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PMDD is more than just severe PMS.

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“We aim to highlight mental conditions that affect people’s day-to-day lives and what products, apps, and services they use to make their every day easier in the mental health series You’re Not Alone. Jaishree Kumar is a graduate student and writer who has premenstrual dysphoric disorder.”

Content warning

This article mentions feelings of depression, anxiety, and suicidal thoughts.

If you’re thinking of hurting yourself or are having suicidal thoughts, please call the National Suicide Prevention Lifeline at 800-273-8255.

You can also call 911 in the case of a mental health emergency.

Premenstrual dysphoric disorder (PMDD) is a condition that induces severe physical and mental symptoms around 7 to 10 days before your period. PMDD is classified as a DSM-V disorder, but there’s little understanding or awareness about what PMDD actually is.

The underlying causes of PMDD are still up for debate. Some professionals say it’s a hormone disorder, while others say it’s a reaction to hormonal changes in the body during the luteal phase (this is the first stage of the menstrual cycle. It occurs after ovulation).

However, there seems to be a consensus that PMDD is a condition with severe premenstrual syndrome (PMS)-like symptoms that can hinder someone’s quality of life. PMDD can linger around until menopause, but it tends to worsen during perimenopause.

“During perimenopause, symptoms can worsen as the hormone cycle varies greatly, but for some, it improves,” says Dr. Verity Biggs, an expert in menopause and female health.

Many menstruators don’t realize they have PMDD for many years, and I was one of them.

I noticed that I would experience bouts of depression and anxiety around 2 weeks before my period. The spirals of anxiety and depression would disappear on the second day of my period.

I would downplay it and tell myself to suck it up. They told me that it was just pre-mesis when I sought help. The intense spirals that sometimes bordered on suicidal tendencies would arrive almost 10 days before my period.

I spent more than a year tracking my cycle through a period tracker app and making notes of my symptoms, but nothing made sense. At the age of 22, I have a better understanding of what PMDD does to my body.

“It still blows my mind that people don’t know about PMDD. When I was 19 I stumbled upon PMDD, which was a term I had never heard of. I was related to every video and article. I finally felt heard after years.”

Emily Marquis is a coach who has PMDD and she stresses the importance of highlighting the voices of people with PMDD.

“It is important for clients to feel heard, validated, and personally accept that what they experience each month is real and that they don’t know how to control it, says Marquis.”

It is very difficult to work through the idea of shame, embarrassment, and frustration with having PMDD. The disorder is not visible, so this is an ongoing practice. It is hard for outsiders to understand what is happening.

This is especially true for me, since I live in India, where it’s hard to see medical practitioners who acknowledge PMDD. My current gynecologist sees my PMDD flare-ups in connection to my polycystic ovary syndrome (PCOS), for which I was diagnosed recently.

uterus owners with polycystic ovarian syndrome can skip menstrual cycles and make it harder for them to get pregnant because of the condition.

Everyone will have their own experience with PMDD. PMDD is not one-size-fits-all. I could lose control of my emotions when PMDD flared up. Toxic relationships, stress, and feeling out of control were some of the factors that made these flare-ups worse.

“When I was 19, I stumbled upon what PMDD was when I Googled ‘severe PMS.’ I related to every article and video on PMDD. After years, I finally felt heard.”

Sometimes, my flare-ups were not intense, but I would have emotional breakdowns and snap at everyone around me.

I would hold my breath beforehell week, a phrase many people use for their PMDD flare-ups. I was afraid of how I would act in front of my friends and family. I became afraid of my PMDD.

People with PCOS have trouble ovulating every month, which leads to irregular menstrual cycles. Sometimes, I’ve had my period after a gap of 51 days or as early as 22 days. However, my PMDD acts as an “indicator” to me that my period is coming, even if it’s early or really late.

“There is no connection between PMDD and PCOS or endometriosis, but they can occur together, and PMDD is more common in people [who] ovulate regularly,” Biggs explains. “With PCOS, you may not ovulate each month, and therefore, you will not necessarily get the symptoms each month.”

Doctors advised taking birth control pills to manage my symptoms. I am not on birth control pills. I am not sure if taking medication is the best option for me.

I have tried to repair my relationship with PMDD with the help of therapy and healing practices.

I am aware of my cycle changes. I try to eat healthy and exercise a lot before my PMDD flares up. I have found yoga to be very relaxing and soothing. I use yoga to stay connected to the present and not to think too much. It helps clear the brain fog.

Melissa Sue Ogden, a yoga therapist who runs Yoga for PMDD and also has PMDD, says, “I often use postures that bring the breath downward in the body to support the alleviation of cramps and bloating. For symptoms, like anxiety and migraines, breathwork practices, like Sithali (a cooling breath), can help soothe a frazzled nervous system.”

Lately, my biggest PMDD symptom is extreme fatigue. I sometimes feel fatigued and lethargic, even after having a good night’s sleep and eating nutritious meals. On some occasions, I’ve had to cancel meetings, because my fatigue demanded that I rest instead of working. It’s a phase when I can almost feel my system shutting down little by little.

