Disclaimer: The following article has been researched and written by Emasitsa. Neither Emasitsa nor any other member of bcdx.org are medically trained, so this information cannot be verified or relied upon as accurate. If you need support with any of the topics raised in this article, please contact a fully qualified medical practitioner.

Women and those AFAB have been plagued with numerous symptoms of varying degrees because of their menstrual cycle. From migraines, cravings, cramps from hell, lack of appetite, nausea, mood swings, breast tenderness, etc. Mostly we attribute it to PMS, ride the wave of pain/ discomfort and daydream about having our ovaries removed.


More like angry mini ninjas inside you trying to kill you.

I had my first period at 12, I still remember the discomfort from the cramps. Unfortunately, all subsequent experiences were a downhill from there. I am one of the unlucky ones who, more often than not, have to take breaks from school/ work to ride out the first day or two of periods. Because of the physical nightmare that is my symptoms, I barely noticed the psychological impact of my monthly cycle. While doing research on mood disorders, I recently learnt about Premenstrual dysphoric disorder (PMDD). It affects about 1 in 20 of the population, but the research on it is sparse at best.

PMDD 101 – my findings

Premenstrual dysphoric disorder (PMDD) is a cyclical, hormone-based mood disorder. It is a severe, sometimes disabling extension of premenstrual syndrome (PMS).

PMDD is a condition similar to PMS in that it also happens in the week or two before your period starts as hormone levels begin to fall after ovulation.  While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance. PMDD is a severe negative reaction to the natural rise and fall of estrogen and progesterone. It is a disorder in the brain’s ability to adapt to hormone changes.

Although PMS and PMDD both have physical and emotional symptoms, PMDD causes more severe symptoms than PMS, including severe depression, irritability, and tension that can disrupt daily life and damage relationships. Symptoms can worsen over time and or around reproductive events such as the first menstrual cycle, pregnancy, birth, miscarriage, and perimenopause.

In both PMDD and PMS, symptoms usually begin 7 to 10 days before your period starts and continue for the first few days of your period. Both may cause bloating, breast tenderness, fatigue, and changes in sleep and eating habits. In PMDD, however at least five symptoms must be present in the final week before the onset of menses:

  • Lasting irritability or anger that may affect other people
  • Feelings of sadness or despair, or even thoughts of suicide
  • Feelings of tension or anxiety
  • Panic attacks
  • Extreme mood swings or crying often

One (or more) of the following symptoms must additionally be present,

  • Lack of interest in daily activities and relationships
  • Trouble thinking or focusing
  • Tiredness or low energy
  • Food cravings or binge eating
  • Trouble sleeping
  • Feeling out of control
  • Physical symptoms, such as cramps, bloating, breast tenderness, headaches, and joint or muscle pain.

The cause of PMDD isn’t clear. Underlying depression and anxiety are common in both PMS and PMDD, so it’s possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders.

Menstrual blood is the only source of blood that is not traumatically induced. Yet in modern society, this is the most hidden blood, the one so rarely spoken of and almost never seen, except privately by women.  – Judy Grahn

Treatment of PMDD is directed at preventing or minimizing symptoms and may include painkillers, antidepressants, birth control, nutritional supplements, herbal remedies, diet & lifestyle changes including stress management.

Bipolar Disorder v. PMDD

Almost all PMDD symptoms are identical to those experienced by people with anxiety disorders, major depression, post-traumatic stress disorder, bipolar disorder, borderline personality disorder, among other disorders. Since PMDD is caused by a hormonal imbalance, and hormones are made up of chemicals, PMDD is technically caused by a chemical imbalance — just like any other mood disorder.

PMDD is often times misdiagnosed as BP. There are many similarities between bipolar disorder and PMDD; they have similar symptoms and are both disorders characterized by extreme moods and cycling between different emotional states. The two disorders can often be differentiated by when the symptoms occur. In PMDD, symptoms only appear within a certain window of the menstrual cycle, triggered by ovulation.  In contrast, the mood swings associated with bipolar disorder are not necessarily linked to any regular body cycle.

Even with adequate BD treatment, some people can find that their symptoms worsen around their menstrual cycle. This is known as Premenstrual Exacerbation (PME). One may experience either PMDD or BP or both. Sometimes PMDD and bipolar disorder can co-exist, so it is possible to be diagnosed with both, with or without PME symptoms. The lack of specificity of it can be frustrating, but it is worth looking into for proper management of either illness.

It could be that around ovulation and the beginning of your period, you have felt a lack of control of your mood or been accused of being overly emotional, too sensitive, or unstable. With the guidance of your therapist, PMDD diagnosis can be done through tracking of psychological and emotional changes during the menstrual cycle.

Unfortunately, there is no treatment exclusive to PMDD although some expert clinicians have recommended the combined use of bipolar medications (mood stabilizers or antipsychotics) and hormone stabilization treatments in people who experience both bipolar and hormone sensitivity. It is regrettable that like many illnesses unique to women and AFAB individuals, not a lot of studies have been done on PMDD. But hopefully, through raising awareness and creating communities we can bridge the gap.

There is no power for change greater than a community discovering what it cares about – Margaret J. Wheatley

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