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PMDD is more than just severe PMS.

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Welcome back to You’re Not Alone: A mental health series where we aim to highlight mental conditions that affect people’s day-to-day lives, and what products, apps, and services they use to make their every day easier. This month, we hear from Jaishree Kumar, a graduate student and freelance writer who has premenstrual dysphoric disorder (PMDD).

Content warning

This article mentions feelings of depression, anxiety, and suicidal thoughts.

If you’re thinking of hurting yourself or are having suicidal thoughts, please call the National Suicide Prevention Lifeline at 800-273-8255.

You can also call 911 in the case of a mental health emergency.

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Premenstrual dysphoric disorder (PMDD) is a condition that induces severe physical and mental symptoms around 7 to 10 days before your period. PMDD is classified as a DSM-V disorder, but there’s little understanding or awareness about what PMDD actually is.

The underlying causes of PMDD are still up for debate. Some professionals say it’s a hormone disorder, while others say it’s a reaction to hormonal changes in the body during the luteal phase (this is the first stage of the menstrual cycle. It occurs after ovulation).

However, there seems to be a consensus that PMDD is a condition with severe premenstrual syndrome (PMS)-like symptoms that can hinder someone’s quality of life. PMDD can linger around until menopause, but it tends to worsen during perimenopause.

“During perimenopause, symptoms can worsen as the hormone cycle varies greatly, but for some, it improves,” says Dr. Verity Biggs, an expert in menopause and female health.

Many menstruators don’t realize they have PMDD for many years, and I was one of them.

When I was 19, I noticed that, around 2 weeks before my period, I would experience anxiety attacks and bouts of depression. These spirals of anxiety and depression would fade away on the second day of my period, or sometimes even hours after getting my period.

Oftentimes, I would downplay it and tell myself to suck it up. When I sought out help from a gynecologist, they told me that it was just PMS. However, the intense spirals that sometimes bordered on suicidal tendencies would arrive like uninvited guests almost 10 days before my period.

I spent more than a year tracking my cycle through a period tracker app and making notes of my symptoms, but nothing made sense. Now, at the age of 22, I have a better understanding of what PMDD is and what it does to my body.

As a journalist who’s reported on mental health, gender, and sexuality in the past, it still blows my mind how little people know about PMDD. When I was 19, I stumbled upon what PMDD was when I Googled “severe PMS.” I related to every article and video on PMDD. After years, I finally felt heard.

Emily Marquis, a wellness coach who has PMDD, stresses the importance of highlighting the voices of people who have PMDD.

“I believe it’s important for clients first to feel heard, validated, and personally accept that what they experience each month is real and that it’s not a problem… that they don’t know how to control,” Marquis says.

“It’s very hard to work through the idea of shame, embarrassment, and frustration with having PMDD. This is an ongoing practice, because the disorder is not visible. [So] it’s hard for outsiders to truly understand what is going on.”

This is especially true for me, since I live in India, where it’s hard to see medical practitioners who acknowledge PMDD. My current gynecologist sees my PMDD flare-ups in connection to my polycystic ovary syndrome (PCOS), for which I was diagnosed recently.

PCOS is a condition that affects a person’s hormone levels, often causing uterus owners to skip menstrual cycles and making it harder for them to get pregnant.

Everyone’s experience with PMDD is going to be different. Like other health conditions, PMDD isn’t one-size-fits-all. When I was younger, I could feel myself lose control over my emotions during PMDD flare-ups. These flare-ups were further worsened by toxic relationships, stress, and feeling out of control at all times.

“When I was 19, I stumbled upon what PMDD was when I Googled ‘severe PMS.’ I related to every article and video on PMDD. After years, I finally felt heard.”

My flare-ups weren’t always intense, but sometimes, they were so debilitating that I would snap at everyone around me and have emotional breakdowns.

For about 2 years, I would hold my breath before “hell week,” a phrase many people use for their PMDD flare-ups. I was afraid of how I would lash out in front of friends and family, or how I would deal with the constant fatigue and anxiety. I started to become afraid of my PMDD.

People with PCOS have trouble ovulating every month, which leads to irregular menstrual cycles. Sometimes, I’ve had my period after a gap of 51 days or as early as 22 days. However, my PMDD acts as an “indicator” to me that my period is coming, even if it’s early or really late.

“There is no connection between PMDD and PCOS or endometriosis, but they can occur together, and PMDD is more common in people [who] ovulate regularly,” Biggs explains. “With PCOS, you may not ovulate each month, and therefore, you will not necessarily get the symptoms each month.”

To manage my symptoms, several doctors advised taking antidepressants or birth control pills. Currently, I am not on antidepressants or birth control pills. While there’s nothing wrong with taking medication, I’m not sure if it’s the best option for me.

However, with the help of psychotherapy and a few healing practices, I’ve tried to repair my relationship with PMDD.

I’m now more aware of my cycle changes. A few days before my PMDD flares up, I try to eat healthier and exercise more. I’ve found that yoga can be extremely relaxing and soothing for PMDD. Yoga helps me stay connected to the present and not go into a downward spiral of overthinking. It also helps clear the brain fog.

Melissa Sue Ogden, a yoga therapist who runs Yoga for PMDD and also has PMDD, says, “I often use postures that bring the breath downward in the body to support the alleviation of cramps and bloating. For symptoms, like anxiety and migraines, breathwork practices, like Sithali (a cooling breath), can help soothe a frazzled nervous system.”

Lately, my biggest PMDD symptom is extreme fatigue. I sometimes feel fatigued and lethargic, even after having a good night’s sleep and eating nutritious meals. On some occasions, I’ve had to cancel meetings, because my fatigue demanded that I rest instead of working. It’s a phase when I can almost feel my system shutting down little by little.

