Understanding Premenstrual Dysphoric Disorder

Sometimes postpartum depression and anxiety occurs in tandem with other medical or psychological issues that can complicate recovery and the journey towards optimal health. Recognizing and treating these other conditions can help women to resolve their PPD/A since dealing with other health issues may cause additional stress and anxiety. Sometimes new conditions like PMDD can arise after the experience of PPD/A which may make women feel that their PPD/A has not properly resolved.  Kelley Allen shares her story of dealing with Premenstrual Dysphoric Disorder (PMDD) in addition to PPD/A.

I recently attended a Premenstrual Syndrome (PMS) and PMDD Workshop at BC Women’s Hospital. Following my experience with PPD/A and the return of my cycle, I slowly started to notice a pattern in which my mood deteriorated  drastically in the days leading up to my period and the first week after. At first I told myself that it was typical PMS and that I hadn’t experienced it for so long I had forgotten how annoying it could be. But it started to get progressively worse. I would feel, each month, like my world was crashing down around me all over again. I had the same thoughts I experienced during my hardest days of PPD/A, my anxiety skyrocketed, I was incredibly angry, and I had trouble sleeping. This was not just typical PMS, it was having a pretty severe impact on my life. I did a bit of reading on PMS and PMDD,  which is a severe variant of PMS. I had heard of it briefly before but always wondered if it was a real thing. From the reading I did, it seemed that in order to have PMDD  all symptoms needed to disappear on Day 1 of a woman’s cycle, therefore excluding me as my symptoms seemed to continue through the first week.

I went to see my Doctor who referred me to the workshop to learn more about PMS and PMDD. While I was there I met a group of women – all mothers who had also experienced some degree of PPD/A – who were having the same difficulty. The facilitator of the group noted that in her experience running the workshop this was very common; research shows that women who experience PPD/A have a sensitivity to hormone changes and that this sensitivity also includes minor fluctuations in estrogen and progesterone levels, which happens each month during a woman’s cycle. Even women who had no experience of PMDD prior to pregnancy and childbirth can start to show symptoms afterwards. This isn’t meant to alarm readers, in fact 80% of women experience PMS while only 2%-6% experience PMDD.

In terms of diagnosis, the most important tool is charting. There are Monthly Charts that can be downloaded from the BC Women’s Reproductive Mental Health website.

Doctors typically want a woman to rate her symptoms over at least two cycles in order to provide support for the diagnosis. My initial reading of PMS and PMDD was not correct – in order to meet PMDD criteria  bothersome symptoms occur 7-10 days before your period begins and are gone by the end of the first week.

From what I learned  there are many contributing factors to PMS and PMDD, which include poor nutrition, excess caffeine, lack of sleep, lack of exercise, stress, and alcohol/drug use. But the underlying cause of PMS and PMDD is purely biological. For some women, a change in lifestyle can drastically reduce symptoms. For others, medication may be required.

I tried everything in an attempt to figure out what was going on with me. I didn’t want to feel this way every single month and I also felt that it was getting worse, which scared me. I tried hormone therapy (birth control pills), acupuncture and Traditional Chinese Medicine, a complete change in exercise and eating habits, vitamins and supplements, and counselling. In the end, a few of these changes helped temporarily but what really made the difference for me was the combination of counselling and the right medication. It took many different attempts to find a med that worked, but I finally did. After a few months of “regular” PMS following two years of significant struggle, I can honestly say that yes, PMDD is a real thing, and that if you think you may have it, you don’t have to feel awful every month. There is help.
If your cycle has returned following childbirth and you are noticing severe mood changes each month, I strongly encourage you to connect with your Doctor and see about attending the workshop I did through BC Women’s Reproductive Mental Health. It was phenomenal. I also highly recommend checking out a book by Deborah Sichel and Jeanne Watson Driscoll titled “Women’s Moods: What Every Woman Must Know About Hormones, the Brain, and Emotional Health”. The book is somewhat dated (1999) but when I read it, I felt it really illustrated exactly how I was feeling each month. I also recommend connecting with a counsellor who specializes in PMS and PMDD. The one I saw was so helpful in reminding me each month that I wasn’t sliding back into PPD/A and that it wasn’t the end of the world; rather it was the 10 or so days that I needed to be extra kind to myself. She reminded me that it was temporary and provided me with many tools to use during the hardest days. She gently provided me with perspective during those times, which was hard for me to find in the midst of it all.

