Your irritability levels are high, you’re staying away from everyone and you just feel down in the dumps. Your period is on its way, isn’t it? 

Most of us know about PMS or premenstrual syndrome, but sometimes it feels like it's a bit worse than what your friends and family members are going through. Welcome to PMDD - or premenstrual dysphoric disorder. 

Premenstrual Dysphoric Disorder (PMDD) is a condition that has similarities to PMS - it happens in the week or two before your period starts, you’ve got mood swings, feeling anxious, or you simply just really don’t feel great. 

While PMDD and PMS share similarities, PMDD causes a more severe version of these symptoms, and if you haven’t been diagnosed with it, you may be wondering just what’s going on.

Who gets PMDD? 

So here’s the big difference between PMS and PMDD. With PMS, three in four women and menstruating say they suffer from these symptoms at some point in their life. It’s super common and easy to pick up on. 

PMDD on the other hand is really uncommon, and it is much harder to be diagnosed. Only up to five per cent of those who are of childbearing age are affected by it. These people also tend to be affected by anxiety and/or depression. 

What Causes PMDD?

Sadly, like many issues that those who menstruate have, the cause of PMDD is essentially unknown. We know that our hormones change as we go through our cycle and it is thought that these hormones, along with serotonin may play a role in PMDD. 

Similarly to our hormones, our levels of serotonin change throughout our menstrual cycle, and as with anything, some women may be more sensitive to these changes than others. 

Symptoms of PMDD

It’s really important to be aware of PMDD symptoms, because in many cases, you need to be showing a number of these symptoms, including one mood-related symptom for your GP to diagnose you with PMDD. 

The best thing you can do is to keep a “cycle diary” where you note down your symptoms daily, how you feel, and generally what is going on in your life. 

Here are the symptoms and types of pain look out for:

• Lasting irritability or anger that may affect other people
• Feelings of sadness or despair, or even thoughts of suicide
• Feelings of tension or anxiety
• Panic attacks
• Mood swings or crying often
• Lack of interest in daily activities and relationships
• Trouble thinking or focusing
• Tiredness or low energy
• Food cravings or binge eating
• Trouble sleeping
• Feeling out of control
• Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain

Treatment options for PMDD

There are two ways that your GP can treat PMDD, and it really is worth looking at the natural options first. 

When we talk natural options, we’re talking nutritional supplements, lifestyle and diet changes, and this is where it may be worthwhile getting an experienced health dietician on board. Take a look in the Red Pages to find some we love. Nutritional supplements such as calcium, B6, and magnesium may help, as may some herbal supplements.

Diet and lifestyle changes are another great option, and may include:

• Cutting back on caffeine
• Avoiding alcohol
• Giving up smoking
• Getting some extra sleep in 
• Relaxation techniques including meditation and yoga
• Avoiding stressful and emotional triggers such as arguments and toxic relationships. 

Then there are the medicated options, which may work better for you. Medications such as antidepressants can reduce emotional symptoms and birth control pills can reduce pain. There are no real surgical options, as PMDD is an ovarian cycle issue, and by removing the ovaries, particularly in younger women, there is a good chance of opening up even more issues. 

Misdiagnosis of PMDD

Again, because PMDD hasn’t been extensively researched, and because many of the symptoms can lead into other areas, it’s understandable that PMDD has been misdiagnosed for other issues.

The Women's Health & Research Institute of Australia notes that PMDD can easily be confused with bipolar disorder as well as generalised depression, and anxiety. This is why it is important to keep that cycle diary so that your GP can get an overall view of what is happening. 

Because PMDD does have those mental and mood-related issues, it is so important that if you are being affected by these, you seek treatment straight away, whether that be from your GP or visiting your local emergency room. If you are caring for someone with PMDD, during these “down” periods, keeping a closer eye on them and stepping up your level of care may well be required. 

PMDD isn’t something people do to themselves, and unfortunately, because the causes are completely understood, it is something the patient and their family or friends really need to advocate for. 

It is also important to know that you aren’t alone, there are other women with PMDD out there going through the same thing, who are feeling the same way. 

If you do need support, reach out to Beyond Blue, or the Australian PMDD Support Group on Facebook.