Treatment Options for Premenstrual Dysphoric Disorder (PMDD)

Periods are a normal part of life for the majority of women and teenage girls. At worst, it’s a monthly pain; at best, it serves as a gentle reminder that our bodies are functioning as they should. However, the start of menstruation can feel miserable for girls with Premenstrual Dysphoric Disorder (PMDD).

What is Premenstrual Dysphoric Disorder?

PMDD is a collection of both physical and emotional symptoms, much like its more well-known but milder cousin, premenstrual syndrome (PMS). They happen just before your period, during the menstrual cycle’s luteal phase when the uterus prepares for the possibility of pregnancy by secreting an increased number of hormones.

PMS and PMDD symptoms frequently resemble one another and include:

• Feelings of depression, anxiety, irritability, or even rage that appear out of nowhere are referred to as being moody.
• Excessive crying or sobbing without cause.
• Intense sensitivity to rejection: worrying that everyone is upset or angry with you.
• Feeling overburdened or like you’re barely getting by.
• Difficulty staying focused or having trouble staying on task.
• Changing or decreasing one’s appetite.
• Physical symptoms such as exhaustion, bloating, cramps, headaches, tender breasts, and body aches.

Typically, symptoms appear 5-8 days before your period, but they can appear earlier. Once your period starts, the symptoms stop. PMDD can begin at any point after puberty.

So, what’s the difference?

Around their periods, approximately 75% of women and girls report some emotional and physical discomfort, but PMS typically has a minor effect on their lives. The signs of premenstrual dysphoric disorder are much more severe, and they frequently lead to issues that last long after the tampon box has been put back in the cabinet.

Although everyone experiences mood swings before the start of their periods, Stephanie Samar, PsyD, a clinical psychologist who works with young women at the Child Mind Institute, claims that PMDD involves feeling completely different from oneself. If it seriously impairs, it is likely PMDD.

For instance:

• A girl experiencing PMS might feel worn out or a little off. A girl with PMDD might have trouble getting out of bed or focusing on even easy tasks.
• A girl experiencing PMS may feel irritable or frustrated. A girl with PMDD may experience spurts of irrational rage, unexpected arguments with family members, or friendships or romantic relationships that are already in trouble.
• A woman with PMS may be more sensitive and cry easily at things like depressing commercials. When a girl has PMDD, she may feel as if she’s experiencing a major depressive episode, with feelings like worthlessness, misery, and suicidal thoughts.

Premenstrual dysphoric disorder is brought on by an increased sensitivity to progesterone and estrogen, two hormones that peak the week before a period. In 2017, National Institutes of Health researchers discovered evidence suggesting that PMDD is probably genetic. Girls who have PMDD are more likely to have mothers who have a history of severe premenstrual symptoms.

Fallout from PMDD

Girls are extra sensitive and react more hastily and intensely to anything that reads as rejection when premenstrual dysphoric disorder is in full swing. Her boyfriend’s casual remark or a sibling’s refusal to turn the TV off can result in major meltdowns.

One of the most challenging aspects of PMDD is that while the symptoms that lead to these meltdowns go away once girls start their periods, the conflicts, academic challenges, and interpersonal issues they cause remain. Some girls report feeling better when their period came only to be faced with the damage done during PMDD. Although they feel better, the issues persist.

Monitoring symptoms of PMDD

The first step in determining whether someone has premenstrual dysphoric disorder is tracking. Experts require tracking for a minimum of two cycles that demonstrate consistent patterns in behavior and mood to make a diagnosis.

Work with your daughter to note down symptoms, including what they are, how bad they get, and how long they last, if you suspect your daughter has PMDD. Paper calendars are useful, and a lot of period-tracking applications have a feature that lets users log symptoms. Teenagers can track on their own or with their parents.

Consult your physician.

Make an appointment to see a gynecologist after tracking at least two cycles. Share the tracking data you’ve gathered with the doctor and let them know you suspect your daughter may have PMDD. Since PMDD is still a new diagnosis, some medical professionals might need some time to find the most effective treatments for your child.

Finding someone who will be thoughtful and thorough is crucial, says Dr. Samar. She suggests getting a second opinion if you think this diagnosis applies but your doctor isn’t listening or is downplaying your concerns. “You need to find someone who understands and values your concerns.”

Medication.

In some circumstances, doctors might advise taking medication to treat PMDD. Due to their ability to control and balance premenstrual hormonal changes, birth control pills are frequently chosen as the first line of defense. Antidepressants may occasionally be prescribed by doctors. When your child’s symptoms are at their worst during the week, her doctor may advise increasing the dosage of any antidepressants she already takes.

Organizing and controlling PMDD.

The same data you gathered through tracking may also make it simple to carry out some preventative scaffolding at home. According to Dr. Samar, knowing how your PMDD affects you is important knowledge. Planning can help reduce the impact and fallout of PMDD.

When a girl is feeling good, planning how she will handle stress, interpersonal interactions, and physical symptoms can help her get through the challenging situations that may come at a different point in her cycle.

If she frequently gets into altercations, she may avoid big social commitments like parties or dates. If issues do arise, she might decide to revisit upsets or conflicts once she is back to feeling like herself.

Other things she can do to help are:

• Prepare a healthy diet in advance and make sure to drink plenty of water.
• Alcohol frequently worsens symptoms. If she is of legal drinking age, she could promise to abstain from alcohol until her period.
• Foster physical activity. In terms of PMDD, “we know exercise is a big help,” says Dr. Samar. Encourage her to move. Enrolling in a yoga class or making plans to go for a run can help her feel better and relieve symptoms.
• Try cognitive behavioral strategies to help control some of the more erratic emotions. Dr. Samar advises: “Try to challenge thoughts and emotions where you can that you know might be out of proportion.”

“Slow down and take a moment to ask: Am I really this upset that I’m responding in this way? Is this how I’m reacting because I’m feeling particularly sensitive at the moment?”

Girls will be better able to lessen the effects of PMDD as they develop their coping mechanisms, which will become even more crucial as they get older. PMDD is persistent. They will require these skills throughout their lives.

Being serious about it.

According to Dr. Samar, “This is a serious disorder, but historically we haven’t treated it as such. Many women and girls who have PMDD aren’t even aware that it’s abnormal behavior.” Dr. Samar explains that one of the first things girls with PMDD as well as their families and doctors need to realize is that they can’t just get over it. You are unable to choose not to feel it.

Even as they work to teach their daughters how to better control their emotions, parents must be careful to validate their daughters’ experiences. Samar advises against responding with phrases like “Oh, you’re just saying that because you’re on your period, you’ll be over it soon.” She advises parents to say something like, “I can understand how upset you are. Take a break for a moment, and then we’ll discuss this when you’re more at ease.”

Discovering a path forward.

As you seek a path forward for yourself or your daughter, the counselors in our office can offer support that will make the journey easier. Reach out to our counselors to set up an appointment today.