World Health Organization Validates Premenstrual Disorder as a Global Health Concern

BOSTON, MA, 14 June 2019 --  In a landmark decision, the World Health Organization (WHO) has added Premenstrual Dysphoric Disorder (PMDD) to the International Statistical Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11), validating PMDD as a medical diagnosis worldwide and confirming the growing scientific and medical understanding of this little known, debilitating and life-threatening condition.

This groundbreaking move gives PMDD its own ICD code (GA34.41), which will help drive diagnosis, treatment, reimbursement, and research. A staggering 60 million people globally, 1 in 20 people with menstrual cycles, suffer from PMDD, caused by an increased sensitivity to reproductive hormones during the luteal phase between ovulation and menstruation. This sensitivity leads to alterations in the brain chemicals and pathways that control mood and well-being. Symptoms include severe depression, mood swings, irritability or anxiety, and drastically increases the risk of suicidal behaviors. Appropriate diagnosis and treatment of PMDD are therefore important not only for reducing suffering but also for saving lives.

“This decision is a game changer for PMDD,” according to Sandi MacDonald, Board President of the International Association for Premenstrual Disorders (IAPMD).  “The WHO has officially classified PMDD as a true and diagnosable disorder, and differentiated it from the wide collection of premenstrual symptoms commonly known as PMS.”

Historically, PMDD has been studied and treated by both (1) nervous system (brain) experts (neuroscientists and psychiatrists) and (2) reproductive system experts (reproductive endocrinologists, obstetrician-gynecologists). This multi-specialty approach has been reinforced by PMDD’s ICD-11 cross-listing in multiple chapters; the chapter on mental, behavioral, and neurodevelopmental disorders, as well as the chapter on diseases of the genitourinary system (system of the reproductive organs and the urinary system). This will foster more effective collaboration between these specialties.

“Given that evidence-based treatment algorithms for PMDD require a broad set of clinical expertise and skills, it is becoming increasingly clear that multiple providers with different specialties are required to offer truly comprehensive care for PMDD,” according to Tory Eisenlohr-Moul, PhD, IAPMD Clinical Advisory Board Chair and Associate Director of Translational Research in Women’s Mental Health at the University of Illinois at Chicago.

“The IAPMD recommends that clinicians build collaborative, multidisciplinary treatment teams for PMDD patients in order to facilitate patient access to the full range of evidence-based treatments. It is our hope that the inclusion of PMDD in ICD-11 will facilitate greater collaboration among treatment providers of differing specialties,” added Eisenlohr-Moul.

The ICD is published by the WHO and used worldwide for morbidity and mortality statistics, reimbursement systems, and automated decision support in health care. In May 2019, member states agreed to adopt the ICD-11, to come into effect on 1 January 2022. The system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. Like the analogous DSM (which is limited to psychiatric disorders and almost exclusive to the United States), the ICD provides a common language that allows health professionals to compare and share health information across the globe.

The International Association for Premenstrual Disorders (IAPMD) is the leading voluntary health organization which aspires to create a world where people with Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME) can survive and thrive. Our mission is to inspire hope and end suffering in those affected by Premenstrual Disorders (PMDs) through peer support, education, research, and advocacy. What began as a collective of fellow suffers in 2013 has grown into a global movement accelerating the progress being made around the world.

The Voices of PMDD: Sharing our Struggles

Today we have a guest post from a woman who has taken what I think is the very healthy step of naming her PMDD.  Naming your PMDD helps to separate you from your disorder.  You are not your PMDD and that is what we all need to remember when PMDD strikes.  We are more than our PMDD, and better than our PMDD.

I call her Agatha. 

Some of you may have met her unknowingly. Her presence is noticed only by my few nearest and dearest...and even most of them don’t understand her. I’ve decided to talk about Agatha because I spend so much time as/with her, I am tired of trying to explain myself, or feel guilty, or desperately sad that things annoy me when they shouldn’t even make a shadow. 

