PMDD: what is premestrual dysphoric disorder and how can you help yourself to manage it?

You might have heard Premenstrual Dysphoric Disorder (PMDD) crop up on social media and recent TV interviews (check out Vicky Pattinson on How to Fail Podcast where she talks about her experience). But in conversations with friends, family and clients, I've been surprised how little women have heard of PMDD or understand what it is. So today I wanted to dive into this hormonal condition, give you some information on the symptoms and what to do if you think you or a loved one might be suffering from it.

What is PMDD?

PMDD differs greatly for every person suffering from it, but symptoms can include severe mood swings, fatigue, anxiety, severe depression, panic attacks, inflammation, sensory overload, bloating, digestive issues and sleep problems. For some, it can even develop into extreme hopelessness and suicidality. It truly can be a debilitating condition which alters the reality of the person for up to two weeks of their cycle. As a result, some PMDD sufferers struggle with sustaining work, relationships and basic self-care.

So what happens?

PMDD hasn't long been a researched topic (SHOCK) in medicine, but it's thought to be caused by individual sensitivities to hormonal fluctuations that come during and post-ovulation. After ovulation, oestrogen levels initially rise, then drop sharply in the days before menstruation; this dramatic decline appears to be particularly problematic for people with PMDD. Potentially more important is the role of progesterone and its metabolic byproduct allopregnanolone. Progesterone rises sharply post-ovulation, peaking around mid-luteal phase (one week before your period). And allopregnanolone (a neurosteroid) which normally acts as a calming factor on the brain also follows suit. But instead of the usual reaction to these changes, we see an exaggerated response where anxiety and depression rule the roost. As a result, the body follows suit—causing physical symptoms such as inflammation, fatigue and gastrointestinal issues as the body essentially freaks out from these changes.

Why does it happen?

Again, this isn't confirmed, but there are a few theories on why it might happen for some. PMDD tends to run in the family. This is tougher to track as it's only been recently acknowledged, so perhaps your mum or nan might have had the symptoms but were simply called 'crazy' or forced to push down their feelings. There are also theories around the link with chronic stress and trauma; it can increase inflammation in the body and brain. This inflammatory state can make you more sensitive to hormonal fluctuations and worsen mood symptoms during the luteal phase. What's more, past trauma and stress can alter hormonal patterns such as the interaction between cortisol, progesterone and oestrogen. There is (surprise, surprise) so much to learn when it comes to PMDD and what causes it. But it is a very real condition which affects 5-8% of menstruating women and people assigned female at birth.

What can you do about it?

If you suspect it might be something that's affecting you, it's always key to speak to your GP about potential routes for treatment. Currently, they are somewhat limited:

Contraceptive pills: taking them back to back or having structured breaks to 'override' the usual dips. However, progesterone-only pills can worsen symptoms and PMDD symptoms can still break through as the body is hypersensitive to any changes.

SSRIs: taking consistently or cycling. This always seems odd as a non-hormonal treatment for a hormonal condition (we see the same sort of prescriptions for women during the menopause) but can be helpful for those really struggling with the mental health effects of the condition, allowing them to 'bridge the gap' in the luteal phase.

Talking therapy: as we spoke about before, trauma and chronic stress can play a part. So getting on top of and potentially unpacking this can help to regulate symptoms to a more manageable level.

Outside of 'medical treatment', some supplementation, foods and stress-relieving techniques, lifestyle adjustments and forms of movement can all be helpful. That being said, anything online that is claiming to 'fix' your PMDD symptoms should absolutely be avoided. Unfortunately, at present, there is no 'magic pill'. Rather, it's more about experimenting with different treatments and approaches to help manage your body and symptoms.

I hope this has given you a little introduction to what PMDD is to either help yourself or others around you. Remember, your feelings and experiences are valid, so please seek help if you're looking for medical treatment. Check out my blog next week for more insight and rabbles! And if you're looking for a trainer that can help you navigate training and nutrition with PMDD, give me a shout.