Premenstrual dysphoric disorder (PMDD) is a type of PMS that causes more severe physical and psychological symptoms. As with PMS, PMDD occurs prior to your menstruation cycle and resolves at the onset of the cycle. PMDD can have severe impacts on the quality of your life without medical intervention and careful management of daily symptoms. In fact, people who experience PMDD are at increased risk of hospitalization and suicidality. However, it is important to bear in mind that this condition can be successfully managed by developing an individualized treatment plan with your doctor and any relevant specialists.

PMDD vs. PMS

Experts are not yet certain what causes PMS to escalate to PMDD. However, current theories suggest that underlying issues such as hormonal disruptions and various mental health conditions may be a contributing factor. Many potential symptoms of PMS and its more severe form, PMDD, overlap. PMDD is diagnosed based on the severity and persistence of symptoms, as well as the impacts on daily life.

The impacts of PMDD on daily life

As mentioned, PMDD can have severe negative effects on your daily life. These will vary depending on the individual. However, they can include the following:

• Various difficulties in the workplace;
• Strain on relationships;
• Lack of high quality sleep;
• Dissatisfaction with daily life;
• Inability to maintain interest in hobbies;
• Difficulty finishing tasks;
• Struggles with maintaining a healthy diet and exercise.
• Challenges related to maintaining personal hygiene.

By treating underlying conditions and managing daily symptoms people with PMDD can significantly reduce short and long term negative impacts on your quality of life.

Symptoms of PMDD

The symptoms of PMDD can be far-ranging. In fact, many PMDD sufferers go undiagnosed due to the range of potential symptoms and its concurrence with other hormonal and psychological issues. As such, if you are experiencing potential PMDD symptoms during premenstrual phases that are impacting your overall well being, it is important to address your concerns with your doctor.

Psychological

Potential psychological symptoms of PMDD can include the following:

• Irritability;
• Agitation;
• Depression;
• Disinterest in activities;
• Poor self image;
• Anxiety;
• Panic attacks;
• Mood swings;
• Bouts of crying;
• Difficulty focusing;
• Fatigue;
• Food cravings;
• Difficulty sleeping;
• Confusion;
• Forgetfulness;
• Paranoia;
• Emotional sensitivity;
• Feeling a lack of control;
• Suicidal thoughts.

The specific symptoms you experience and their severity may vary from cycle to cycle.

Physical

Potential physical symptoms of PMDD can include the following:

• Gastrointestinal symptoms;
• Fluid Retention;
• Respiratory Problems;
• Eye Problems;
• Skin problems;
• Cramps;
• Bloating;
• Joint pain;
• Muscle pain;
• Nerve pain;
• Dizziness;
• Numbness;
• Fainting;
• Headache;
• Backache;
• Bruising;
• Nausea;
• Vomiting;
• Constipation;
• Pelvic pressure
• Heart palpitations;
• Muscle spasms;
• Decreased coordination;
• Easy bruising;
• Painful periods;
• Appetite changes;
• Hot flashes;
• Decreased sex drive.

These symptoms, when left untreated can lead to long term health issues and a general decrease in quality of life.

Risk factors for PMDD

There are many individual traits and personal circumstances that may increase your risk of PMDD or exacerbate PMDD symptoms. These may include the following:

• Past traumatic events;
• Mood disorders;
• Anxiety disorder
• Cigarette smoking;
• Depression;
• Obesity;
• Genetics.

While the research regarding the connections between these risk factors and PMDD is in its early stages in many cases, the cause and effect relationships are continually being studied.

How is PMDD diagnosed?

In order to get diagnosed with PMDD, you should speak to your doctor. It may also be helpful to speak to various relevant specialists as well, such as gynecologists, psychiatrists, and psychologists. You can find and reach out to these specialties through a referral from your regular doctor or by using online search tools. As mentioned, PMDD can be difficult to diagnose, especially if it is co-occurring with other conditions. Therefore, it is vital that you not only see relevant specialists but follow up with them for further diagnostic measures as needed. If you are concerned about addressing this with your doctor, it is important to bear in mind that menstrual health is a normal concern for a significant part of the population, and to arm yourself with information in preparation for your appointment.

