PMDD: The severe form of PMS that can ruin your life

Premenstrual Syndrome (PMS) is something a lot of people might make jokes about. Once it's over, most women can look back and sheepishly grin at their dramatic hormone-induced episodes.

But what if the onset of your period makes you feel an overwhelming sense of hopelessness, completely drains you of energy, causes your anxiety level to soar and even fills your head with thoughts of suicide?

Premenstrual Dysphoric Disorder (PMDD) is no laughing matter and according to Associate Professor Helen Chen, Head and Senior Consultant at the Department of Psychological Medicine at KK Women's and Children's Hospital (KKH), this uncommon condition affects around five per cent of women who are currently in their reproductive years.

PMDD has been known to sabotage friendships, destroy relationships and ruin the lives of those who suffer from it, so just how different is it as compared to PMS and what can you do to treat this rare medical condition?

My PMS morphed into PMDD

It took me many years to conceive my first baby, so when she finally arrived, I happily embraced motherhood and enjoyed every single minute of it because my dream had come true.

However, once my period returned one and a half years after giving birth, I began to notice some very strange things happening to me which were more severe than the usual PMS I used to experience since my teenage years.

I would get more emotional than usual to the point where I even scared myself, regularly pick fights with my husband over the most trivial matters, feel on edge and my heart would constantly be racing throughout the day. And I would randomly break down and cry uncontrollably for hours at a time. 

There were moments where I would just sit and stare blankly into space as this overwhelming sense of hopelessness crept over me.

At first, I wondered if it was because I was feeling stressed from being a stay-at-home mum with no helper, but I truly was enjoying the precious time I spent with my daughter and wouldn't want to have it any other way.

So I suspected it could be due to postnatal depression – but was it possible for it to suddenly appear almost two years postpartum when I was doing perfectly fine before?

I even thought perhaps I was being haunted or possessed by an evil spirit at one point because there seemed to be no other logical explanation for my random outbursts and manic episodes!

It almost made me harm my baby

As I was walking home with my toddler one day, a voice inside my head urged me to pick her up, hold her in my arms and climb over the railing to jump down from the 16th storey.

I was shocked and terrified that such a horrible thought could have ever crossed my mind and I clutched my daughter tightly as I ran back home.

It was very unlike me to ever think of suicide or harming my beloved child. I had pretty much everything in life I ever asked for, so why was I feeling this way and thinking of ending it all?

It didn't make any sense and I thought I was slowly losing my mind.

These frightening voices would also tell me to step in front of an oncoming bus as I stood with my daughter at the bus stop, or to jump onto the MRT tracks while she slept soundly in her stroller.

I was desperately fighting to control the disturbing thoughts that were beginning to affect my emotional health while I feared for my daughter's safety and also began to question my own sanity.

Even my husband noticed that as soon as I got my period each month, my mood would drastically improve and I would be cheerful once again. He said it was as though I was a completely different person.

After doing a lot of research and speaking to some other women who suffered the same symptoms as I did, I went to see a specialist at KKH and was officially diagnosed to be suffering from Premenstrual Dysphoric Disorder (PMDD) which developed after I gave birth.

Finally, I could put a name to my condition and stop thinking that I had become Dr Jekyll and Mrs Hyde!

ALSO READ: Menstrual disorders: Symptoms, causes and treatments

PMDD symptoms

There are many symptoms of PMDD which can be debilitating to those who suffer from it two weeks prior to getting their period.

These can include (but are not limited to):

Psychological

• Irritability
• Marked anger
• Sleep problems (such as insomnia or hypersomnia)
• Increased nervousness
• Difficulty in concentrating or staying focused
• Overwhelming sadness or depression
• Severe fatigue or lethargy
• Anxiety and panic attacks
• Confusion
• Forgetfulness
• Negative self-image
• Paranoia
• Emotional sensitivity
• Prone to crying spells
• Extreme moodiness

Physical

• Swelling of hands and feet
• Weight gain
• Breast fullness, tenderness and pain
• Abdominal bloating
• Constipation
• Nausea
• Vomiting
• Backache
• Skin irritations and conditions (acne, eczema etc.)
• Headache
• Dizziness or giddiness
• Fainting
• Numbness or tingling sensation of extremities
• Easy bruising
• Heart palpitations
• Muscle spasms
• Overeating or food cravings

Relief often comes once menstruation begins, and most women find that they are back to their normal selves and are free of almost all symptoms for about two weeks.

Suicidal ideation

According to Harvard Medical School around 15 per cent of PMDD sufferers may even attempt to commit suicide.

