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Menstrual woes: PMDD and its symptoms, causes, and treatment

Most of us are familiar with the term premenstrual symptoms (PMS), which is a combination of physical and psychological symptoms that many women experience before the onset of their period. However, premenstrual dysphoric disorder (PMDD) may be a new term for many, which is a more severe form of PMS – affecting an estimated three to eight per cent of women of reproductive age, according to studies.

PMDD is a clinical disorder, yet, it remains shrouded in misunderstanding and misdiagnosis. To accurately understand and manage PMDD, we talked to renowned psychiatrist Professor Dr Anwara Syed Haq MBBS, FCPS, MRCPsych (London), who offered her valuable insights into the causes, symptoms, and effective coping strategies.

A glimpse into PMDD

PMDD is a distinct clinical condition with psychiatric dimensions. Dr Haq explains, “PMDD is most certainly related to the body, and I would call it a psychiatric disorder because the symptoms are psychiatric.”

According to Dr Haq, PMDD is marked by “extreme mood swings, irritability, depression, anxiety, feelings of overwhelm, difficulty concentrating, or even sleep problems.” Therefore, the symptoms of PMDD are debilitating and largely impact daily functioning and even relationships.

Listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), under the category of Depressive Disorders, PMDD has been categorised as a psychiatric disorder. However, the person suffering from the ailment can experience physiological symptoms, for example, muscle aches, headaches, or weight gain related to fluid retention.

The disorder’s roots can be genetic. Dr Haq notes, “PMDD can be genetic, for example, if the mother is suffering from PMDD, her daughter may suffer from it as well. I have seen many people suffering from it as an isolated disorder.”

Environmental and psychological factors

The symptoms of PMDD, while partly genetic, are also influenced by one’s environment and psychological state. “If your lifestyle includes anxiety and stress and if you do not live in a peaceful environment, the symptoms are bound to exaggerate,” Dr Haq states.

This highlights the variability in how individuals respond to stress and trauma, which can be shaped by upbringing and personality. It is vital to understand that stress and trauma do not cause PMDD but can worsen its symptoms.

Dr Haq clarifies, “I would say trauma or stress does not cause PMDD but rather aggravates the symptoms. Therefore, PMDD cannot be termed as a psychosomatic disorder.” This distinction is important in debunking myths that PMDD is just a manifestation of emotional distress.

Treatment approaches

The treatment for PMDD involves a comprehensive approach, primarily managed by psychiatrists due to the psychiatric nature of its symptoms.

“The person diagnosed with PMDD experiences extreme mood swings. To combat this condition, we usually give the patient mood stabilisers or antidepressant medicines,” mentions Dr Haq.

However, medication is not always necessary as psychological counselling alone can be effective, particularly when addressing the psychological underpinnings of PMDD.

Dr Haq advises, those experiencing irregular menstrual cycles to consult a gynaecologist to rule out other underlying conditions. This multidisciplinary approach ensures that all potential factors are considered, providing a holistic treatment plan.

‘Never overlook PMDD as something trivial’

One of the biggest challenges in managing PMDD is the societal stigma and the tendency for women to hide their emotional and mental struggles. “Due to societal prejudice or other restrictions, women tend to hide their emotions, trauma, or other mental health issues,” Dr Haq notes.

It is important for us to understand that the behaviours exhibited by individuals with PMDD are not for attention but are manifestations of their suffering. Thanks to advancements in understanding and treating PMDD, women no longer have to endure this struggle without support.

“We didn’t understand this disorder properly or didn’t have proper treatment back then. But now we have all of these, so there is no need to go through this struggle without treatment. We should never overlook PMDD as something trivial, and the patient should be given the treatment she needs,” Dr Haq asserts.

Recognising PMDD as a serious medical condition, understanding its complexities, and implementing effective treatment strategies are indispensable for improving the lives of those affected.

By acknowledging the real pain and disruption caused by PMDD, and fostering an environment of support and understanding, we can ensure that women suffering from this disorder receive the help they need. It is not just a matter of managing symptoms but of transforming lives through compassionate and informed care!