PMDD: are women’s periods making them mentally ill?
My day job is managing the marketing for a children’s psychiatric hospital; I take mental illness seriously. Depression, for example, is not a fleeting feeling of sadness, it’s a dark hole that can take every bit of someone’s ability and will to live normally. The last version of the Diagnostic and Statistical Manual, the DSM-5, lists for the first time Premenstrual Dysphoric Disorder (PMDD), sometimes described as “PMS on steroids,” as a distinct mental disorder. This new classification has raised serious concerns among some women who understandably fear the stigma and misrepresentation that can be associated with it. Yet such a prevalent condition must be recognized by the medical profession and properly classified so that it’s not neglected. Here is a quick overview of the disease and a breakthrough approach of treatment.
What is PMDD?
Premenstrual Dysphoric Disorder or PMDD is a unique health condition. The patient experiences extreme depression, irritability, anxiety or anger in the two weeks preceding menses. It is far more severe than the mood swings and general crankiness that women often experience as part of premenstrual syndrome (PMS). Women with PMDD cannot function in everyday life and are at risk of harming themselves or others during this period of hormonal imbalance.
The symptoms are all similar to those in PMS – but with markedly greater severity. If five or more of the following symptoms are experienced at least 4 days prior to menstruation, the possibility of PMDD should be investigated:
* Sudden disinterest in daily activities and relationships
* Overwhelming fatigue or low energy
* Extreme feelings of sadness or hopelessness, with possible suicidal thoughts
* Feelings of tension or uncontrollable anxiety/pain attacks
* Food cravings or binge eating
* Mood swings marked by periods of crying for no reason
* Persistent irritability or anger that affects personal relationships
* Trouble concentrating on simple tasks
* Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
* Sleeping too much or too little
A mysterious disease?
While several of the symptoms of PMDD look like those of severe depression, it is very different in that these symptoms come and go along the stages of the woman’s cycle. The patient will start experiencing them about 2 weeks before the first day of a her period and feel better when menses start.
Researchers are uncertain as to why the disorder occurs in some women but not others. There are a few theories that may explain why PMS escalates to PMDD, ranging from a progesterone deficiency to diminished serotonin activity triggered by the ovarian cycle. PMDD definitely falls in the general category of mental illness as defined by the American Psychiatric Association: “Mental illnesses are health conditions involving changes in thinking, emotion or behavior (or a combination of these).”
Psychiatrists are trained to treat a mental disease with medications targeting the brain chemistry of the patient, so that the symptoms of the disease can be lessened and the person regain a more normal life. Hence, treatment for PMDD often involves anti-depressant serotonin re-uptake inhibitors (SSRIs) and counseling. This route can be effective and is an option for women who experience PMDD, especially for those who are at risk of harming themselves. Always consult with your physician to find the appropriate treatment.
But there is more to the story.
Recently, some doctors are recognizing the hormonal factors and have called PMDD “a hormonal disorder with psychological expressions.” Because of the hormonal connection, researcher have attempted to treat PMDD with a variety of hormonal contraceptives designed to suppress the hormonal variation. While the idea seems logical, these attempts are inconclusive or come with serious side-effects.
A customized approach based on the cycle
In his groundbreaking research conducted over the past 30 years, Dr. Thomas Hilgers is pointing to a new way to effectively treat this condition. In his 2004 book Medical and Surgical Practice of NaproTECHNOLOGY, he reports conclusive research on the effectiveness of his approach. He presents a study where 37% of PMDD patients showed marked improvement and 43% a moderate improvement after a three-month long treatment.
The key to his approach is the use of fertility awareness based methods (FABMs) to chart and identify the actual changes in hormonal levels at different stages of the cycle. Ovulation time can vary a lot between patients and between cycles and this first step is critical to diagnose the cause of PMDD. FABMs allow a woman to observe and report the time when she ovulates based on her bio-markers such as cervical fluid secretion, change in temperature, or change in hormone levels using an LH monitor. This advanced technology to track cycles is widely available through networks of instructors throughout the US.
Using the information in the woman’s chart, which shows not only the beginning of her periods but the time when ovulation happened, blood work at different times allow the medical provider to know her levels of hormones and compare them to healthy patients’ levels. Normally, the hormone progesterone rises right after ovulation. In the study, on average, patients with PMDD showed a significantly lower level in the progesterone rise after ovulation.
Armed with this information, Dr. Hilgers designed a series of treatments aiming at increasing these levels at the critical time. Again, the hormonal support, which is administered using bio-identical hormones, must take into account the time of ovulation, which requires that the patient chart her cycles. Providing hormonal supplements at the wrong time simply won’t work and may make things worse.
The Creighton FetilityCare Networks offers a network of affiliate medical consultants trained in identifying and treating PMS/PMDD using the NaProTECHNOLOGY approach. FEMM is another organization that helps women based on a deeper understanding of their unique cycle, including a full basic hormonal panel, assessment of hormone levels and medical history in order to see if there is a chemical/hormonal component, and/or collaboration with counseling.
With the right medical attention, women with PMDD improve and often become able to continue activities of daily living during their premenstrual period. I fear that because the general public misunderstands such disorders and sometimes ridicules them, they are still shrouded with silence, and as a result many women who need help are not getting the support they need. We can’t close our eyes to the reality of PMDD for fear of stigma, but seek to really understand and treat it.