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When It’s More than PMS: Here’s What You Can Do

March 17, 2023

Few women escape PMS symptoms at some point in their life: irritability, mood swings and negativity, for starters. For some, though, the unpleasant symptoms tied to menstrual cycles are so intense, and last for so long, that the issue isn’t premenstrual syndrome after all. It’s premenstrual dysphoric disorder (PMDD), and its symptoms can be crippling.

What Is PMDD?

If you experience extremely strong symptoms starting two weeks before your period that last into the first days of menstruation, you might have PMDD. This disorder starts sooner and lasts longer than PMS and is technically a “cyclical, hormone-based mood disorder.”

Many of the symptoms are the same, such as a foggy brain, bloating, mood swings, tender breasts and temporary depression. There’s more, though. If you suffer from PMDD, you might have achy joints or muscles, lethargy, headaches, sleeping problems or bowel issues, including constipation.

Many women shrug it off as, thinking it’s just part of having their period. And those who seek medical advice might be told the issue is related to their thyroid, use of drugs recreationally, perimenopause or psychiatric issues such as anxiety disorders. Only the PMDD symptoms lift at some point during every cycle, whereas the other medical issues would not.

Researchers are working to determine what causes PMDD. Hormonal changes such as increased progesterone during your period or decreased estrogen around that time, genetic issues, anxiety, cellular brain activity and depression might contribute.

What To Do If You Think You Have PMDD

If these symptoms match what you experience, go see a gynecologist or primary care physician. Explain what you’re going through, giving details about how what you feel is different than what you went through in the past.

It’s best if you keep a journal about your symptoms before visiting with the doctor. Seeing specific symptoms and timelines can help the doctor see what’s going on and might enable you to begin treatment sooner. Give details, such as “I urinate 20 times a day” rather than “I urinate all the time.”

Just as post-partum depression is far different from the “baby blues,” giving specific information is key to understanding when you have PMS or PMDD.

If the doctor suspects you might have PMDD, you’ll be asked to do a specially designed assessment that uses science and objective criteria to help determine if you have PMDD. Do-it-yourself assessments are available online, but it’s best to work with a medical professional for more reliable results and interpretation.

Having a name for your upsetting and unsettling symptoms can help you, since you can slash “crazy” off the list. It will also validate what you experience and let you know that you are not alone in having these reactions related to your monthly cycle. Then, you and your doctor can work on medical and lifestyle changes that might decrease your symptoms.

How To Treat Your PMDD

A mix of medicine and lifestyle actions might help alleviate your PMDD.

  • Medications. Some patients benefit from taking mini doses of drugs known as SSRIs, such as fluoxetine, for the two weeks before their periods. Those meds are usually prescribed in bigger doses, and taken every day, for anxiety and/or depression, but this different schedule often helps with PMDD.
  • Birth control pills. Some birth control pills contain the estrogen ethinylestradiol and the progestin drospirenone. A prescription to that, or similar products, might alleviate your symptoms.
  • Talk therapy. Undergoing cognitive behavioral therapy — a type of talk therapy — with a professional sometimes makes a difference.
  • Living a clean life. Sleep regular hours, and a whole lot. Exercise nearly every day. Avoid processed foods. And reduce stress where you can. Cut back on alcohol, caffeinated beverages and sugary foods, too. They can stimulate the pancreas and adrenal glands.
  • Consider supplements. Studies are still underway, but you might find calcium, magnesium, and/or vitamins B6, E and D can help. Talk to your doctor before adding those to your regimen since some can have negative side effects.
  • Take a shot. Injections of leuprolide acetate might put you into a menopause-like state and therefore alleviate symptoms. It is expensive.
  • Surgical menopause. In extreme cases, you can have your ovaries removed. That will taper hormone fluctuations.

Together, three or four of these changes can ease your symptoms.

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