How to reduce the impact of PMDD on daily life

The following are ways that you can reduce the impact of PMDD on daily life:

• Talk your feelings and experiences out with someone you trust: Talking out your feelings with a trusted person can alleviate any negative feelings and open up an avenue for much-needed support. However, you should avoid overdoing this to the point that it becomes unhealthy co-rumination. If these concerns persist you should also enlist the help of a licensed therapist. 
• Try peer support: Peer support can improve your situation in many ways. Trusted people can help you talk through your concerns, provide information about resources, and assist you with various tasks such as transportation to medical care facilities. 
• Get to know your cycle: By being aware of the typical timing of your menstrual cycle as well as how your cycle coincided with various symptoms, you can provide valuable information to healthcare professionals that can help them diagnose and treat your symptoms. Your healthcare professional cannot properly attend to your needs if you cannot first recognize your needs yourself and communicate them. 
• Use various techniques to manage your emotional well-being: Managing your symptoms in order to improve your daily emotional well-being will be an ongoing effort that will include various lifestyle management efforts. These efforts may include things such as self-soothing techniques, grounding techniques and good sleep hygiene. 
• Use various techniques to manage your physical well-being: It is important to not only have a management plan in place for your emotional well-being, but also your physical well-being. Increased structure can be one of the best ways to manage your physical well-being. It is important to maintain things like a regular diet plan, exercise routine and sleep schedule.

It is important to bear in mind that by managing your daily symptoms and struggles related to PMDD, you can also improve long-term health outcomes related to both your mental and physical wellbeing. Left untreated and unmanaged, issues related to PMDD can create or exacerbate other long term health problems.

How is PMDD treated?

There are many options for treating PMDD, and they may be more effective when used together. In particular, it is important to pair prescribed treatments with healthy lifestyle changes in order to maximize outcomes.

Medical interventions

Medical interventions that may be used to treat PMDD include:

• Various birth control methods;
• SSRIs;
• Anxiolytics;
• Painkillers;
• Anti-inflammatory drugs;
• GnRH analogue injections;
• Talk therapy;
• Hysterectomy;
• Oophorectomy.

If one treatment is not effective, you should address this with your healthcare specialists in order to adjust your treatment. While surgical interventions are sometimes used to alleviate the symptoms of PMDD, they are typically a last resort.

Lifestyle changes and at-home treatments

Lifestyle changes and at-home treatments that may be used to treat PMDD include:

• Healthy diet;
• Meditation;
• Regular exercise;
• Good sleep hygiene;
• Mindfulness exercises;
• Grounding techniques;
• Warm baths;
• Aromatherapy;
• Yoga;
• Time spent outside;
• Regular social interaction;
• Time spent doing structured activities;
• Caffeine reduction;
• Quitting smoking;
• Reduction of alcohol intake;
• Spending time with pets.

Overall, it is important to implement a schedule — especially during times that you expect to be experiencing PMDD symptoms. It is also important to bear in mind that some at-home treatments may be more effective for some people than others, and therefore you will need to determine which are most helpful for you.

Resources for transgender individuals with PMDD

Transgender individuals can experience a variety of issues related to hormonal cycles and PMDD. Transgender people who were born with ovaries may continue to experience menstrual cycles and any hormonal issues related to them depending on their individual circumstances. Meanwhile transgender people who were not born with ovaries may begin to experience symptoms typical of menstrual cycles if they take estrogen. Because these concerns can be so complex and individualized, it is important that transgender people are aware of the resources available to them. The following resources may be helpful for transgender individuals experiencing PMDD symptoms:

• The International Association For Premenstrual Disorders (IAPMD): The IAPMD provides peer support, education, and advocacy related to PMDD. 
• See Her Thrive: This organization provides education and training related to women’s health in the workplace. 
• Planned Parenthood: Planned Parenthood health centers provide a variety of services related to gender-affirming hormone therapy. 
• American Congress of Obstetricians and Gynecologists: This organization advocates for the equal healthcare of transgender individuals and develops guidelines for proper care.
• American Psychological Association: This organization provides guidelines for psychological care related to gender dysphoria, as well as various mood and anxiety disorders that can cause or complicate PMDD.

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