Premenstrual Dysphoric Disorder (PMDD)

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What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) occurs in the luteal phase of the menstrual cycle (commonly the week or so before the onset of menstruation). PMDD may severely impact the quality of life. The main symptoms include;

• Lasting irritability or anger that may affect other people

• Feelings of sadness or despair, or even thoughts of suicide

• Feelings of tension or anxiety

• Panic attacks

• Mood swings or crying often

• Lack of interest in daily activities and relationships

• Trouble thinking or focusing

• Tiredness or low energy

• Food cravings or binge eating

• Trouble sleeping

• Feeling out of control

• Physical symptoms include cramps, bloating, breast tenderness, headaches, and joint or muscle pain.

• The key feature is that these symptoms are relieved in the first day or two of menstruation [1]

Diagnostically, PMS and PMDD represent the same symptoms, but PMDD is the severe form of PMS.[2] The incidence of PMS is relatively high. About 95% of people of reproductive age have premenstrual symptoms,[3] and 13% to 18% of individuals need treatment due to PMDD.[4] 

Cause 

Although the definite cause of PMDD is still unknown, research has shown that symptoms are likely to be attributed to fluctuations in levels of neurotransmitters in the central nervous system and cyclic hormonal changes [5].

Mainstream Treatment 

The standard treatments of PMDD are Selective Serotonin Reuptake Inhibitors (SSRIs), Anxiolytics or Oral Contraceptives. Research shows an increase in nutrients such as Calcium, Magnesium, Vitamin E, Vitamin B and following a healthy eating plan also improves symptoms. Whilst including a minimum of 20 minutes of movement daily also improves symptoms. Due to the side effects of drugs for PMDD, such as; headache, weight gain, sexual dysfunction and insomnia, to name a few, exploring other avenues is essential [6].

PMDD and me 

I have been diagnosed with PMDD. Some of the symptoms I experienced are; panic attacks, loss of interest in daily activities, and extremely low moods. All these symptoms disappear after I bleed, and I cherish a blissful couple of weeks ahead. What's so irritating about PMDD is once you're in it, it's tough to do the things you know help, such as; exercise, calling a friend and eating well. Thankfully, using Chinese Medicine, I can manage these symptoms. As soon as I feel that wave of fog and heaviness settling over myself (anytime from ovulation to a few days before I bleed), I take my herbs and symptoms are hugely decreased or may not present.

Chinese Medicine Viewpoint

TCM views PMDD as an imbalance in the body. We treat these symptoms using acupuncture and Chinese Medicine herbs to help regulate these hormones and decrease the sensitivity in changes. PMDD is mainly related to a pattern called Liver Qi Stagnation or disharmony between the liver and spleen. 

Research shows that the formula Jia Wei Xiao Yao San is the most commonly used, " free and easy wanderer powder'. The results of 30 studies utilising  Chinese Herbal Medicine for the treatment of Premenstrual syndrome (PMS) on 861 patients was 651 (75.6%) full recovery, 177 (20.6%) some effect and 33 (3.8%) showed little or no effect [7].

In a six month trial of Chinese Herbal Medicine, 81% of participants who were initially diagnosed with PMDD no longer fit the criteria of the DSM-V [8] Although more rigorous clinical trials are needed, clinical experience outlines the importance of TCM as an option for individuals with PMDD.

Tips

• DO book in with your Chinese Medicine Doctor. 

• DO get a period tracker app. This way, you aren't completely surprised every month 

• DO  move- walk, dance, exercise, especially before the onset. Aka, just after ovulation, the movement has been shown to decrease the severity of symptoms [9].

• DO try and eat a healthy and varied diet recommended by your TCM doctor [10].

• DO educate. I love Yumi Stynes Secret Life of Hormones 

• DO be aware that you may have more addictive and compulsive behaviours during this time. 

• DO seek out talking therapy or Cognitive Behavioral Therapy (CBT) if this is available to you. There are also free support lines such as Life line on 13 11 14 or Rainbow Door 1800 729 367 for LGBTIQA+ support.

• DO tell the people close to you. 

• DON'T change medications or stop taking current medications without discussing with your primary care physician.

• AVOID alcohol, alcohol is a depressant and can increase the severity of  symptoms  

• AVOID social media spirals 

• AVOID important meetings and significant events (where possible) during the lead up to your period