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.

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