Agatha is my PMDD...or who I am for up to two weeks out of the month. Yes...EVERY month. I have PMDD...Pre-Menstrual Dysphoric Disorder. Have you heard of PMT (or PMS if you’re American)?  Well, PMDD also has to do with the menstrual cycle, but is a million time worse. Maybe a billion...at least. After I have ovulated and the hormone levels change, so do I. I become someone that has taken me years to recognise, and more to understand. I describe it as having the ‘Dementor’s Kiss’; Harry Potter fans will of course understand the reference. For the rest of you, that is when all of the happiness you have ever felt, experienced, or hoped for, is sucked out of your soul, leaving you with no choice except to dwell on every bad thing that has ever happened to you...in the deepest pit of despair. 

I now understand it has got worse the older I get, because I have more experiences. So there’s more happy to be sucked away, and more pain to be left with. PMDD doesn’t just mess with your mind and soul, it likes to play with your body too. Any pre-existing conditions are highlighted and heightened...luckily for me, I have a back condition, so usually I am in considerable extra pain in the lead up to the bleed. I also get a barely-controllable eczema outbreak, and permanent, draining headaches. Then there’s being so tired, that I’m not sure if I’ve been to sleep. And I’m pretty positive that the world tricks me by deciding to speak a different language to me...because I haven’t got a clue how to distinguish between words, let alone decipher what they are saying. It’s all very confusing, and delays cause you to feel very silly; therefore, it’s better not to talk to anyone.

Ah...but wait! Why would anyone want to talk to you anyway? You are nothing, and nobody. Your past experiences have shown you that, right? There’s no hope for you, so stay put and don’t move, because nobody wants you. Your children can’t stand you, you’re so irritable, and their noise hurts your oversensitive ears. They also want you to come out of your dark, safe hole - they want food, they want to talk to you, but they are far too loud for you, and they would be better off without you...right? You’re lucky your back is screwed, and your muscles are aching in every area, because then you can’t drag your unwanted, pathetic self into the road for some juggernaut to put the world out of its misery, fed up of having to have your unworthy ass live in it....no one could possibly want you around, and you should probably top yourself to do them a favour. Everyone you know would have a greater life without you in it. 

The disillusionment of the world eats you up, the unfairness of “the system” has you physically aching for the world to end. You dislike your family, you don’t want to talk to your friends...and there is nothing but pain and despair.

And then one day, I wake up and something feels different. I have a harsh stomach cramp, but that’s nothing compared to the aches and pains of the previous week. I smile at my text messages, and I kiss my husband - it feels nice. Everything feels nice, and everything looks nice. I go to wake my children up with the biggest hugs and talk about upcoming plans for fun things. Oh wow, I also need sex. Like NOW. I want sex ALL the time (see, there is an up side to imbalanced hormones!) my mind and body are depraved instead of in pain. It feels good. And I wake up the next day feeling the same...and so on. I have a wonderful two weeks of coping with everything and having big smiles, and then something happens that will either irritate the crap out of me, or a loud noise hurts my ears, or I wake up and can’t move because of back pain...so I check the calendar - shit, it’s Agatha time. 

I gave the person I become a name, so I can fight myself, tell myself ‘it’s just Agatha, she’ll go soon, just hold on’. This is my most recent tool for the battle - after exhausting diets, exercise, herbal treatments, vitamins, finally giving in to my Doctor and attempting anti-depressants. Nothing works. So it’s me against her.

She’s getting stronger, and I can feel her on her way. I’m not ready, I’m still not over last month’s visit. I want to keep smiling...but no, time to batten down the hatches, because she will be here by the weekend; I will be forced to face every demon I have ever encountered, and I’m scared.

Can’t give up though, I have to keep fighting. I can now differentiate between who I am, and what is caused by her. It’s me against her....

.....c’mon then bitch.

PMDD: Suddenly it All Makes Sense

Now I know why!

I know why two weeks out of every month I am waiting to feel like myself again. I know why for two weeks I suddenly don’t give a crap about anything I was excited or cared about in the weeks before. I know why I feel contempt for everyone and everything when I recently felt so in love with it all. I know why I suddenly doubt my abilities and talents. I know why I isolate myself on certain days…when I just know I’m not going to be able to accomplish the simplest of tasks without getting irritated or downright angry. I know why I am afraid to schedule anything in advance, lest whatever I have to do falls on a day when I am incapable of behaving reasonably. I know why hateful thoughts become so insistent and pervasive despite the fact that just two weeks ago, I was 100% certain I had finally transcended them all. I know why I can’t stand to be touched, when just last week, I couldn’t get or give enough hugs. I know why I suddenly feel so disconnected from my friends, doubt their friendships, and suddenly want to walk out on my husband.