22 Responses to “Understanding Premenstrual Dysphoric Disorder”

  1. olga

    I would like to share my experience as well. I also developped PMDD after baby weaning. And with each passing month it got worse and really worse. Life seemed terrible in all aspects. And it was way worse than PMS. Nothing would help except for AD which has its’ own side effects but they are definitely easier than those terrible symptoms. And they also lasted 1 week more after periods. So I had just one normal week per month. Another symptoms which was terrible was absolute exhaustion, till the point it was hard to breath. Just to share my experience. Thank you for sharing this

  2. Emma

    The exhaustion till you can hardly breathe sounds like iron deficiency which would tie in with being worse at menstruation. I have that. I’m just writing to you in case you haven’t had that checked yet even though it was May you wrote that 🙂 xxxx

  3. Jillian

    I am in the exact same boat! It has been completely dismantling my life one month at a time, since I stopped nursing my son.

    I am 9.5 weeks pregnant and thought I was in the clear until I started noticing PMDD tendencies. Sore breasts (not related to pregnancy, literally started happening as I watched my mood unregulate) lashing out at my partner, suicidal thoughts. The little bit of research I’ve done, women react to cortisol as they would during PMDD while pregnant. Aaaah I don’t know what to do anymore

  4. Ganriele

    Girls I have the sameyhing. It is horrible. Did any of you get back to normal ? Or how long do you have this for? I’m in this situation for almost two years now. I’m look for an answer and how to fix it

  5. Sheila Duffy

    Please call us if you would like support at 604-255-7999 or 855-255-7999. We often hear from other family members who are having a hard time. Especially if it has been for a long time, it is good to see or find resources that may work to help you so you aren’t suffering. We can help with that.

  6. Romsey

    Hi,

    I feel like this describes my mood symptoms post babies, currently expecting the first period after my third baby and I feel very agitated. Is there anything I can do now to help this or is it better to waiting and documenting a few cycles before seeing a doctor to investigate?

  7. Christina Walker

    I had PPD/A with my first two pregnancies and thought I had escaped it with my 3rd. Now I am struggling with exactly what is described in this article -PMDD. It is pike PPD/A but only before my period and the first week following. I am in Florida- know if any resources here?

  8. febe

    Thank you for this. I have been struggling ever since with my moods. I hardly recognize myself from who I was before pregnancy. It was until a friend of mind mentioned to take notice of my cycle and moods. And that’s when I notice, i am incredibly scranky during my period and i always feel sick( flu like sick) with full body tiredness.

  9. Lisa

    Hello all,
    just reading all these makes me feel so much like. My son is 8 and I am still experiencing it breaks my heart cause during this time I don’t want to be with my husband, son or friends am tired, weak and anxious I get paranoid and dizzy no one in my country as doctors seems to understand what I am going through it’s debilitating. My mom told me to take B complex with iron which sometimes help.
    I would like to have another child but I am scared.
    Can someone help me…I can’t scream help any longer…

  10. Kelly

    I’m not sure if this is what I’m experiencing. I have General Anxiety for years now to begin with but didn’t experience this with my first two children. My first period after weaning began today and for the past week I’ve been a complete mess – anxiety, no sleep, exhaustion. I’m on an AD already but it doesn’t seem to be helping.

  11. Sheila Duffy

    Hi Kelly… it’s not unusual for moms to experience more symptoms after weaning and especially when they first start their period again. If your symptoms continue to worsen, it would be a good idea to talk with your doc and maybe look at your current dose of AD etc… What some people find is that it starts to even out again after a little while as your body is adjusting hormonally. Feel free to call our support line if you want to discuss more 604-255-7999.

  12. Sheila Duffy

    Hi… we may have missed your comment on here… are you still looking for support with these questions? I would say that yes, the first period and maybe first few cycles can be intense as far as hormonal changes and mood etc… If you are still struggling please call us for support and yes, I would say talk to your Dr. as well.

  13. Meg

    I think I might be suffering from PMDD after my son’s birth I thought I had Post partum depression that never went away. I have been dealing with incredible sadness and anxiety for 4 years now. I really don’t know who I am anymore. Thank you for this post.

