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Cycle of sadness: How to combat Premenstrual dysphoric disorder

With PMDD significant psychological symptoms may accompany the physical symptoms of menstruation

Published: Thu 21 Nov 2024, 3:04 PM

  • By
  • Ghenwa Yehia

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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.

Dr Anjulie Dhillon: 'Women who suffer from PMDD can experience overwhelming feelings of anxiety and irritability. Mood swings can create challenges in day-to-day life, which can cause a sense of isolation.'

Dr Anjulie Dhillon: "Women who suffer from PMDD can experience overwhelming feelings of anxiety and irritability. Mood swings can create challenges in day-to-day life, which can cause a sense of isolation."

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.

“I will often use Acceptance and Commitment Therapy to help individuals open up, notice and accept uncomfortable thoughts or feelings, learning to respond to them in a different way. This approach also encourages individuals to take meaningful steps towards their values.

“Individuals often ‘struggle,’ or give themselves a hard time in relation to how they are feeling, which can further exacerbate symptoms. Compassion-Focused Therapy is particularly useful in reducing harsh self-criticism and developing self-compassion.”

Overall, sometimes individuals just need space to talk through and process some of the challenges that they are experiencing. Having the opportunity to express and process experiences, related to menstrual health or other life challenges, can be therapeutic. This allows people to explore not just surface level symptoms, but the whole context of their lives.

Priya was ultimately diagnosed with PMDD. Consultations with many doctors eventually led her to work with a specialised therapist. Both she and Arjun are in counselling — the diagnosis didn’t erase the hard days, but it gave them the tools they needed to navigate them together.

“I realise that out of my concern for her I wanted to try to fix things, and that didn’t really help. There are moments I still felt overwhelmed and helpless. But my journey with Priya isn’t just about being a supportive husband, it’s about learning, growing, and understanding the complexities of this condition.”

Dr Dhillon, who does not treat the couple, emphasised how educating boys and men about menstruation can contribute to easing the mental health burden on women. “If boys and men understand women’s health and menstruation, they can then come from an understanding and supportive place.

“We still need to be talking about our menstrual cycles more, to reduce the stigma and empower women to connect their symptoms to their cycles and to ask for support if they feel they need it. Things are moving in a positive way, and we are now normalising people talking about women’s health; this just needs to continue.”

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