In my quest to understand, I’ve been given plenty of opinions. I’ve heard some labels, and some I even tried to make fit. But in the end, I knew they didn’t. I knew I wasn’t “bipolar”. I knew I wasn’t “borderline” or “mood disordered” (even though that’s still the involuntary category in which I’m pegged). I knew I wasn’t “just imagining things” either. Nor was it the whole story that I was “just hormonal”. Something inside me had changed in the last couple of years and something was happening throughout my menstrual cycle to make me feel like two completely different people. Only recently, it had gotten much worse.

The Fighting Bell Rings

In one corner: a woman full of radiance and quick to smile. She can be so full of love inside herself to the point of bursting. She is centered and enthusiastic, bright and cheerful, optimistic and strong. She’s not perfect, of course, but she’s so okay with that. She’s on top of her thoughts and more than willing to be alive. She is excited about projects and new ventures…even if they are challenging. Anything seems possible…anything reasonable, that is. (She isn’t about to jump off a building or into traffic.) She believes in an abundant universe and that she has something to offer the world. She enjoys the company of others and lives to laugh, create, and feel gratitude. She would never dream of hurting herself or anyone else. She may have bad days, but she recovers quickly.

In the opposite corner: a bedraggled, wild-haired psycho who has to apply every ounce of her will to not lash out…though she eventually does, usually by imploding on herself or exploding at those closest to her. She is the wily animal who shudders at her own hateful attitude as she mourns the loss of her other self. She is the one who simply CAN’T control anything. She is full of shame for her inability to control herself. After all, hasn’t she learned anything? She cannot forgive or forget. Everything is the end of the world. She stomps to feel she exists, yet the very force of her enraged feelings lifts her off the ground. There is no justice, no joy, no purpose, and no comfort to give or receive. All is bullshit. She isolates to protect herself and others from this “thing” that has overtaken her, but life pokes and prods all the same.

Eckhart Tolle, author of The Power of Now, talks about the pain body in his work which comes close to matching the insane being that shows up in my mirror every month. There’s also this idea in spiritual circles about embracing and integrating the shadow-self. I wholeheartedly agree with the importance of doing that. It’s powerful stuff, but I don’t think it is the whole story for me. Always favoring the holistic over the quick fix, I’ve been exposed to a lot of different teachings in my quest for well-being. But none of them have satisfied this itch under my skin that what I was dealing with wasn’t just some egoist resistance on my part, wasn’t just some weakness in my character, lack of awareness in my being, or deep wounding from childhood . In fact, I have LOADS of awareness and more strength than a lot of people. So, something wasn’t jiving.

Something else is going on. Whatever it is, this pain body feels universal…not personal…yet it attacks in a personal way for sure. It isn’t a permanent state of being but it is one that, when I’m in it, feels like the only state of being I will ever know. Sometimes, it turns on a dime…a cruel word, a task gone wrong, a frustration or irritation that sends ever-widening ripples of tension out into my environment…but, and here’s the key, only at certain times within my cycle.

What I’ve discovered is the term PMDD or Premenstrual Dysphoric Disorder. Though I don’t agree with a lot of the psychological/medical establishment bullshit (excuse my language…but let’s call it what it is) behind it, it has come closer than anything else I’ve ever encountered to explain what’s been happening increasingly so with me since going through a period of intense and prolonged stress.

I feel like I have to start by saying that I’m not interested in excuses for bad behavior. I’m not looking for a convenient explanation for bouts of anger or anxiety or anything else. I’m not trying to protect my identity as a “got my act together--no problems here” person, nor am I holding my shadow aspects in a closet of denial. I’m not interested in using the label of PMDD to explain away or justify crazy-making, just as I’ve never been interested in the label of “depression” to explain away unexamined pain and the absolutely natural waves of ups and downs that society would rather call a disease than a sign of being human in the world in which we live. What interests me about PMDD is that elements of it actually fit and explains myself to myself.  What fascinates me is that there are other women who feel like I do…that it is a real phenomenon to be examined and explored. It is a real phenomenon to be healed.

