“This isn’t rational. I should be happy. There’s something wrong with me.”
“I become…completely unlike myself.”
“I feel like my friendships have suffered.”
“I didn’t know that you weren’t supposed to want to die every month when you get your period.”
These are words from women around the globe who have been diagnosed with premenstrual dysphoric disorder, or PMDD. If any of these experiences sound familiar, you are absolutely not alone. Premenstrual dysphoric disorder is a severe, debilitating premenstrual condition characterized by mood swings and irritability—and thirty one million women around the world suffer from it. Nevertheless, PMDD is critically undiagnosed, highly stigmatized, and something we need to talk more openly about.
Before you do your internet deep dive, here’s what we know about premenstrual dysphoric disorder.
Is PMDD a mental health condition?
The answer to this is a hearty “yes, AND.” Though PMDD has been listed in the DSM-5, or Diagnostic and Statistical Manual of Mental Health Disorders, since 2013 as a depressive disorder, newer research shows that it may be much more than that. In a meta-study published in BMC Women’s Health, clinicians found major evidence that there are several neurobiological and genetic differences in women who have PMDD—meaning the condition is also a biological disease. And in 2019, the World Health Organization officially listed PMDD in its International Classification of Diseases (ICD) as a genitourinary condition.
How do I know if I have PMDD?
Like all health conditions, premenstrual dysphoric disorder manifests differently in each person that it affects. But the most universal theme among those who suffer from it? Debilitating effects on mental health.
In addition to intense bloating, cramping, and other premenstrual symptoms, common PMDD symptoms are as follows:
- Intense mood swings
- Depression or feelings of hopelessness
- Thoughts of suicide
- Intense anger and conflict with other people
- Increased irritability and anxiety
- Disinterest in daily activities
- Difficulty concentrating
- Paranoia
- Feeling out of control
Let’s stop right here and say that if any of these sound like you when your period is on its way, it’s time to consult your physician. Feeling out of control, suicidal, and/or like your world is spinning on axis every period is not normal—and it’s definitely not your fault.
Why didn’t I know about PMDD?
The answer is frustratingly simple: you didn’t know about PMDD because we aren’t talking about it enough.
Remember that BMC Women’s Health meta-study? Well, it found that there is a deeply “limited awareness and understanding” of PMDD within the medical community. And it shows. According to the National Library of Medicine, almost 90% of women who have PMDD are undiagnosed—and over 25% of women who are diagnosed with the disorder were originally misdiagnosed with another condition.
Up until recently, many clinicians believed that premenstrual dysphoric disorder didn’t exist. Several claimed that PMDD was actually just depression or anxiety — and the disorder’s inclusion in the DSM-5 was highly controversial. In fact, as late as 2015, some have tried to argue that PMDD is a “socially constructed” disorder. Eyes will roll.
The mystery around PMDD isn’t helped by the dated narrative that periods are supposed to be excruciatingly painful and make women crazy. Many people, even medical professionals, witness severe mood swings and think “dramatic and emotional,” rather than “serious condition.” These attitudes have dire effects on those who struggle with this very real disorder.
Why should we talk about PMDD more?
Many women who live with PMDD report feelings of intense loneliness, and it’s no surprise why. Not knowing what’s going on in your body and with your moods is incredibly isolating.
Think about this: if no one around you, including you, knows that you’re struggling with a serious disorder, it’s easy to feel like there’s something fundamentally wrong with your personality. Or even worse, that there’s no way out.
Untreated, this disorder can lead to hospitalization, psychiatric distress, and suicide. To us, that’s an emergency.
How to manage PMDD—in yourself and others
If you think you may have premenstrual dysphoric disorder, your first step is chatting with your physician and getting yourself on a treatment plan. Let your doctor know why you think you have PMDD and consider logging daily symptoms before and during your cycle for backup. In response, your doctor may suggest a range of PMDD treatments, including antidepressants like SSRIs, hormone or cognitive behavioral therapy, or changes to your lifestyle.
Step two? Talk about it. Let your community know what you’re struggling with so they can support you. Tell your friends about PMDD so they can be aware of how to show up on a really tough day. Share some information with your manager at work, just in case you’ll need to take a day or two off each month (yes, paid menstrual leave is a real thing.)
Got a mental health team, like a therapist or psychiatrist? Amazing! Make sure they’re in the loop, too, so you can talk through coping strategies. The mood swings, anxiety, and suicidal ideation that come with this condition are not things that you should brave alone—even if you’re being treated. An added bonus? You may help someone you know realize that they’re struggling with PMDD, too.
The third (and most important) step? Build an info fort. Seriously! Get informed. It’s easy when dealing with a condition like PMDD to see yourself as a crazy, uncontrollable monster. So, you need to take in as much media as possible that reminds you that you’re a human being struggling with a condition that many others have. Grab a book that details PMDD experiences, write about how you’re feeling in a special PMDD journal, or watch vlogs from content creators with PMDD. The more you understand the condition you’re struggling with, the less likely you are to blame yourself. And that’s a win for everyone.
