Premenstrual dysphoric disorder (PMDD), a more severe form of premenstrual syndrome (PMS), can affect the ability to work, impact women’s relationships and increase their risk of suicide.

During Women’s Month, the SA Society of Psychiatrists (Sasop) aims to raise awareness about women’s mental health and the importance of early, correct and effective treatment to minimise risks of more serious mental health problems developing later in life.

The association said while PMS is well-known and affects about 75% of women, PMDD is a recognised clinical mental health condition and affects 5% of women.

“The combination of physical discomfort with the extreme mood shifts and behaviour changes caused by PMDD impact just as severely on a woman’s quality of life, ability to function and years lost to ill-health as other, more widely recognised and major mental health disorders such as depression,” said Sasop member Dr Bavi Vythilingum.

Some describe feeling as if a switch had been flicked to turn them into a different person in the week before their menstrual period, feeling out of control and responding to events that wouldn’t usually upset them with extremes of anger, tears or even violent behaviour.

“Others shift from [being] energetic extroverts to withdrawn, unable to function in their normal daily life, and depressed to the point of contemplating or attempting suicide,” she said.

Vythilingum said hormone levels fluctuate through women’s different life stages, from the onset of menstruation to the reproductive or child-bearing years, to the changes during and after pregnancy and through to menopause.

“Hormones affect brain function, and this makes women particularly vulnerable to mental health challenges arising from the physical changes,” she said.

Although PMDD affects “a relatively small percentage of women”, Vythilingum said it was important to raise awareness of the condition as it was not well understood and was frequently misdiagnosed and mistaken for depression or bipolar disorder.

“It is brushed off as being hormonal and women are told there is nothing wrong with them. However, the correct treatment, which is specific to PMDD and not the same as treatment for conditions such as depression, can dramatically improve the lives of women who go through the monthly cycle of severe, even suicidal, symptoms,” she said.

Vythilingum said women with PMDD have normal hormone levels but are unusually sensitive to the normal changes in oestrogen and progesterone levels that occur through the menstrual cycle, affecting the brain chemistry that controls moods, emotions and sense of wellbeing.

Stress and childhood trauma, especially sexual trauma, are risk factors for developing PMDD, as well as a personal or family history of anxiety and depression, PMS or postnatal depression.

“The latest research shows there is a biological basis for PMDD, that the disorder is related to abnormal metabolism of hormones causing mood disruptions. This is an assurance for women living with PMDD that their condition can’t simply be brushed off as imaginary or hysterical, and it opens the door to more effective treatment,” said Vythilingum.

PMDD adds extreme and debilitating mental distress to the typical physical symptoms of PMS such as bloating, breast tenderness, headaches and muscle or joint aches and pains, fatigue, difficulty sleeping and food cravings.

The mental symptoms include extreme anxiety, irritability or anger, distinct mood swings, deep sadness or despair, lack of interest in things the woman usually enjoys, panic attacks and difficulty thinking or focusing.

“PMDD is highly treatable and treatment could include selective serotonin reuptake inhibitor antidepressants to remedy mood and emotional symptoms and difficulties with sleeping and concentrating. Depending on the woman’s overall mental health, antidepressants can be taken daily or only in the days between ovulation and the start of her menstrual period.

“Birth-control pills can also aid in controlling hormone levels as well as relieving physical aches and pains, while nutritional supplements are also helpful, especially 1,200mg of calcium daily, as well as vitamin B6, magnesium and Omega 3 and certain herbal remedies. Consult with a doctor on the most appropriate supplements.

 “Getting enough sleep and using relaxation techniques such as mindfulness, meditation and yoga may also help. Avoid stressful and emotional triggers, such as arguments over financial issues or relationship problems, whenever possible,” advised Vythilingum.

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