I’ve joined a couple of online PMDD groups, and what I’m noticing is that a lot of women feel they have no choice but to treat PMDD with very toxic antidepressants and hormone-related treatments that further disturb the delicate balance of the body. Some even decide to remove a part of their bodies, having hysterectomies, and are overjoyed with the results. I know many women get absolutely ill with vomiting. Why is the newly established “disorder” which was recognized in 2013 seem to be increasingly prevalent? I have my own theories circling around my head…the poisoning of our food supply perhaps or our increasing exposure to radiation and toxins. Who knows?

For me, it is mostly a mood challenge though I also get headaches, stomach aches, sleep disturbance, and other physical manifestations. Nothing like vomiting, thankfully. I feel incredibly blessed by and grateful for the management tools I’ve found that are side-effect free and have a great deal of sympathy for those who are buying into the system of big pharma (whose sole interest is to get everyone on their drugs regardless of whether it actually helps or even does more harm than good) and a patriarchal medical system (with a track-record of locking women away for their complaints). We can be products of the system that would call us “mentally disordered” offering us only what they deem as the answer or we can access inner qualities we can cultivate to cope and turn to more natural therapies until we discover what combination works for us. I know what my choice will always be. And that means that sometimes, I choose to live with a very difficult, very challenging state of being with very little outside assistance at my disposal. So be it.

Not just regarding treatment, PMDD is a hot topic of debate. In addition to being controversial in the medical community, there is, as with all conditions, a lot of general ignorance around PMDD. As I mentioned, it’s only been acknowledged since 2013. Right away, people assume it is PMS with a different name or an excuse for why a woman suddenly gets bitchy, tired or crampy. Or they draw other ill-informed conclusions. One woman made the mistake of sharing her condition with her employer to be told they feared she posed a threat to either herself or coworkers at work. I suspect there are people in their employ at far greater risk of flying off the handle, the ones they’d least suspect. Others are told, even by well-meaning friends, that it is all in the head and are told to chill out or get over it or try some quick fix. Clearly, those who don’t experience it are not in a position to offer advice!

Here’s the thing about PMDD. We may think about bludgeoning judgmental, self-righteous ignoramuses who think they know all the answers, but we tend not to act on it. Good thing, because there are plenty of them around.

Just as I have been (unprofessionally) mislabeled before discovering what is known as PMDD, I am sure there are women ascribing their behavior to PMDD when it truly belongs in another camp altogether. Supposedly, 40% of women who seek treatment for PMDD may have either what is known as PME (premenstrual exacerbation) or even an underlying mood disorder such as bipolar. It’s complicated. Of course, the professionals will continue to debate if any of this is real or not, some kind of anti-female rhetoric or not, or whether it is a mental disorder or not. This just muddies the waters, but what’s to be done? Human beings are intricate and unknowable and this “dis-ease” is extremely complicated because there are so many variables! In the meantime, there are those of us who live the spectrum. There are those of us who know.

Speaking of the spectrum…

There is PMS, the catchall that pertains to the mild, acute fluctuations of mood, irritability, fatigue, appetite changes, and cramping that affect 30 to 80% of menstruating women. It may be uncomfortable, but it is not generally debilitating.

There is PME. This is when a condition from which a woman suffers, such as asthma or an eating disorder, is worsened during PMS. So, PMS disappears after one’s period whereas PME symptoms merely improve.

Now there is PMDD which affects 3-9% of menstruating women. (With a female population of over 3 billion on the planet, 3-9% of those with periods is no small number!) With PMDD, the symptoms associated with PMS become debilitating and can include: depression or hopelessness, anxiousness, irritability, low energy, lack of interest, sleep and focus disturbance, loss of control and feelings of overwhelm, and suicidal thoughts. These symptoms tend to intensify as a woman nears her period and finally begin to abate a few days into her period. Women with PMDD generally feel themselves again for 7 – 10 days after their menses before entering the cycle again.

I’m not crazy about another label…another diagnosis…especially one categorized as a depressive disorder which, to me, shows very little understanding of the scope of symptoms different women have. I’m not crazy about listening to “experts” tell me about myself and never have been. What I am interested in is knowing my own truth for myself, suffering less, finding ways to cope and relate, and living as fully as I can. And I want to help other women reeling with this monthly curse and feeling that they are robbed of half of their lives to do the same.

