This article, originally published in Undark Magazine, discusses the challenges and controversies surrounding premenstrual dysphoric disorder (PMDD). The author shares their personal experience with PMDD, highlighting the relief they found in learning about the condition and the available treatments.
PMDD is a condition that affects around 1 to 7 percent of menstruating women, as well as trans men and nonbinary individuals who menstruate. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) defines PMDD as experiencing significant emotional and physical changes in the week before menstruation, such as sadness, anger, difficulty concentrating, and fatigue.
While the diagnosis of PMDD has been met with controversy, with some viewing it as a result of historical oppression of women, the American Psychiatric Association (APA) decided to include it in the DSM-5 as an official diagnosis in 2013. However, the criticism surrounding the diagnosis made the author question the validity of their own experiences.
Research on PMDD has shown mixed results regarding hormonal differences between those with severe premenstrual distress and those without. Some studies suggest lower levels of estradiol, a form of estrogen, in individuals with PMDD, but no definitive biomarkers or hormone tests exist for diagnosing PMDD. Instead, diagnosis is based on keeping a symptom diary over several menstrual cycles.
The severity of symptoms recorded in these diaries can be alarming, with reports of suicide attempts and self-harm. Treatment options for PMDD include selective serotonin reuptake inhibitors (SSRIs), birth control pills, cognitive behavioral therapy, and calcium supplements. SSRIs, in particular, have shown to be effective in relieving PMDD symptoms, though the exact mechanism of action is still unknown.
Some experts argue against labeling PMDD as a mental illness, attributing the distress experienced to societal factors and the disproportionate stress placed on women. They believe that symptoms such as irritability, anxiety, and low mood are understandable responses to life stressors rather than signs of mental illness.
While medical interventions for PMDD can be life-saving, addressing the societal factors that contribute to the distress is also crucial. This includes acknowledging the caregiving load, which can be a significant stressor for individuals with PMDD, and encouraging co-parents to share the responsibility. Relationship difficulties and dismissive attitudes from partners can also exacerbate premenstrual distress.
In conclusion, it is essential to continue researching and understanding PMDD biologically, as well as developing more effective treatments. However, it is equally important to create a better support system and tackle the underlying societal factors that contribute to the distress experienced by individuals with PMDD. This involves making workplace accommodations, fostering co-parenting responsibilities, and challenging casual sexism in medical discourse.
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