Emily Holloway is a psychotherapist and co-founder of the PMDD Collective, a source of support and initiative raising awareness of PMDD. She recommends splitting up time in “can do/can’t do zones.”

“We believe in living cyclically, finding ways to split up the month into ‘can do’ and ‘can’t do’ weeks. In those ‘can’t do’ ones, something as small as just moving your body by getting off the sofa to make a cup of tea is a big deal to be recognized,” Holloway says. “It comes with the bonus of resetting your nervous system and shaking off those intrusive thoughts.”

I’m working on applying a similar approach to my PMDD journey.

As a freelancer, I depend on pitching editors to get work. On several occasions, my PMDD flare-ups have caused me to not work, because I was too overwhelmed. Now, during PMDD flare-ups, I focus on my most important tasks and leave out the rest.

“During flare-ups, it’s important that clients have the space to relax as much as possible in their own way. This can be created by making sure their work and personal life are not overloaded,” Marquis says. “I personally struggle with PMDD and always make sure I have therapy and acupuncture scheduled during my flare-up.”

Although people experience different symptoms and treatment options, here are some of the most helpful products and apps that I use to manage my PMDD.

Make sure to talk to your doctor

There are some supplements and teas on this list that may work well for some people, but not all. Prior to introducing any new products into your diet, you should consult your doctor to make sure they’re a good fit.

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Pricing guide

  • $ = under $20
  • $$ = over $20

Sports Research Evening Primrose Oil Capsules

  • Price: $

This was the first-ever supplement suggested to me by my gynecologist. It helped lessen my PMDD symptoms for a few months. While it didn’t make them go away completely, I generally felt calmer and less sad.

Since my last doctor’s appointment, I take a higher dose of evening primrose oil and find it continues to help me.

There’s also research on how evening primrose oil can help with PMS and PMDD. Researchers have found it has the potential to reduce PMS, hot flashes, gestational diabetes, and cervical ripening.

LuxFit Foam Roller

  • Price: $$

I have a lot of muscle tension in my body. As a grad student, I usually spend long hours at my desk studying or writing. I’ve noticed that, during my “hell week,” the pain in my muscles and joints is significantly worse.

I recently started using a foam roller, and it’s been a game-changer for me. When my anxiety is particularly high, I can feel myself slowly calm down after a foam rolling session.

Gaiam Print Yoga Mat

  • Price: $$

This is probably my favorite yoga mat of all time. During PMDD flare-ups, I try to start my day with Surya Namaskar, also called sun salutations. I then move on to breathwork practices to relieve feelings of stress and anxiety.

Soulflower Rosemary Essential Oil

  • Price: $$

Research has shown that rosemary oil has properties that help reduce anxiety. On the days when my anxiety disrupts my sleep, I sprinkle a few drops of rosemary oil on my pillowcase. The smell of rosemary is really calming and helps me fall asleep after a long day.

FGO Organic Spearmint Tea Bags

  • Price: $

According to a 2010 study, spearmint tea has anti-androgen properties that can help with PCOS symptoms. People with PCOS also can have high levels of testosterone, and spearmint tea may help lower them.

I’ve been drinking spearmint tea almost every day for the past few months, and not only does it help with the intense cramps I experience, but it also helps calm my PMDD symptoms.

Organic India Moringa Green Superfood

  • Price: $

Moringa, an antioxidant-rich plant native to north India, has been found to help:

  • lower cholesterol
  • reduce inflammation
  • lower blood sugar

I take it a couple of times during the week, and I feel it helps improve my gut health. I can feel a visible difference in my energy levels, and I no longer feel bloated all day.

Flo Health App

  • Price: free

Flo is the period tracker app I’ve been using since 2016. The app shows you graphs related to your menstrual cycle. I’m also able to log PMDD flare-ups, which helps me keep track of frequent mental and physical symptoms that I’m experiencing.

When I first started noticing my symptoms, I thought I was just really sensitive to PMS. Turns out, PMDD and PMS are not the same.

Holloway says that the biggest misconception about PMDD is that it’s a hormonal imbalance disorder.

“It’s assumed that, as it’s cyclical and related to hormones, it must be an insufficiency or excess of certain hormones,” she says. “Women go to the doctor experiencing PMDD symptoms, only to be sent for blood tests, which come back normal. The doctors then dismiss it as being hormone-based and put them on antidepressants, or in some cases, misdiagnosing them with bipolar or any other personality disorder.”

While there’s emerging research on PMDD, there’s a need for more understanding of the severe mental health effects of PMDD.

Over 30 percent of people with PMDD attempt suicide at one point in their lives, while over 70 percent of people with PMDD are at risk of experiencing suicidal ideation.

It’s estimated that around 5 to 8 percent of women have symptoms that cause significant enough distress to be classified as PMDD.

There’s also a pressing need for research and awareness on PMDD in the trans and nonbinary community. Not everyone who menstruates identifies as a woman, yet most of the sparse data available on PMDD focuses only on cis women menstruators.

There’s also a lack of attention on premenstrual exacerbation PME), which is the worsening of another disorder, such as major depressive disorder during the luteal phase.

My PMDD journey is far from over. I carry the weight of emotionally hurting myself and my relationships during my flare-ups. I also deal with the guilt of not being able to work and be productive enough during the flare-ups.

However, I’ve learned that a support system and community help tremendously. I’m part of multiple PMDD support groups on Facebook, including the International Association for Premenstrual Disorders, which has close to 11,000 members.

Through these spaces, I realize that what I feel is OK, and it deserves a care plan that also addresses my other health concerns.