Do I believe in PMDD? Not as boxed-in psychological babble and checklists, certainly. I’ll never see a doctor for it myself. But it is a condition with which I resonate with unquestionable certainty. I’ve charted my cycles. I know when “the shift” is about to occur. I know when it is over. I know it is linked to my cycle. I know the changes I feel are described by other women who think they have PMDD, too. I know the challenges such changes bring and the impact they have on my life. I know my perspective goes out the window. I know some months are worse than others. And I totally relate to the increasing amplification of symptoms as I near my period and that feeling of complete and utter relief when suddenly the sun is shining again a day into it.

Maybe we need another word for it…one not bound up with so much baloney…one immune to the twisted machinations of men who hate women and women who hate themselves. I don’t know. Here’s what I do know: this is my experience. Maybe it won’t be mine in two years. Maybe it wasn’t mine two year ago. But it is mine now. Bravely facing that self and being open about it with others going through the same experience is crucial. There is power in numbers, and we’ll learn more by exploring this together. If nothing else, maybe the diagnosis of PMDD will simply prove to be a means for women to talk about what being alive as a women today is like for them. That itself is a relief.

Liana's note:  The above guest post was written by the blogger Cheekyminx. With her permission, several of her posts about PMDD are featured on this blog. In the meantime, to find out more about her work as a PMDD Advocate, please visit her Facebook page, PMDD Life Support. 

May is Mental Health Month - A Primer on PMDD

The following guest post was written by the blogger Cheekyminx. With her permission, several of her posts about PMDD are being featured on this blog. To find out more about her work as a PMDD Advocate, please visit her Facebook page, PMDD Life Support.

Many women the world over experience the usual discomforts associated with the premenstrual cycle. PMS is a well-known condition that often includes irritability, bloating, and physical pain. But if you feel like PMS takes you out of commission every month, there may be more to it for you. Could you be one of the growing numbers of women who realize they are suffering from Premenstrual Dysphoric Disorder, or PMDD? What many women, and indeed many doctors, do not know is that in 2013, PMDD was officially recognized as a mood disorder (this classification will have to do for now) experienced by about 10% of all women who menstruate.

Now word is getting out. So how do women who have PMDD discover they have it? PMDD is caused by a sensitivity to normal hormone fluctuations rather than a hormonal imbalance, and getting tested for hormone levels usually reveals nothing. Many women discover it when they are at their wit’s end, having tried birth control, antidepressants, and other treatments to target symptoms they often think are the result of something else…like bipolar disorder or depression. In fact, many women with PMDD report not only PMS-like symptoms that are extreme and debilitating, but also much more dramatic and difficult-to-manage changes in mood and thought patterns, often leading to misdiagnosis. But intuitively, they know there’s something about their monthly cycle that seems to be playing a role, so they begin to chart their symptoms.

These symptoms are numerous and vary from person to person but generally involve anxiety, increasing irritability, hypersensitivity of the senses, depression, rage and other uncontrollable emotions. Thoughts can become insistent and feel “uncharacteristic” to the person having them. It is as though the mind becomes polluted, distorting everything. PMDD also seems to exacerbate underlying medical conditions, making it unique to every woman and can include dizziness, sluggishness, bloating, heavy bleeding, and sore muscles. But by and large, it is the increasing loss of patience and intensifying irrationality that makes PMDD such a nightmare, not only for the women, but for the people they love.

In fact, many find that during the 10-15 days of their hormonal sensitivity, they lose interest in their partners…not just sexually, but often to the extent of detesting them altogether. Some report regularly breaking up with their partners on a monthly basis. This Jekyll and Hyde transformation wrecks havoc on relationships of all kinds, not just romantic ones. It’s difficult for mothers to parent and for employees to continue with duties as usual. Overwhelmed by fatigue, cravings, paranoia, or even suicidal thoughts, normal life remains out of reach until the sensitivity ends, usually with the onset of menses–though there is debate the sensitivity fluctuates for some women at other times in their cycle. What’s important to realize is that the symptoms do disappear, sometimes instantaneously, whether it is the day the menstrual cycle starts or several days later. And suddenly, things are back to normal…but often leaving a great deal of destruction behind. In fact, women with PMDD often feel as though they spend two or more weeks a month in hell and the other two or less making up for it.

