Premenstrual dysphoric disorder (PMDD)—often called “PMS on steroids”’—is a mood disorder that rears its ugly head every month. Usually it occurs sometime between ovulation (around 14 days before your period) and through to the first few days of your period.
The Difference Between PMDD and PMS
It’s normal to feel moody, irritable, or anxious right before your period. You may also experience symptoms such as cramps, bloating, headaches, and sore breasts. In fact, over 90 percent of women of childbearing age say that they experience PMS. However, only approximately five percent can be classified as having the more severe premenstrual dysphoric disorder.
What’s the difference? PMDD is so debilitating that it negatively affects your mental health and relationships. “PMS symptoms can come and go, and they’re not as intense. We can be annoyed by them, but they’re not disrupting our lives the way [that] PMDD symptoms do,” says Mayra Mendez, Ph.D., LMFT, a licensed psychotherapist and program coordinator for intellectual and developmental disabilities and mental health services. “It’s very real and it can be really traumatic, especially when others are dismissing what you’re experiencing,” she adds.
Symptoms of PMDD
The symptoms of PMDD are so debilitating that they resemble depression. They include:
- Feeling depressed most of the day, almost every day
- Lack of interest in usual activities
- Lack of energy, or fatigue
- Insomnia or hypersomnia
- Headaches
- Back and joint pain
- Water retention, or bloating
In other words, PMDD is similar to depression, but it’s cyclical. Being depressed one or two weeks of the month, every month, can really interfere with going about your everyday life. That’s why it’s important to see a doctor to discuss your symptoms and possible treatments. “Definitely talk to a gynecologist,” advises Mendez. “You need a specialist’s knowledge [about] targeting and understanding hormones, and what the chaos is that’s impacting you.”
Common Treatments for PMDD
If you’re diagnosed with PMDD, the doctor will likely recommend a personalized treatment to help ease your symptoms. Some common treatments include:
- Antidepressants. SSRIs, such as Zoloft, Prozac, and Sarafem may help with sleep problems, fatigue, and psychological problems.
- Hormonal medications. Birth control pills or a patch can help regulate hormone levels and may improve PMDD symptoms.
- Supplements. Talk to your doctor about taking supplemental calcium, Vitamin B-6, magnesium, and/or L-tryptophan, which have shown some evidence of easing symptoms. There are a few herbal remedies, such as chasteberry (vitex agnus-castus), that haven’t been scientifically proven to work, but show promise.
Some doctors say that reducing stress, getting plenty of sleep and exercise, and eating right are important steps that you can take to better handle PMDD bouts. Eating fewer simple carbs, and sticking to a healthy diet rich in whole grains, fruits, veggies, and calcium may create a marked difference, as well. Mendez recommends not overdoing caffeine and avoiding alcohol, which can make depression-like symptoms worse.
Self-Care for Women with PMDD
Unfortunately, researchers say treatments for PMDD only work in about half of women. Whether your doctor’s orders are working for you or not, it’s important to practice self-care if you have PMDD, says Mendez. Talking with a therapist could be beneficial for learning to think more positively and better keeping your mood and actions in check.
And, some self-awareness can go a long way. “Just kind of understand what generally has helped in the past,” she says. “Little simple things that you can use to help empower yourself to manage it as best as you can for own self care and self help.”
This may mean taking things a little easier on the days around ovulation until the second or third day of your period. It might mean getting a massage, creating a mindfulness routine, or altering your workout to something less intense. As much as it might be tempting to skip workouts completely while you’re having PMDD symptoms, getting up and moving might actually help your mood.
“If you can plan ahead, then you can have your roadmap for what you’re going to do when you have PMDD symptoms,” explains Mendez. “For example, if biking is your usual workout, and it’s uncomfortable, think ‘What can do instead that will still help me keep in motion?’ [While] PMDD is occurring is not the time to make a plan. [Rather] it’s the time to enact the plan to manage it the best that you can. When the PMDD is over, you can revise the plan and try again.”