Normally you’re a pretty chill person. Things usually don’t get to you much. But today, you wake up bloated and tired. It is a week before your period. You couldn’t sleep last night. You’re late for school because you overslept and none of your jeans fit. You yell at your mom because she’s telling you to hurry up. Your locker is jammed and you have a zit. It seems a lot harder to concentrate in Spanish class. You burst into tears when someone tells you that you look tired. You cry in gym class because you have cramps, and you yell at your best friend for no reason. The world sucks and everything is going wrong. Usually you would want to hang out with your friends to make you feel better, but today you go home and all you want to do is curl up on the couch and eat a pint of Ben and Jerry’s.
Does this sound like you?
If this happens to you every month, the week before your period, you may have PMDD.
What is PMDD?
PMDD stands for premenstrual dysphoric disorder, and is a severe form of premenstrual syndrome, or PMS. People with PMDD have intense mood and physical changes that happen each month before their period and go away as soon as they start their period. While the mood swings, cramps, and food cravings may last only a few days with PMS, they may last for up to two weeks in people with PMDD.
What are the symptoms of PMDD?
If you have PMDD, you feel fine all month long until about 7 to 10 days before your period starts. The week before your period, you may get some or all of the things listed below:
- Feeling sad or hopeless
“I feel sad and depressed- life is just not as fun.”
- Low self esteem
“I feel so down about myself.”
- Feeling anxious
“Even the littlest things get me stressed out and make me feel nervous.”
- Sudden mood swings
“I start crying for what seems like no reason.”
- Feeling angry and irritable
“My parents and I get into a lot more fights, and I just want to scream at everyone.”
- Not participating in activities you enjoy
“I always go to soccer practice but I skip out the week before my period.”
- Problems concentrating
“Getting my homework done takes so much more energy.”
- Feeling tired
“Right around my period I just want to sleep all day long.”
- Appetite changes
“All I want to do is eat chocolate and potato chips…I don’t want to eat anything else.”
- Sleep changes
“Sometimes I can’t fall asleep before my period, other times I sleep all day long.”
- Feeling overwhelmed or out of control
“Everything seems harder to handle before my period…I feel totally out of control sometimes.”
- Physical symptoms
“I feel like I gain 10 pounds the week before my period. I have cramps, headaches, muscle aches, and just feel gross.”
Why do PMS and PMDD happen?
No one is completely sure what causes PMS and PMDD. Scientists think that the mood and physical changes are related to hormone levels that change during your menstrual cycle. Hormones are chemicals that your brain and other parts of your body use to communicate with each other. During your menstrual cycle, the levels of two different types of hormones, estrogen and progesterone, go up and down. When these levels change a lot, they can cause changes in your mood, your behavior, and can cause physical changes too.
Other chemicals in the brain may be related to PMDD also. Some chemicals (called neurotransmitters) that play a part when people get depressed seem to be involved with the mood changes that happen right before your period. That’s why some people with really bad PMS actually can get better when they take medicine that is also used for people that get depressed.
Some people have found that high levels of stress make PMS and PMDD worse. Diet can also affect PMDD; low levels of vitamins and minerals can make you feel worse. Sometimes salty foods and caffeine make weight gain and bad mood worse right before some women’s periods. That’s one reason it’s important to try to keep a balanced diet with lots of fruits and vegetables.
In the end, it’s possible that all of these factors affect PMS and PMDD.
What can I do?
Be sure to talk to your doctor about how you’re feeling…if you feel moody, depressed, or have physical changes before your period starts, write down what you feel every day of every month. Keeping a journal can help you figure out whether you have PMS, PMDD, or something else. Take the journal with you when you have a doctor’s appointment.
Depending on how bad your symptoms are, a healthy diet and exercise may help. This includes avoiding junk foods, salty food, caffeine, and artificial sweeteners. Sleeping enough, drinking enough water, and reducing stress can also help.
If you try these things but your PMS symptoms are still bothering you, then you should talk to your doctor who can give you advice on what else you can try. If your symptoms are very severe your doctor may talk to you about trying medications. Oral contraceptives (birth control pills) are sometimes used because they can help put your hormones “in check”. Sometimes doctors will suggest medications that are also used to treat depression or anxiety- this doesn’t mean that you have depression or anxiety, it’s just that the same medicines seem to help for severe PMS and PMDD, maybe by changing levels of chemicals in the brain.
It is a good idea to talk to your doctor if the symptoms of your PMS don’t go away between periods, doesn’t follow the same cycle as your periods or if it interferes with your life. This may be sign that the PMS is related to something else.
If you’re in the Boston, MA area…
You may make an appointment to see one of our psychiatrists by calling 617-724-7792.