Think you might have PMDD? Here’s what you’ll want to do:

1. Start by paying attention to your cycle and taking notes. Get yourself a pocket calendar or use and app like iPeriod or PMS Tracker. Then start keeping track. When do symptoms hit? When do they stop? What are the main symptoms and to what degree are they experienced? Do they progressively get worse? Think not just of physical symptoms. Consider your emotional and mental states as well. Are you more prone to tears or anxiety? Is it more difficult to think positively? Have others commented about a change in your mood?

2. Take several months of your notes with you to your doctor if you decide to take a Western approach. Explain that you think you may have PMDD. If he or she dismisses you, find another doctor–one who will help you determine whether or not you have it, explain your options (they aren’t all that great at the moment and there is no known cure), and work with you to help you cope.

3. Educate yourself and find additional support. As a relatively new disorder, there is still much to be discussed and researched about PMDD. Read up on it online and talk to others who have it. Women who realize they have a condition with a name to it are usually very relieved when they realize they are not alone…and not crazy! Facebook has several groups, both open and closed, including a support group for family members of PMDD sufferers that offer insight, coping strategies, the latest science, and a safe place to vent.

If you do indeed have PMDD, now that you know, you can give yourself the support you need to get through it. It may call for changes in your diet, supplements, exercise and meditation, or even medication. And if you don’t have it? Chances are you know someone who does, and she might not realize what it is. So share what you’ve learned with others and help spread the word about PMDD.

Differences Between PMDD and Bipolar Disorder

The following is a guest post inspired by fellow PMDD advocate Danielle Lasher Bosley, who answers countless questions in Facebook groups regarding what she's learned about PMDD.  Today's topic is about the differences between bipolar disorder and PMDD, which are commonly confused in the medical arena.  Welcome, Danielle!
I've had a few women message me lately about the tangled web of bipolar disorder and PMDD and how to tell the difference between them. This is a question that pops up more and more. And the answer is tricky, but I'm going to try to address it since it keeps coming up.
One thing I've noticed is most women who ask me about this do so privately. So many seem ashamed over the idea they could have bipolar disorder (which affects up to 3% of the population). I get it. Having PMDD - an autoimmune hormonal issue - seems a lot less stigmatized than saying you have a well-known mental health disorder people make fun of and mock all the time. So yes, I get it.
Buuuut... The longer you go treating one disorder (like PMDD) when you may not even have it and ignore the other (like bipolar), the worse it gets.  Liana adds: The reverse is also true—you could be taking medications for bipolar disorder when you actually have PMDD. Either way, The treatment plans and medications are not the same. Something to think about.
So... The diagnostic criteria for PMDD and bipolar disorder are different. There are different types of bipolar, too. I'm not gonna get into all of that right now. What I will say is - in the majority of cases with bipolar, there is some level of mania. Yes, there is one type that doesn't have mania. There is also hypomania which is milder. These cases are not the majority of bipolar cases. Most will have mania. Bipolar disorder also brings with it certain typical behaviors: reckless behaviors like frequent sexual partners and impulsive spending. These are not typical of PMDD. Do they exist with PMDD? Sure, they can because we are all different and have differing personalities, but as a whole, it's not a commonly recognized symptom like it is with bipolar.  Liana adds: PMDD impulse control issues generally have to do with mood swings and saying things we don't mean. That doesn't mean we don't indulge in a little retail therapy now and then, but not to the scale of shopping sprees during manic episodes of bipolar.
Most importantly: PMDD doesn't happen outside the luteal phase (the last two weeks of your menstrual cycle). Yes, stress and surprises and emotional upset are still hard for a woman with PMDD to handle. But the depressive lows or extreme highs will not suddenly hit you on Day 8 of your cycle. That's not PMDD.
Now, there is also PME, which throws many with bipolar disorder off track and onto PMDD. Women with PME experience prominent symptoms in their luteal phase because the fluctuating hormones worsen the underlying bipolar disorder. But the difference is that bipolar symptoms are still present outside of the luteal phase. Bipolar disorder is not predictable like PMDD symptoms are and with bipolar disorder it's not happening during the same timeframe month to month.

With bipolar disorder... your depressive state may lead to suicidal thoughts that change over to feelings of euphoria  and endless energy. These extreme mood swings can occur more frequently – such as every week – or show up more sporadically – maybe just twice a year. There is also no defined pattern to the mood swings. One does not always occur before the other – and the length of time you are in one state or the other varies as well... 