Emily Holloway is a psychotherapist and co-founder of the PMDD Collective, a source of support and initiative raising awareness of PMDD. She recommends splitting up time in “can do/can’t do zones.”

“We believe in living in cycles, splitting the month into can do and can’t do weeks. It is a big deal to be recognized in those can’t do ones, for example, if you just move your body to make a cup of tea. It comes with the bonus of shaking off intrusive thoughts.”

I am working on applying a similar approach to my journey.

I need editors to get work. I have had flare-ups of PMDD that have caused me to not work. During PMDD flare-ups, I focus on my most important tasks and leave out the rest.

It is important that clients have the time to relax in their own way during flare-ups. This can be created by making sure their work and personal life are not too much. I struggle with PMDD and always make sure I have therapy and acupuncture.

Some of the most helpful products and apps that I use to manage my PMDD are listed here.

Make sure to talk to your doctor

Some supplements and teas may work well for some people, but not all. Before introducing any new products to your diet, you should consult your doctor to make sure they are a good fit.

Pricing guide

  • $ = under $20
  • $$ = over $20

Sports Research Evening Primrose Oil Capsules

  • Price: $

“This was the first time my gynecologist suggested a supplement to me. It helped reduce my PMDD symptoms. I felt calmer and less sad, even though it didn’t make them go away completely.”

“I take a higher dose of evening primrose oil after my last doctor’s appointment, and it continues to help me.”

There’s also research on how evening primrose oil can help with PMS and PMDD. Researchers have found it has the potential to reduce PMS, hot flashes, gestational diabetes, and cervical ripening.

LuxFit Foam Roller

  • Price: $$

I have a lot of muscles that are tense. I usually spend hours at my desk as a graduate student. I have noticed that the pain in my muscles and joints is worse duringhell week.

I recently started using a foam roller, and it has been a game-changer for me. I can feel myself calm down after a foam rolling session.

Gaiam Print Yoga Mat

  • Price: $$

This is the best yoga mat I have ever used. Surya Namaskar is a sun salutation that I try to start my day with. I then go on to breathwork practices to get rid of stress.

Soulflower Rosemary Essential Oil

  • Price: $$

Research has shown that rosemary oil has properties that help reduce anxiety. On the days when my anxiety disrupts my sleep, I sprinkle a few drops of rosemary oil on my pillowcase. The smell of rosemary is really calming and helps me fall asleep after a long day.

FGO Organic Spearmint Tea Bags

  • Price: $

According to a 2010 study, spearmint tea has anti-androgen properties that can help with PCOS symptoms. People with PCOS also can have high levels of testosterone, and spearmint tea may help lower them.

spearmint tea has helped calm my PMDD symptoms and I have been drinking it almost every day for the past few months.

Organic India Moringa Green Superfood

  • Price: $

Moringa, an antioxidant-rich plant native to north India, has been found to help:

  • lower cholesterol.
  • Reduce inflammation.
  • Lower blood sugar.

I take it a couple of times a week and it improves my gut health. I no longer feel bloated all day, and I can feel a visible difference in my energy levels.

Flo Health App

  • Price: free

Flo is the period tracker app I’ve been using since 2016. The app shows you graphs related to your menstrual cycle. I’m also able to log PMDD flare-ups, which helps me keep track of frequent mental and physical symptoms that I’m experiencing.

I thought I was just sensitive to the pain of pre-mesis. PMDD and PMS are not the same.

The biggest misconception about PMDD is that it is a hormonal disorder.

She says that it is assumed that it must be an insufficiency or excess of hormones. Women who experience PMDD symptoms go to the doctor, only to be sent for blood tests which come back normal. The doctors then dismiss it as being hormone-based and put them on antidepressants or in some cases, misdiagnosing them with a personality disorder.

There is a need for more understanding of the mental health effects of PMDD.

Over 30 percent of people with PMDD attempt suicide at one point in their lives, while over 70 percent of people with PMDD are at risk of experiencing suicidal ideation.

It’s estimated that around 5 to 8 percent of women have symptoms that cause significant enough distress to be classified as PMDD.

There is a need for research and awareness on PMDD in the trans and nonbinary community. Not everyone who menstruates identifies as a woman, yet most of the sparse data available on PMDD focuses only on cis women menstruators.

There’s also a lack of attention on premenstrual exacerbation PME), which is the worsening of another disorder, such as major depressive disorder during the luteal phase.

My journey is not over. I carry the weight of hurting myself and my relationships during my flare-ups. I deal with guilt of not being productive enough during flare-ups.

However, I’ve learned that a support system and community help tremendously. I’m part of multiple PMDD support groups on Facebook, including the International Association for Premenstrual Disorders, which has close to 11,000 members.

Through these spaces, I realize that I need a care plan that addresses my other health concerns, and that what I feel is OK.