Demystifying PMDD

Content warning: this article contains mention of suicidal ideation and self harm

Premenstrual dysphoric disorder (PMDD) is a severe and under-recognised form of PMS. One student diagnosed with the disorder shared that whilst she often tries to explain it as “PMS times 100”, this doesn’t even begin to fully describe the complexity of having PMDD. For some, PMDD proves a completely debilitating condition. To shed some light on this little-known issue, I spoke to several people about their personal experiences with PMDD.

The women I interviewed all described suffering from physical and especially debilitating emotional symptoms due to PMDD. Senior Fresh student Kate Byrne described the mental toll that it takes in the two weeks leading up to her period: “I was having intense mood swings ranging from anger to extreme lows, but I couldn’t understand why I was feeling that way.” Kate recalls beginning to recognise a pattern in when these symptoms occurred, making the connection between these erratic mood changes and her menstrual cycle as her symptoms consistently ceased when her period came. This led to a revelation when she “started googling stuff like ‘feeling depressed until period comes’ and found PMDD”. Another Senior Fresher shared a strikingly similar experience, also stumbling across PMDD online in her search to understand the symptoms she’d been having for over a year. She recounted: “I finally did a Google search of ‘why am I suicidal on my period’ and found out about PMDD.” Describing the effect PMDD had on her mental health, this student stated that “for a week or two of the month it would feel like the world was ending, and one small thing could set me off on a horrific spiral, and then the next week I would be completely fine”.

This exhausting recurring pattern is one that many of the interviewees and others with PMDD are all too familiar with, and one that often plants seeds of self-doubt. Kate admitted to “constantly doubting myself all the time about it”, adding that “it’s hard to explain to people”, whilst another student explained that “because the depression isn’t something you’re experiencing all the time, you end up gaslighting yourself into thinking you‘re fine.” Interestingly, Kate raised the point that PMDD is not explicitly mentioned on the HSE website, feeding into the sense of doubt that follows many people experiencing symptoms as they attempt to carry out their own research online. The stigma that surrounds not only menstrual health, but also mental health, makes it even harder for individuals suffering from PMDD to seek medical advice and gain a diagnosis promptly. Luckily for both of the second year students I spoke to, their female doctors instantly recognised what they were describing as PMDD, confirming their suspicions.

However, this is not always the case; in fact, oftentimes PMDD can go undiagnosed for years. Speaking to Trinity News, Senior Sophister Andrea explained that she has not yet received a diagnosis but is currently in the process of recording her symptoms so she has sufficient evidence to present to her doctor. She stated that “women’s health concerns are so often swept under the rug, minimised, or explained away, that I know I’ll feel more comfortable walking in with something of substance to back up my concerns.” Kate also shared a similar concern, explaining, “I think as women we have it ingrained in us to keep quiet about this kind of stuff,” but stressing the importance of being open and talking “to people in your life about it.”

Describing how she eventually came to realise what may be the root of her severe symptoms, Andrea says that for her “it starts off as headaches, muscle pain and general physical discomfort but quickly develops into anxiety, uncontrollable rage, suicidal ideation and self-harm” recalling how she felt “lost, scared and confused until I made the connection that it was happening around the same time every month, and it was so incredibly freeing to realise that my behaviour was likely due to extreme sensitivity to hormone changes, rather than because I’m just a terrible human being”.

Echoing the thoughts of other interviewees, Andrea noted that most of the information and resources she has found “have been in the form of online communities and these are almost all America-centric as there is not much information out there surrounding PMDD in Ireland or how to go about a diagnosis over here”. Clearly, this is an issue that needs to be discussed and emphasised much more than it currently is; there is a lack of awareness of the disorder, not only in Ireland, but globally. It was only as recently as 2019 that the World Health Organisation officially recognised PMDD, validating it “as a legitimate medical diagnosis worldwide and acknowledging our growing scientific and medical understanding of this little-known but debilitating condition”.

Past Trinity student, Caroline Flood, reached out to share her PMDD journey, explaining that it began when she “knew something was very wrong at 16 and I went to my GP who prescribed me the pill”. Recalling the excruciating road to officially being diagnosed, Caroline explained that this “took years of tracking my symptoms and showing mental health professionals the information that I collected”. She added that “the cyclical nature of my premenstrual dysphoria” led her to “believe the only future option would be to have my womb and ovaries removed and induce menopause”. Inducing menopause is one form of treatment that is sometimes used in severe cases of PMDD.

PMDD can have a dramatic impact on the daily lives of those who suffer from it, as many of our interviewees could attest to. Caroline shared how it affected her academics and relationships with those around her: “It affected my attendance and performance in school. I was always missing days and crying over my homework. It was part of the reason I had to leave Trinity twice. It made me super irritable so it would cause conflict with my family and made me not want to socialise with my peers.” Kate similarly emphasised the strain having PMDD places on your relationships: “PMDD can really affect your relationships with people, since it pretty much dictates your behaviour and your mood.”

Hannah Ross, aged 28, recalled the toll it took on her relationships as well: “I started a new relationship at the beginning of 2020 and it became apparent how my PMDD symptoms were putting a strain on us. With friends and family I could hide it but living together made it almost impossible.” Hannah’s experience with PMDD shared more similarities with the other women I spoke to, including her struggles with depression. Hannah shared that reaching out to her therapist about these feelings “has really helped me deal with the hard emotions while I’m experiencing PMDD”. For Hannah, “9-5 jobs aren’t feasible” and she explains that as she finds no “cure” she focuses instead on “creating a life that supports my PMDD”.

The majority of the women who were interviewed revealed that they did not know anyone else who suffers from PMDD — a fact that can make the disorder all the more isolating. Hopefully there will be someone out there reading this and experiencing the same feelings shared by these individuals who can find comfort in knowing that they are not alone. By highlighting the experiences of those who live with PMDD and discussing menstrual issues more openly, we can raise awareness on this topic and help break down the stigma that surrounds it.

If you have affected by any of the stories in this article, Samaritans are here to help – day or night, 365 days a year. You can call them for free on 116 123, email them at [email protected], or visit samaritans.org to find your nearest branch.