Also, and this is the most important part: if you don't have physical symptoms, it's very likely not PMDD. The diagnostic criteria for PMDD is used to emphasize this better. Since it was tweaked in 2013, we are seeing more women with bipolar disorder being misdiagnosed or self-diagnosing with PMDD. Traditionally, the most common physical symptoms of PMDD are extreme bloating, an all over heaviness, joint and muscle aching, acne, lethargy and fatigue, weight gain, and food cravings... And most with PMDD have more than one or two of these physical symptoms. If you're dealing mostly with mild mood changes and the physical stuff is more along the lines of PMS, the issue may actually be bipolar with PMS, not PMDD.
Substance abuse (whether it's pills and needles or you're the woman who "needs" wine every day) is also far more common in women with bipolar disorder than PMDD.
Danielle sums up: This is how I differentiate between bipolar and PMDD. You don't have to agree, but I think the differences need to be mentioned and that women who suffer with either PMDD or bipolar disorder need to recognize what exactly they have, own it, and get the help they need. As we well know, doctors haven't been the most helpful in this regard over the years. So we need to be our own best advocate. We need to be  honest with ourselves about what's going on.  Liana chimes in: I agree.  We need to do our own research.  With just a little effort, you *can* figure out the difference for yourself.  The tools are available and the information is out there.  And we deserve better than to spend years taking the wrong medication for something we don't have.
As always, get your hormones and thyroid tested annually (if only to find out what you don't have). Chart your cycles.  It's the best way to determine whether you have PMDD or not.
But most of all: Don't give up. ❤ The answer that is right for you is out there somewhere.

Is it PMDD or Pre Menstrual Exacerbation?

I was wrong.  In my last post, I thought I was experiencing an episode of PMDD.  I felt like I had an iron band around my head and it pounded all day long.  It had been going on for four days with no relief.  Turned out, though, it was my allergies acting up. 

About 15 years ago, I started having sinus and breathing problems during the changing of the seasons.  For a few years I had a prescription I would dutifully take for 30 days each spring and fall.  Gradually, I switched to homeopathic remedies.  Then, as I specifically began to concentrate on my diet and nutritional needs, the need for even that went away.  But the allergy medication (bought on sale, as it was by now available over the counter) remained in the medicine cabinet, unused except for when nothing else would work.

So the other day, with my head pounding as it had been for days, I opened the medicine cabinet for something else, and all of a sudden the allergy medication was front and center in my vision.  It's always been in the same spot, I just haven't paid attention to it in a while.

But that day it practically jumped out at me.  Since I practice awareness, I thought, hmmm....you know, it *is* allergy season...maybe that's my problem. 

I took one and my headache cleared right up.  I took one for the next five days, until I ran out, and haven't had a problem again until...this month.

Imagine that.  Is it a coincidence or what?

It's *or what*. What's happening is called pre-menstrual exacerbation (PME) of an underlying condition.  That's when your body might be able to handle (insert condition here) during the rest of the month --  but during the week prior to your menses, it can't, and you have breakthrough symptoms of whatever your underlying condition is. 

When this happens, many of us seek treatment for the underlying condition, not realizing its connection to our menstrual cycle.  When the symptoms ease off, we feel the medication we are now (quite often unnecessarily) taking daily has solved the problem—until the next time around.  At this bewildering and frustrating point, dosages are increased, medications are changed, or we simply give up looking for help and try to cope on our own because our doctors don’t know what else to do for us.

So here's a primer on (just some!) Conditions That Can Be Exacerbated During Episodes of PMDD:

Acne                      

Allergies

Arthritis

Asthma

Bipolar Disorder

Blood Sugar Problems

Chronic Fatigue Syndrome

Depression

Dysthmic Disorder

Eating Disorders

Endometriosis

Fibromyalgia

Headaches

Hypoglycemia

Insulin Resistance

Irritable Bowel Syndrome

Joint Pain

Lupus

Migraines

Panic Disorder

Peri-menopause

Personality Disorders

Seizure Disorders

Somatoform Disorders

Thyroid Disorders

A Special Word About Bipolar Disorder

            The depression in PMDD is similar to that experienced in Bipolar Disorder, but PMDD does not include the manic phases of Bipolar Disorder.  Many, many, women have been misdiagnosed as bipolar, and have been put on a wide array of bipolar medications, one after the other, to no effect, when the real culprit was PMDD.

