You may or may not have heard of it, but either way, it's definitely something we need to talk more about.

Premenstrual Dysphoric Disorder (PMDD) - a more severe, often debilitating extension of PMS - is a real mofo of a thing that can seriously affect your relationships, work and day-to-day life. It's often goes undiagnosed (and therefore untreated) and whilst there's no 'cure', there are ways to manage the symptoms.

Here's what you need to know about PMDD; including how it differs from PMS, what to look out for and how to treat or manage it.

WHAT IS PMDD?

PMDD, a.k.a. Premenstrual Dysphoric Disorder - is a more severe form of Premenstrual Syndrome (PMS) whereby the symptoms are debilitating and can severely affect your daily life, work and relationships. It is considered more of a 'mood' disorder, in that those who suffer from it will experience more extreme emotional and behavioural symptoms (more on that below).

Whilst the cause of PMDD isn't really known, it's said to be influenced by the naturally occuring hormonal changes in estrogen and progesterone levels during the menstrual cycle.

WHO IS AFFECTED?

Whilst anyone who experiences a menstrual period can be affected by PMDD, those with a personal or family history of PMDD, depression, or other mood related disorders are more likely to be affected.

Statistically speaking, PMDD is said to affect around 3 - 8% of 'women' (this particular study seems gender specific) in their reproductive years.

WHAT ARE THE SIGNS OR SYMPTOMS OF PMDD?

"PMDD symptoms are split into two main categories: affective and behavioural/cognitive symptoms", explains Sydney based OBGYN and regular Moxie contributor, Dr. Nicole Stamatopoulos. "You must have 5 out of 11 of these symptoms to confirm a diagnosis".

Affective symptoms are:

• Feelings of sudden sadness, tearfulness or sensitivity to rejection
• Irritability or anger
• Depressed mood or feelings of hopelessness
• Anxiety

Behavioural/cognitive symptoms are:

• Decreased interest in regular daily activities
• Difficulty concentrating
• Fatigue
• Change in appetite
• Insomnia or hypersomnia
• Feelind overwhelmed

There are also physical symptoms like: breast tenderness, headache, joint or muscle pain, bloating and weight gain.

WHEN DO PMDD SYMPTOMS START?

Much like PMS, symptoms of PMDD usually start about a week before your period, and will continue for the first few days of the bleeding phase of your cycle.

HOW IS PMDD DIFFERENT FROM PMS?

There's quite a bit of overlap between the symptoms of PMS and PMDD and so it may be difficult to decipher between the two. Symptoms of both include:

• Anxiety or depression
• Irritability and mood swings
• Abdominal bloating
• Breast tenderness
• Headaches
• Fatigue

Though with PMDD, these symptoms might be more intense and you'll likely experience more severe behavioural/cognitive symptoms as listed earlier, like extreme moodiness or irritability, severe bouts of depression or even high levels of anxiety.

(Extra reading: Catch up on our interview with Naturopath Georgie Collinson about how anxiety can affect your period).

PMDD vs. DEPRESSION

With one of the main symptoms of PMDD being depression, it can be difficult to know if these feelings are related to our menstrual cycle or not.

The tell-tale sign is usually in the length of time you experience depressive feelings. With PMDD (and simiarly, PMS), feelings of depression will usually subside when your period starts. Whereas with depression, they do not, and will continue beyond your period (and perhaps indefinitely). 

If you're feeling depressed, you may initially opt to speak to your Doctor, but there are also support services out there to assist (within Australia), like:

Lifeline  13 11 44

Beyond Blue  1300 22 4636

Kids helpline (for those aged 5 - 25)  1800 55 1800

HOW TO GET DIAGNOSED WITH PMDD

Dr. Stamatopoulos recommends tracking your cycle to help uncover any synergies between your mental health and your cycle. "You should track your symptoms for at least two menstrual cycles, which will help your Doctor confirm a diagnosis", she says. "PMDD is dianogsed when someone has at least 5 out of 11 specific symptoms that occur the week before the onset of your period and improve within a few days of the period starting. Symtpoms are minimal or gone post menses", she adds.

Are you experiencing some of the symptoms we mentioned above, particularly the behavioural ones? When do these symptoms start and stop (if at all)? How strongly would you rate each symptom from 1 - 10, with 10 being extreme/severe?

Any information you can gather and then take to your Doctor will assist them in making a diagnosis of PMDD (or otherwise), and also in recommending the right treatment plan for you. Your Doc will likely ask you about your lifestyle and family history, too, and may conduct a physical exam (including blood tests) to rule out any other issues.

TREATMENTS FOR PMDD

"There are hormonal and non-hormonal options available", says Dr. Stamatopoulos. "The hormonal options are to try and stop the large fluctuations in hormones that exxacerbate symptoms, and inlcude the contraceptive pill, progesterone only pill, Implanon, Mirena and Nuvaring. I've treated women with PMDD effectively with Mirena", she adds.

And the non-hormonal options? Accroding to Dr. Stamatopoulos, "these target the chemical brain pathways associated with depressive symptoms and include low doses of Selective Serotonin Reuptake Inhibitors".

"The most definitive treatement is removing the ovaries, but this is quite drastic as once you remove them, you obviously can't put them back!" says. Dr. Stamatopoulos."I'd trial the patient on medication first to see if symptoms improve before resorting to this". 

You may also opt for an over-the-counter type anti-inflammatory medication, which might help with the 'affective' symptoms, but behavioural symptoms may need further intervention. Check in with your Doc. 

HOW TO TREAT PMDD NATURALLY

Here are some alternatives that might be affective in helping you manage your PMDD symptoms:

• REDUCE STRESS. Remember to take time out and do what you need to do to keep stress and negativity to a minimum. This might mean finally saying goodbye to bad habits or toxic relationships. Put you first, Moxette.
• REST UP! Get plenty of (quality) sleep, have a power-nap if you feel you need it and say no to those plans if you're not feeling up to it.
• EAT REGULARLY, EAT WELL. Leafy greens, lean proteins and water are your friends. Eat small meals more regularly and reduce your intake of caffeine, sugars and salty foods, which can be inflammatory and add to the bloat/them sluggish feels.
• GET PHYSICAL. Moving your body releases endorphins, which are also known as natural pain-killers! Do whatever you feel you're up to, but we promise you'll feel better afterwards.
• ACUPUNCTURE. Helps to increase blood-flow around the body and aids in the healing process. 

WHO TO TALK TO ABOUT PMDD

You're never alone, Moxette. There are people who care about and want the best for you. Talk to trusted family and friends about what you're feeling, and don't be afraid to seek medical or clinical support - whether that's via a counsellor, psychologist or even your GP might be a good place to start and they can help guide you. If you're not satisfied with a medical diagnosis you receive, find another Doctor.

Everyone's experience with their period or conditions like PMDD will be different - there's no one-size-fits all treatment and so it's important to monitor your symptons over time, ask questions and seek help - don't setlle until you get the answers, treatment and care you deserve!

Photo by Max Ostrozhinskiy on Unsplash.