Cycle of sadness: How to combat Premenstrual dysphoric disorder

Arjun always considered himself an enlightened guy when it came to women’s menstrual health. Growing up with four sisters, he never shied away from the topic.

“The cramps, the mood swings, the hormonal ups and downs. I had first-hand experience witnessing the impact these things could have on women as my sisters and mother went through their monthly courses,” explained the 34-year-old Indian expat.

So when Arjun married Priya, 33, in 2022, he was prepared to be a supportive and sympathetic partner.

But nothing could have prepared him for what Priya was going through.

“At first, everything seemed normal. Priya’s cycle came and went, with the usual aches and moodiness,” he recalled. “But then over time, the changes became more severe.”

Arjun noticed a startling shift about 10 days before her period. Her mood swings were growing more intense, and she would say things like, “I feel like I’m drowning,” or “I just don’t want to be alive right now.” The words shook him.

Arjun knew about premenstrual syndrome (PMS), but he didn’t think this was it.

PMS is experienced by women before their period and is usually characterised by mood swings; feeling low, irritable, upset, or anxious; fatigue or trouble sleeping; bloating or cramping; breast tenderness; headaches; skin breakouts; changes in appetite or food cravings, etc. Symptoms are sometimes severe enough to interfere with school, work, social activities, and relationships.

But, as Dr Anjulie Dhillon, a British health psychologist working at Connect Psychology, explained, there’s another little-known psychological disorder that many people are unfamiliar with, and it can affect women severely if left untreated.

“Premenstrual dysphoric disorder (PMDD) is a much more severe form of PMS with significant psychological symptoms that can accompany the physical symptoms of menstruation,” she explained.

“Women who suffer from PMDD can experience overwhelming feelings of anxiety and irritability. Depression in PMDD can involve feelings of hopelessness, low self-worth and severe fatigue. Mood swings can create challenges in day-to-day life, which can also cause a sense of isolation. Over time, these can impact overall well-being and quality of life.”

The way that PMDD presents can overlap with other mental health conditions, making it more difficult to diagnose. Underlying depression and anxiety are common in both PMS and PMDD, so it’s possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders.

As it is also linked to menstrual health, symptoms can be confused with ‘normal’ mood or hormonal changes. Dr Dhillon notes that the key difference is the severity. If a woman is experiencing extreme emotional turmoil around 10 days before her period, making alarming statements and spiralling into despair — which is typically uncharacteristic — it may be PMDD.

There are several psychological approaches that can be used to treat the condition.

“Knowledge is empowering and so psycho education is a useful place to start, so that individuals have a strong understanding of what their body is experiencing at a physiological and psychological level,” said Dr Dhillon.

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