  14. Shaz

    So grateful for info like this. My pnd stopped at about 5 months when I put my daughter into childcare, but as a result I wasn’t breastfeeding as much and then at 6 months I got my period. I remember being a bit cranky. But the other day I was in a terribly dark place, starting fights, depressed, bawling my eyes out all day, suicidal thoughts and it reminded me of when I was a teenager and super depressed. Then the next day I got my period. I started researching can your period trigger pnd and that’s when I learned about PMDD.
    Still more research to do but now I’ve started tracking periods and have warned hubby that it might happen once a month. I think arming myself and hubby with knowledge will help. Might plan to book in a massage or self medicate, cut out caffeine, sleep more or who for a long walk on these days. It also makes me wonder if my teenage depression was caused by a sensitivity to hormones.

  15. Mari

    I had no idea what pmdd was! My periods have just gotta I out of hand I finally decided to join a Facebook group for pms & learned about pmdd & know this is what my problem is. I’m irritated angry and emotional a week before my period, during my period and I’m back to my “normal“ self the last day of my period. It’s like finally being able to breath again. I’m 38 and never experienced this until after I stopped breastfeeding my second child. My husband and I have seriously considered him just leaving for a week or so at a time but that would be ridiculous every month, we’re just tired of the arguments associated with this mess! I’m in 3rd day right now looking forward to the end!! I’m in Dallas tx- sorry so long just good knowing I’m finally not alone.

  16. katie

    Thank you for this. I have been searching for help. I did not have post partum depression – in fact it was the happiest and most constant time of my life, after having lots of depressive and anxious bought throughout my life. I long term breast fed to 2.5 years and stopped 6 months ago. Since then, I have noticed severe PMT – much more than I used to have – and it seems to be getting worse. For the week before my period and a few days after I am a wreck: irrational uncontrollable rage (usually over nothing at all – I tore all the Christmas decs down a few days ago), severe mood swings & very down. This is increasing to suicidal thoughts and wanting to get in the car and abandon it all the last two months. This is getting worse every month and increasing in time feeling like this – more days either side. I am scared for the impact on my gorgeous little boy who I adore, but feel during these weeks he is better off without me. I have a doctors appointment in a couple of hours and thought I might search online to see if there was anything or anyone who had experience something similar post breast feeding – that was the turning point. I have always been so sensitive to hormones, I couldn’t even take hormonal contraception. I don’t know what to do to fix this. But thank you for showing me I am not the only one.

  17. Heather

    Omg same. I stopped breastfeeding in December and was miserable for almost 2 weeks, my period started a week after I stopped. Katie I was like you, no PPD, super even keeled thru pregnancy and first 8 months. The second I stopped breastfeeding everything changed! The fatigue is crazy, my nerves are so raw and my periods are horrible. Going to my Ob this week, but glad to know this happens. I seriously contemplated leaving my husband because he opened a bag of crackers and woke me up.

  18. Amy

    Its relieving to hear other ladies are going through this. I had my boy back in september and suffered with severe PPA and OCD intrusive thoughts. After months of CBT I was finally discharged 2 weeks ago and thought I was okay. I am currently on day 3 of my period and I am full of rage whenever something negative happens. Even my boy who I love so very much I got angry with him waking up in the middle of the night! Then this spiralled to ‘oh my God what if this means I’m back at square one again, what if this means I am a bad mother’ etc. I stopped taking the mini pill around 2 2 months ago and this all started when I did that, my first period on no birth control was awful, suicidal thoughts, wanting to pack my things and leave my son and partner. I will be phoning my doctors tomorrow that’s for sure.

  19. Heather S

    Those of you who have PMDD from weaning, what did your doctors recommend? I nursed my daughter for 2.5 years before weaning completely. As she gradually weaned and my period came back at 18 months, my anxiety got progressively worse. I’m almost a year from when I weaned her and I’m still dealing with what I think is PMDD. I’m emotional, angry, bad anxiety. I have tried acupuncture, chinese meds, neurological chiro, therapy..a ton of stuff including AD (only 1). I had a bad reaction to the AD med so I’m terrified to try another. Is this my only fix? Trying another AD medication (I’m scared)? I was so different pre baby and it brings me to tears thinking this is my new normal. I just want to feel ok in my own skin again. This thread from y’all about weaning is one of the only discussions on it I’ve seen and it gives me hope. Thanks