How to Cope with Premenstrual Dysphoric Disorder

Dahlia Mayerson
September 20, 2022

1in 20 people who menstruate suffer from Premenstrual Dysphoric Disorder (PMDD). That’s an estimated 5.5% of women, transgender men, & non-binary individuals of reproductive age. With something as common as that, it can be alarming to consider just how much of an effect it has on all areas of life ranging from work to interpersonal relationships. However, it often goes undiagnosed or misdiagnosed, and resources for the condition are somewhat scarce. That’s why raising awareness for PMDD is so important. In today’s issue of Thought Lab, we’ll answer the following:

  • What is PMDD?
  • How is PMDD Detected?
  • How To Cope With PMDD
  • PMDD Treatments
  • Finding Help For PMDD

What is PMDD?

PMDD stands for premenstrual dysphoric disorder. Sometimes described as a “severe form of PMS,” it is a depressive disorder that affects around 3-8% of people who menstruate. Unlike PMS, however, PMDD can be debilitating and have a serious impact on a person’s life.

To get a PMDD diagnosis, someone must experience at least five of the following symptoms, including at least one of the first four:

  • Feelings of hopelessness, a depressed mood, or self-deprecating thoughts.
  • Mood swings, increased sensitivity to rejection, crying more than usual, or sudden feelings of sadness.
  • Tension, anxiety, or feeling “keyed up”/” on edge.”
  • Increased irritability or anger.
  • Loss of interest in daily activities (e.g., work or school, friends, and hobbies).
  • Trouble with concentration or focus.
  • Lethargy, marked lack of energy, or becoming fatigued more easily than usual.
  • Changes in appetite (e.g., eating more than usual) or specific food cravings.
  • Feeling overwhelmed or out of control.
  • Physical symptoms such as headaches, bloating, and joint or muscle pain.
  • Hypersomnia or insomnia.

Symptoms of PMDD start 1-2 weeks before the start of a menstrual period and dissipate once menstruation begins. The two weeks before a person’s period starts is called the luteal phase. Accordingly, PMDD was once called “late luteal dysphoric disorder.”

How Is PMDD Detected?

Due to a lack of awareness, it isn’t uncommon that PMDD goes undiagnosed or misdiagnosed. PMDD also differs from Premenstrual Exacerbation (PME), which refers to the exacerbation of other conditions, such as major depressive disorder or bipolar disorder, during PMS, though it is possible to experience both.

What should you do if you think that you have PMDD, then? If you believe that you may have PMDD, talk with a medical or mental health professional such as a primary care doctor, therapist, or psychiatrist. Typically, a healthcare provider will ask you to track your symptoms for at least two months before diagnosing PMDD. Then, they should be able to provide a formal diagnosis of PMDD or refer you to someone who can.

In many cases, a diagnosis of PMDD is a breath of fresh air. It offers an explanation for symptoms and opens the door to proper treatment, which can make a world of difference.

How To Cope With PMDD

In addition to physician-recommended treatments, there are things you can do to help yourself manage PMDD symptoms. Here are some of them:

Keep track of your cycle

Many people with PMDD use period trackers or track their cycle through other means, such as a physical calendar. Tracking your menstrual cycle can help you:

  • Know when to expect PMDD symptoms (if your cycle is regular).
  • Plan ahead. For example, you might plan important activities for times when PMDD symptoms are not active.
  • Detect changes in your menstrual cycle or symptoms.

Especially if you don’t currently track your cycle and find yourself thrown off by PMDD symptoms, this can be worthwhile.

Emphasize stress management

Mental stress puts a strain on the body, especially if it’s frequent or persistent. It can lead to feelings of depression and anxiety, trouble sleeping, irritability, body aches, muscle tension, and worsening of existing conditions. Stress management is critical for us all, but with PMDD, it is particularly critical to keep your stress low during the luteal phase.

You may take less on, set aside more time for relaxation, and make it a point to stick to self-care routines. Some individuals find that it’s most practical to have a “bare minimum” routine for this time of the month. Rather than pressure yourself to do it all, it’s okay to return to the basics.

Build a toolbox for tough days

When PMDD symptoms such as irritability and feelings of depression are at their worst, it can be tough to think of how to address them. To mitigate this, write a list of helpful tools you can use for tough days. That way, instead of trying to think on the fly, you’ll have options in front of you when you need them. Here are some examples:

  • Breathing exercises, progressive muscle relaxation, and meditation.
  • Physical activity (e.g., lifting weights, walking).
  • Distractions and low-stress activities, such as art, time outdoors, or comfort TV shows and books.
  • Items or products that soothe or provide relief from physical symptoms, such as heating pads.
  • Social support (e.g., time with a friend, calling a loved one).

Positive affirmations, cognitive reframing, and mindfulness surrounding PMDD symptoms can be useful. Give yourself compassion, and remember that symptoms will dissipate.

Find a support group

If you feel alone in your battle with PMDD, know that there are others out there who are going through the same thing. Meeting other people who have PMDD through support groups can be cathartic. PMDD support groups are often free of cost and can be found online.

Providers and peer support coordinators should be mindful of the fact that PMDD does not affect women only. It also impacts transgender and nonbinary people. There are support groups designed specifically for transgender and nonbinary people with PMDD, and these are safe spaces to discuss general PMDD symptoms as well as LGBTQIA+-specific concerns, such as heightened gender dysphoria.

Additionally, some support groups may focus on specific age groups and other demographics. Similar to how the best PMDD treatment varies from person to person, it’s okay to try different support groups until you find the right one.

PMDD Treatment

Lifestyle interventions, antidepressant medication, and birth control are often recommended as the first line of treatment for those who live with PMDD. If these aren’t effective, some opt for surgery and other interventions. Therapy gives individuals with PMDD the opportunity to vent, establish coping skills, work through problems such as those that relate to their occupation or interpersonal relationships, change negative thought patterns, and get to a better place overall. Therapy doesn’t only help when you’re in session; you can use what you learn in therapy long-term, and many find that the information and tools they acquire in therapy are valuable long after they stop working with the therapist.

Find Help For PMDD

Research indicates that internet-based therapy can help individuals who live with PMDD. Resilience Lab will match you with a clinician who meets your needs when you fill out the “Find Your Therapist” form here. Once you select a preferred therapist, you can schedule a free introductory meeting within 48 hours. Whether you’re coping with PMDD or need help with something else that’s on your mind, we make finding the care you need more convenient and straightforward.

Get started with therapy today.

Our team can help you find the right therapist.