PMDD Awareness Month
April is PMDD awareness month. PMDD is a severe, cyclical mood disorder that causes rage, depression, anxiety, and physical symptoms that can take over your life. In this post, I break down what PMDD feels like, how it’s diagnosed, and how I’ve learned to manage it through medication, supplements, CBT, and art.
PMS vs. PMDD
Premenstrual syndrome, (PMS) symptoms include mood, behavioral, and physical indications that occur in a cyclic pattern prior to menstruation and then wane off after the menstrual period in women of reproductive age.
Premenstrual dysphoric disorder (PMDD), accounts for the most severe form of PMS with the greatest impairment of women’s functioning and perceived quality of life, often prompting them to seek treatment.
PMDD Facts
Most females have only mild discomfort with their menstrual cycle, and symptoms do not interfere with their personal, social, or professional lives; however, 5% to 8% of women have moderate-to-severe symptoms that can cause significant distress and functional impairment.
Anyone who has ovaries can have PMDD, including transgender individuals.
Bipolar is a common comorbidity with PMDD, although I do not have it myself. Bipolar disorder is characterized by episodes of depression and mania, and like PMDD, is a disorder that tends to “cycle” between mood states.
What Does PMDD Feel Like
Emotionally
Imagine yourself driving a car. You feel in complete control. You feel confident that if something happens, you can navigate your way out of it. You’ve done it before and you’ll do it again. That is, until you’re taken hostage, shoved in the trunk, and the kidnapper starts driving the car 100 mph with no regard for anything, or anyone around you. That’s how PMDD feels.
PMDD is the deepest, darkest hole of depression that feels like there’s truly no escape. PMDD is a rage that you didn’t even know you had inside you, showing up completely uninvited over something you normally wouldn’t think twice about. PMDD is your worst anxiety, amplified a hundredfold. PMDD is being mean to people who love and care about you, even when you REALLY don’t mean to. It’s disruption on every level of your being. Your emotions become completely out of control and there’s no way of grasping the steering wheel. Not to mention, the extreme physical side effects, bloating up to 10 pounds in a day, breast tenderness and swelling, migraines, sleep problems, changes in appetite, etc. It’s a real nightmare.
Physically
PMDD is not just emotional. There are extreme physical side effects such as bloating up to 10 pounds in a day, breast tenderness and swelling, migraines, sleep problems, changes in appetite, etc. It’s a real nightmare.
How is PMDD Diagnosed?
I was not diagnosed until age 29, when I started tracking my cycle. I noticed the onset of my depressive states, as well as the physical symptoms were very clearly associated with ovulation and the luteal phase of my cycle.
Before getting PMDD under control, it’s easy to do a lot of damage around you. If you think you may have PMDD, please speak with a doctor, such as your primary care physician, gynecologist, or naturopath. They can help you find the right treatments.
Currently, PMDD is listed in the DSM-5 as a separate entity under Depressive disorders, with the criteria for diagnosis as follows:
From the NIH —
Currently, PMDD is listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) as a separate entity under Depressive disorders, with the criteria for diagnosis as follows:
Criterion A - At least 5 of the following 11 symptoms (including at least 1 of the first 4 listed) should be present:
Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
Marked anxiety, tension, feelings of being “keyed up” or “on edge”
Marked affective lability
Persistent and marked anger or irritability or increased interpersonal conflicts
Decreased interest in usual activities (eg, work, school, friends, and hobbies)
Subjective sense of difficulty in concentrating
Lethargy, easy fatigability, or marked lack of energy
Marked change in appetite, overeating, or specific food cravings
Hypersomnia or insomnia
A subjective sense of being overwhelmed or out of control
Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.
Criterion B - symptoms severe enough to interfere significantly with social, occupational, sexual, or scholastic functioning.
Criterion C - symptoms discretely related to the menstrual cycle and must not merely represent an exacerbation of the symptoms of another disorder, such as major depressive disorder, panic disorder, dysthymic disorder, or a personality disorder (although the symptoms may be superimposed on those of these disorders).