            Manic Episodes

            This can not be stated enough.  There are no manic episodes with PMDD.  That’s one thing that distinguishes it from Bipolar Disorder.  With PMDD you have time periods when you feel good, and time periods when you feel miserable, overwhelmed, out of control, snappish, sluggish, and/or depressed.  With PMDD, you may spend a lot of time in what may look or *feel* like a manic frenzy, trying to catch up on all the things you weren’t able to do during a PMDD episode, but this is more a function of your personality than genuine mania.  Genuine mania can include any of the following:

Euphoria

Extreme optimism

Inflated self-esteem

Poor judgment

Rapid speech

Racing thoughts

Aggressive behavior

Agitation

Increased physical activity

Risky behavior

Spending sprees

Increased drive to perform or achieve goals

Increased sexual drive

Decreased need for sleep

Tendency to be easily distracted

Inability to concentrate

Drug abuse

An Additional Word About Major Depressive Disorder

            The only difference between PMDD and clinical depression is that the PMDD woman’s episode of depression will end with the onset of her period.  This, and the fact that a PMDD episode can last up to two weeks, the essential feature of a Major Depressive Episode, is why so many women with PMDD are misdiagnosed with Major Depressive Disorder.  Also, depression is most prevalent in women, period, which further confuses the issue.

How MDD predisposes women toward PMDD and vice versa

            Just as the physiological origin of Major Depressive Disorder resides in an imbalance in the neurotransmitters in a woman’s brain, our reproductive hormones (estrogen, progesterone, testosterone) influence those same neurotransmitters, including dopamine, serotonin, and norepinephrene.  This can therefore increase the risk of depression in women during any time of life related to reproductive hormonal fluctuations, such as the menstrual cycle, (PMS and PMDD), the peri- and post-partum period, peri-menopause, and menopause.  Also, women who suffer from Seasonal Affective Disorder (SAD) are more likely to suffer from PMDD and vice versa.  There may be a genetic link between SAD, PMDD, and PMS.

PMDD and Dysthmic Disorder

            It is not clear that Dysthmic Disorder (previously known as Dysthmia) is really separate from Major Depressive Disorder. It may only differ in terms of severity and the course of the illness.  Therefore, Dysthmic Disorder, too, can be confused with PMDD.  But only if you ignore the fact that Dysthmic Disorder can only be diagnosed when you have had depressive symptoms for two straight years without a break.  Unfortunately, many doctors do.

Peri-menopause and Menopause  --  Confusion City

            When a woman enters peri-menopause, her reproductive hormones begin to fluctuate wildly from month to month as their levels start to decline as part of her natural aging process.  Still, to a woman experiencing these wild fluctuations, it’s as if the body doesn’t know which way to go, and a fierce battle to maintain the status quo is being waged inside her hormonally, while at the same time she's trying to hold on to (what's left of) her shape and mental abilities.  If she’s been able to manage her PMDD episodes up to this point, the added instability in her hormones can bring on a double whammy of symptoms, leading to increased episodes of :

Depression

Tension, Anxiety

Lability

Irritability, Anger

Foggy Thinking

Lethargy, Fatigue

Overeating and Food Cravings

Hypersomnia or Insomnia

Physical Aches and Pains

Bloating and Weight Gain

            Considering that during peri-menopause a woman is still having some periods, the sheer unpredictability of when her period will come—or won’t—combined with the increased hormonal activity in her body, and the effects of these wildly fluctuating hormones on her brain, can lead her to think she’s truly going insane. 

 

The Bottom Line  --  PMDD Makes Everything Worse

            The bottom line is if you have PMDD, whatever you're feeling will get worse pre-menstrually, including any underlying depressive or anxiety disorders, and/or the naturally occurring fluctuations in your perimenopausal hormones.  Even reactions to food and drink and drugs will intensify during an episode of PMDD.  This includes cravings and allergic reactions.

So the next time you feel an upsurge of symptoms, no matter what they are, take the time to stop and ask yourself...is it PMDD or PME?

The answer can make all the difference in which path you take to treatment.