Ever felt like the days before your period usher in an emotion storm that feels almost impossible to control? From feeling depressed, anxious and angry to experiencing intense mood swings that spiral out of proportion, emotional wellbeing can take a massive hit. It may feel like the walls are closing in, while physical symptoms such as fatigue, bloating and body heaviness make everything feel even harder to manage.
For years, this has been normalised as PMS, or premenstrual syndrome, something many women are simply expected to endure in the days leading up to their periods. But when the emotional distress becomes severe, recurring and disruptive enough to affect work, relationships, sleep or daily functioning, it may signal towards a more serious clinical condition called Premenstrual Dysphoric Disorder, or PMDD.
It is high time we demystify PMDD, take premenstrual mental health seriously and stop normalising every intense symptom as something women should be silently dealing with. PMDD is a serious clinical condition.
HT Lifestyle, in a conversation with Dr Thejaswini J, consultant – obstetrician and gynaecologist at Motherhood Hospitals, Electronic City, Bengaluru tried to understand PMDD, a clinical condition that occurs during the luteal phase, usually in the week before periods. It can cause extreme emotional distress during this time, going for beyond regular premenstrual mood swings.
Understanding PMDD
PMDD is deeply misunderstood as a simple hormonal imbalance, but the condition is much more complex, it not solely happening because of hormonal imbalance.
The gyneacologist explained in detail, showcasing how in PMDD the neurotransmitters are influenced as well by the hormones, “Most blood tests indicate that women maintain normal biological levels of estrogen and progesterone throughout their menstrual cycle. Rather, the problem is an increased nervous system sensitivity to the normal fluctuations of these hormones. While the level of progesterone increases and then drops precipitously, it affects the neurotransmitters in the brain, particularly serotonin, which controls mood, sleep patterns, and pain.”
Then she went on to describe how the drop in hormones is the chemical trigger that sends one into a world of intense anxiety, despair, or rejection sensitivity, where everything feels catastrophic.
When does PMDD happen?
PMDD follows a pattern, and the symptoms actually appear, as per the doctor, during the luteal phase, which is the phase after ovulation and before the period begins. Once menstruation starts, the emotional distress eases suddenly.
Dr Thejaswini added, “This ‘on-off’ switch creates a cycle of monthly trauma, whereby the individual will have two weeks of crisis and two weeks of damage control to fix the damage done in the first two weeks.”
The pattern is crucial as it helps to distinguish PMDD from general mood disorders. In PMDD, the symptoms are linked to the menstrual cycle and it is not constant throughout the month. It also implies that tracking symptoms is essential. If one experiences intense sadness, anxiety, anger, irritability or rejection sensitivity appears predictably right before periods and improves bleeding begins.
And PMDD is different from regular mood swings as it is intense enough to seriously disturb your work, relationships, sleep and daily life.
Treatment
For treatment, the doctor shared, “The treatment involves stabilization of the neurochemical responses to prevent the brain from reacting in such a violent manner to the changing tide of hormones.” So it may include the use of SSRI (Selective Serotonin Reuptake Inhibitors) medications, which in the case of PMDD have been known to be effective even when only taken in the luteal phase, or those medications which stop ovulation altogether in order to stop the rollercoaster effect.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
