Recently, Indian social activist Shehla Rashid wrote a very personal note on Twitter, where she disclosed that she had been having suicidal thoughts over the last two weeks.
She described that her suicidal tendencies grew so much that one night she began searching for ways online to end her life. The following morning, she had her period. Perplexed, Shehla ran a google search “PMS+suicide” and discovered the medical condition called ‘premenstrual dysphoric disorder’ (PMDD).
PMDD is a severe form of physical and emotional stress that occurs before one’s period. It can cause extreme bouts of anxiety, severe depression, or sometimes anger and rage. Medically speaking, this condition is caused due to a heightened sensitivity to one’s reproductive hormones causing changes to brain chemicals that control the general mood and behavior.
However, PMDD is often diagnosed as pre-menstrual syndrome (PMS), making those who have it suffer through extreme emotions in the weeks before their period. PMDD begins nearly 10 days before menstruation, during which someone can feel completely engulfed by extreme stress, and lapses the day period begins.
Most of us undergo PMS, which involves symptoms like mood swings, fatigue, headache, insomnia, anxiety and often unexplainable thoughts of sadness, and devise our own ways to handle it. While some prefer hot water bags and painkillers, for some a hot cup of green tea along or dark chocolate works.
Whatever the preference, PMS is a well-known and well-discussed condition.
PMDD, on the other hand, largely goes undiagnosed or wrongly diagnosed as PMS. According to studies, nearly 5% of people who menstruate have PMDD, with the number being 3 million in the US and almost 10 million in India.
Owing to its worrying psychological symptoms, PMDD in 2013, was termed as a depressive disorder in the fifth edition of the Diagnostic And Statistical Manual of Mood Disorders, released by the American Psychiatric Association.
So why is PMDD so unheard of?
The primary cause is that those who aren’t cis men – so cis women, trans people, and nonbinary people – are seldom taken seriously in a medical context. Consider the stereotype that people are always moody and irrational when they’re menstruating. The extent of normalizing emotional stress is such that we often ignore the serious indications of underlying medical conditions for years. PMDD is one such example. Gynecologists and medical practitioners alike will often misdiagnose PMDD as PMS, further making the treatment difficult.
So what can be done to understand and manage PMDD?
The most important way is the correct diagnosis.
If you struggle with severe symptoms before your period, please consult a general practitioner or your gynecologist. They might suggest a blood test to determine your hormone levels. This would be beneficial in prescribing the right medication to manage hormonal imbalance.
The International Association For Premenstrual Disorders, has a PMDD Self-Screening Quiz that can be taken 1-2 weeks prior to one’s period. Using this test can enable you to distill your thoughts and have greater awareness around your own sexual health.
If diagnosed with PMDD, developing healthier habits can go a long way in improving one’s mental and physical health. These include: regular exercise, reducing caffeine and alcohol intake, practicing mindfulness and meditation, and incorporating healthy dietary supplements.
However, the most important manner to build more awareness around PMDD is to listen to menstruating people when they express concerns around reproductive health and respect what they feel. It is hard enough for people to be open about their sexual health and its issues, but it becomes harder when their concerns are brushed aside as mood swings.
A larger platform needs to be built in a manner that families, communities and professional spaces can understand PMDD and help those with the condition.
PMDD will only stop being misdiagnosed as PMS when that two-way communication is built.