By: Ari Rojas
Art by: Milanne Berg
In popular media and television, the term “PMS,” or premenstrual syndrome, has come to describe instances of irrational mood swings and outpours of intense emotion. At its best, the phrase is a cheeky punchline and at its worst, the phrase serves to undermine people who menstruate. To that effect, this has led to a large degree of stigma surrounding the term and the related, but lesser known term, PMDD, which stands for premenstrual dysphoric disorder.
PMDD is a chronic condition causing severe psycho-emotional challenges for those affected. Some of these challenges include irritability, depression, anxiety, loss of control, and concentration problems. In 1994, PMDD became recognized in the Diagnostic and Statistical Manual of Mental Disorders IV. According to Harvard Medical School, it is estimated that one in twelve people who menstruate experience PMDD.
The National Institute of Health (NIH) has found that individuals with PMDD have an altered gene complex that is responsible for the body’s response to hormones and stressors. This discovery establishes a preliminary cause for PMDD, grounding its biological foundations. PMDD is a biological condition, not a behavioral one, and it is the duty of every individual, not just those who menstruate, to be aware of the condition and especially empathetic to those dealing with it. In practice, this means employers and educational institutions should acknowledge the condition and have procedures in place to help get treatment for those affected.
On average, individuals with PMDD experience a range of these symptoms over 6.4 days of every menstruation cycle. In a year, this amounts to over 76 days. That is, 76 days in which an individual is affected by symptoms resembling those of acute anxiety and depression. Since these symptoms manifest on a cyclic schedule and are caused by hormonal changes, they are different from other mental illnesses. This means medical practitioners should not conflate treatment options for depression and anxiety with PMDD. Instead, PMDD should be researched in its own right to discover more optimal treatments and potentially drugs as well. This can be achieved through conducting more thorough studies on the condition and creating treatment plans more specifically aimed at treating PMDD.
While women’s health has made progress in the past decades with more available birth control options and greater awareness of differences in the female body’s relation to cardiovascular diseases, there is still more to consider. For instance, the causes of PMDD and appropriate treatment options are still largely unknown. In the past, medical professionals believed the differences in men and women's health were strictly related to reproductive organs. Hence, women's health became known as “bikini health” because research focused on the parts of the body covered up by a bikini. Research on women’s health focused on breast cancers and gynecologic conditions, while the deeper effects of the menstrual cycle on mental health went unexamined.
In practice, this has meant that people who menstruate have been underdiagnosed for PMDD and have even been misdiagnosed with other conditions. PMDD is most often mistaken for bipolar disorder, resulting in individuals taking the incorrect drugs and not getting better. Other individuals are simply dismissed as hormonal and do not receive any treatment. Worse yet, one study found that Black women are less likely to be diagnosed with PMDD than their white counterparts. It is then critical to examine how intersectional identities factor into diagnoses for underrepresented conditions such as PMDD.
Another study found that people with PMDD have “remarkably high risk” of being suicidal with 15.8% self reporting at least one suicide attempt compared to the 3.2% of individuals without PMDD who self report. While there are several possible causes of the difference in suicidal tendencies between these two groups, it is certainly possible that the lack of effective treatment and proper medical attention could be a factor.
Currently, treatment options remain limited. A targeted form of treatment involves taking selective serotonin reuptake inhibitors (SSRIs) a few days before PMDD symptoms manifest. Other treatment options include contraceptive pills to deal with hormonal changes and lifestyle changes. Generally, these lifestyle changes may include journaling to keep track of cyclic emotional changes and a balanced diet and exercise routine to mitigate symptoms. As this condition becomes less stigmatized and better researched, more treatment options will become available. A pivotal step in destigmatizing this condition is to talk about it more openly and educate ourselves on this condition’s impact on people who menstruate.
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 Diagnostic and Statistical Manual of Mental Disorders : DSM-IV. Washington, DC: American Psychiatric Association, 1994.
 Goldman, David. “Sex Hormone-Sensitive Gene Complex Linked to Premenstrual Mood Disorder.” National Institutes of Health. U.S. Department of Health and Human Services, January 3, 2017. https://www.nih.gov/news-events/news-releases/sex-hormone-sensitive-gene-complex-linked-premenstrual-mood-disorder.
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