PMDD Can Be Tamed

angry crazy ladyFor many women, their menstrual cycle can become a nightmare due to altered hormone levels and that may cause Premenstrual Dysphoric Disorder (PMDD), a mood disorder characterised by significant low mood levels in the luteal (second) phase of the menstrual cycle.  This may severely affect their general and mental well-being.

A case in point is Nadia (not her real name), who openly admits that the two weeks before her period, are hell for her and her family. “I’m usually a bubbly easy-going person, but in those weeks I feel like I become a monster. I’m so moody and irritable. It happens every month and then I get my period and I’m back to normal. My poor husband and children get yelled at all the time in the last two weeks and I feel so awful – I just can’t cope,” she says.  Dr Bavi Vythilingum, a psychiatrist based at Akeso Psychiatric Clinic in Kenilworth, Cape Town, explains more about PMDD


angry crazy lady 4“Unlike Premenstrual Syndrome, which is characterised by mild mood changes, breast tenderness and craving for carbohydrates, PMDD is a severe mood disorder with significant distress and impairment in social and/or occupational functional.  It occurs in the second half of the menstrual cycle and the mood changes resolve with the onset of the menstrual period,” explains Dr Vythilingum.


Common symptoms include depressed mood, anxiety and panic attacks, marked irritability, feelings of being overwhelmed, difficulty concentrating, fatigue and even suicidal thoughts. “Women with PMDD are not ‘weak’, nor do they have ‘unstable personalities’. PMDD is not all in your head – it is a diagnosable medical illness that can and should be treated by a medical professional, Dr Vythilingum stresses.


“PMDD is not a directly inherited disorder – in other words if your mum had it, it doesn’t mean that you will get PMDD, but is it is heritable. Women with PMDD are 56% more likely to have family members who also have PMDD. This tells us that there must be genetic mechanisms linked to the disorder.

“Earlier this year, researchers from the NIMH showed dysregulation in a gene complex that controls, among other things, response to oestrogen and progesterone. Findings like this will help us develop new ways understand and of treating PMDD,” she says.


“The diagnosis of PMDD is made on clinical grounds, based on careful evaluation of your symptoms. You may be asked to keep a diary of your mood and menstrual cycles. No specific blood or hormone tests are done to make the diagnosis”, says Vythilingum.

Impact on daily life

angry crazy lady 2“The thing with PMDD is that for half the month you are normal and then for half the month you lose your mind. If you can cope most of time, in the times when you can’t cope, no-one has any sympathy for you,” says Nadia.

“The most important thing partners and families can do is to understand and support. PMDD is not their loved one’s fault. It is a medical illness. That said, it does have an impact on them, and as part of the healing process the whole family may need a space to talk about their feelings, “she stresses.


PMDD is best treated through a combination of approaches – medication, psychological and lifestyle changes, Dr Vythilingum points out.

Lifestyle changes

Self-care is recognising that just like your car cannot run on an empty tank, neither can you. Self-care means taking the time out to make your needs are attended to as well.

“So if you have PMDD you should ensure that you get regular aerobic exercise because it helps your mood and fatigue. Self-care means doing things you enjoy because it decreases your stress and will help decrease your PMDD symptoms. Self-care means taking time every day to do deep breathing and practice your relaxation techniques. And self-care means reaching to your friends, family and partner for support during ‘that’ time of the month when you feel overwhelmed.”


Supplements such as vitamin B6, calcium, magnesium supplements, and Omega 3 fatty acids have all been shown to be useful as adjunctive treatments for PMDD. Before starting any supplement, though, you should discuss this with your doctor, Dr Vythilingum adds.

Psychotherapy and Pharmacotherapy (Medication)

angry crazy lady 3“Many women with PMDD find that Cognitive Behavioural Therapy (CBT) is an effective treatment for their mood and anxiety symptoms. Relaxation techniques and stress management techniques either alone or as part of CBT are also very useful.”

Medication used for the management of PMDD usually falls into two broad categories – antidepressants and hormonal therapies. These methods must be sought out though in conjunction with your doctor’s advice and preferably also your therapist.

The good news, however, is that PMDD is a treatable mood disorder and that “most women with appropriate treatment, recover completely,” concludes Dr Vythilingum. Nadia agrees:  “I was sceptical at first, but meds and therapy have helped me get ‘me’ back. That time of month is something I’m not afraid of anymore.” Support from family and friends is also vital and you should seek the help of an experienced therapist.

1 Andrade C. Premenstrual dysphoric disorder: General overview, treatment strategies, and focus on sertraline for symptom-onset dosing. Indian J Psychiatry. 2016 Jul-Sep;58(3):329-331. doi: 10.4103/0019-5545.192014. PubMed PMID: 28066013; PubMed Central PMCID: PMC5100127.
2: Dubey N, Hoffman JF, Schuebel K, Yuan Q, Martinez PE, Nieman LK, Rubinow DR, Schmidt PJ, Goldman D. The ESC/E(Z) complex, an effector of response to ovarian steroids, manifests an intrinsic difference in cells from women with premenstrual dysphoric disorder. Mol Psychiatry. 2017 Jan 3. doi: 10.1038/mp.2016.229. [Epub ahead of print] PubMed PMID: 28044059.
3: Ismaili E, Walsh S, O’Brien PM, Bäckström T, Brown C, Dennerstein L, Eriksson E, Freeman EW, Ismail KM, Panay N, Pearlstein T, Rapkin A, Steiner M, Studd J, Sundström-Paromma I, Endicott J, Epperson CN, Halbreich U, Reid R, Rubinow D, Schmidt P, Yonkers K; Consensus Group of the International Society for Premenstrual Disorders.. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Arch Womens Ment Health. 2016 Dec;19(6):953-958. PubMed PMID: 27378473.
4: Pearlstein T. Treatment of Premenstrual Dysphoric Disorder: Therapeutic Challenges. Expert Rev Clin Pharmacol. 2016 Feb 6:1-4. [Epub ahead of print] PubMed PMID: 26766596.