Criterion D - criteria A, B, and C are confirmed by prospective daily ratings during at least 2 consecutive symptomatic menstrual cycles. The diagnosis may be made provisionally before this confirmation.
Women with moderate-to-severe PMS or PMDD experience more quality-of-life detriments and work-productivity losses and incur greater healthcare costs than women with no or only mild symptoms.[2]
I experience all of these symptoms on a monthly basis, but after years of working to find the right solution for myself, I feel more balanced than ever going through my cycle.
Managing PMDD
Medications
For most women, an SSRI (taken either daily or after ovulation until menstruation) can improve the emotional symptoms of PMDD; as can birth control & hormones. In the past, I tried both Lexapro and Prozac for SSRIs. While helpful in a lot of ways, my body did not agree with them. Lexapro made me extremely sick to my stomach, and I experienced some seizure-like activity on Prozac.
It’s been a journey trying to find the right treatment for my PMDD. When the traditional medications didn’t work for me, I worked with my naturopath to find the right combo of supplements for me. Supplements that have helped my mood-related PMDD symptoms are SAMe, neurocalm, MacaHarmony, and saffron. For the physical side effects, pycnogenol has helped my bloating, acne, and pain from endometriosis.
After years on natural supplements, my depression was still too intense, and I opted to try another SSRI. Since 2024, I’ve been on a low dose of Zoloft, which has helped tremendously. I would like to be on a slightly higher dose, but higher doses have increased my Cerebral Palsy-related spasticity, leading to more bodily pain and spasms.
Finding a balance in medication is a challenging process that requires time and patience. Given that a low SSRI dose does not fully improve my PMDD, I started taking 400mg of SAMe along with my Zoloft during the luteal phase of my cycle, which seems to be helping.
Therapy
I’d highly recommend trying Cognitive Behavioral Therapy (CBT). CBT teaches you tools that help calm both your mind and body, which in return helps you navigate difficult emotional situations. Learn more about CBT and how it may help you.
While talk therapy can also be useful, learning tools to actually calm your mind and body collectively has been far more effective for me. You can find a cognitive behavioral therapist around you using Psychology Today, or by asking your primary care provider for a referral.
If you think you may have PMDD, please speak with a doctor. Your primary care physician, gynecologist, or naturopath can help you figure out the best medications or supplements and therapies for you.
PMDD Management Overview
Luckily, with medication, supplements, meditating, and CBT, I finally feel I have better control over these emotional periods. Here’s what I’ve explored for PMDD relief (my current treatments are bolded):
All of the following:
Naturopathic Treatments
Acupuncture
Gua Sha
Castor oil packs
Dietary changes
Anti-inflammatory diet
Mediterranean diet
Avoiding alcohol
Lifestyle changes
Exercise
Stress management
Symptom tracking: Knowing when to expect the shift in mood helps you remind yourself that this change is temporary
Medications
Antidepressants/SSRIs - I take Zoloft
NSAIDs
Combined oral contraceptive pill
Progesterone or Estrogen
Supplements/herbal remedies
Magnesium & B6
Visualizing PMDD
I made an art piece using my own MRI scans, which look like a very sad, strange, little man. I blame him for my depression! Sad Brains is my play on Bad Brains, a hardcore punk band.
I originally made this piece for Jordan Jensen of Bein Ian with Jordan. I had never heard anyone talk openly about PMDD. I felt very alone with how severe and out of control my emotional shifts were on a monthly basis, so when one of the best comedians out there today mentioned she also had it too, I couldn’t help but make her a sticker for it.
Read more about PMDD on my previous post, Sad Brains, PMDD Delight on my Disability & Art Blog.
Conclusion
If you’re struggling and it feels like no one understands what’s happening to your body or mind, you are not alone. There is help, and your experience is valid. Start tracking your cycle and reach out to your general practitioner, GYN, or a naturopath for a diagnosis and treatment.
Save this post to reference the symptoms and diagnosis checklist, and share it to help someone who may not know what PMDD is. Thanks for reading!
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