, I had a hysterectomy. That was the best thing I’ve ever done.” Mandy P., 39, Mendon, UT
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