The death of American actress and model, Gia Allemand, has also been reportedly linked to PMDD which she had been diagnosed with.

It is also believed that acclaimed poet and writer, Sylvia Plath, may have suffered from a severe form of PMS too, which could have eventually caused her to take her own life.

In one of her journal entries from 1950, she wrote: "If I didn't have sex organs, I wouldn't waver on the brink of nervous emotion and tears all the time."

So not only does PMDD come with a long list of symptoms, it can disrupt your daily activities, affect your school or work performance, take a toll on your relationship with others and also potentially put your life at risk.

What causes PMDD?

It is still unclear what is the exact cause of PMDD, but the Harvard Medical School says: "Brain areas that regulate emotion and behaviour are studded with receptors for estrogen, progesterone and other sex hormones.

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"These hormones affect the functioning of neurotransmitter systems that influence mood and thinking – and in this way may trigger PMDD."

Dr Chen also agrees that a disturbance in the brain's serotonergic pathways could possibly be the cause of this uncommon medical condition.

PMDD is likely to be genetic and there are other risk factors that might cause you to develop it, such as high levels of stress, obesity and a history of traumatic incidents (e.g. sexual abuse).

How to confirm if you suffer from PMDD

To track your symptoms each month and when exactly they occur, write them down in your diary or download a period tracker app so you can accurately make note of the frequency and severity of the symptoms you experience.

You can also take an online self-assessment quiz to determine whether the premenstrual symptoms you display are PMS or possibly PMDD.

If the results indicate that you might have PMDD and your period tracker app shows a pattern in your symptoms for at least two to three months, it is important that you meet with a healthcare professional who specialises in women's wellness so your condition can be properly diagnosed and you can discuss more of your preferred course of treatment.

A progesterone test might also be carried out to check whether the levels are low and if you have a progesterone deficiency, which can be the cause of PMS and PMDD.

Ways to treat PMDD

Although currently there is no known cure for PMDD, there are several treatment options available to help cut down symptoms and alleviate most of the premenstrual woes, such as:

1. Use of prescribed antidepressant or mood stabiliser medications
2. Taking oral contraceptives (e.g. birth control pills)
3. Trying herbal remedies such as evening primrose oil, agnus castus fruit extract/chaste tree/vitex, gingko biloba, black cohosh, St John's Wort and kava kava
4. Taking certain essential vitamins like Vitamin E, Vitamin B6, magnesium and calcium
5. Getting prescription-dose bioidentical progesterone
6. Going for regular acupuncture treatments
7. Sticking to a healthy diet, cutting down on sugar and salt intake, and avoiding caffeine and alcohol
8. Exercising regularly and maintaining a healthy weight
9. Having light therapy treatments
10. Practising relaxation techniques (e.g. deep breathing, meditation)
11. Going for cognitive behavioural therapy to help control emotions

Remember that our bodies are unique so each person will respond differently to different treatments.

What works for one woman may not necessarily work for you, so try different options before you can figure out which is the most effective method to help curb your symptoms.

Last resort treatment option

For severe cases where other methods of treatment do not seem to be effective, studies show that getting a total hysterectomy or oophorectomy can result in total relief from PMDD symptoms.

Living with PMDD

After consulting with a specialist and taking a daily cocktail of natural supplements, my PMDD is less severe now and I am no longer plagued by disturbing thoughts.

However, each month is still a constant battle as there are many factors that can trigger and affect my symptoms, so I have to make an extra effort to be in tune with my body and more aware of my moods every month.

If you think you have PMDD or are currently suffering from it, it might be beneficial to confide in someone you trust, such as your partner, mother or best friend, so they can understand your condition and give the support and understanding you need.

Remember that you're not alone

You can connect with other women suffering from PMDD by joining support groups online or in your community, so as to learn more about this condition and not feel like you are completely alone.

It is also highly recommended that you seek help from a healthcare professional so you can get properly diagnosed, start a course of treatment, and hopefully no longer have to suffer each and every month.

PMDD can put a strain on friendships and relationships due to your unpredictable moodiness; it can affect your job.

The pain makes it hard for you to move. In truth, there are days when you just physically do not have the strength to get out of bed; it also cuts down your self-esteem and makes you think you are ugly and worthless.

In some cases, PMDD makes you question your ability to be a good parent when it causes your level of patience to drop drastically while your irritability skyrockets; and it certainly takes a toll on your emotional and physical health as there is an alarming number of symptoms that go along with this rare disorder.

But you shouldn't feel ashamed about having this medical condition, nor should you let it define who you are.

It is important that you learn more about PMDD and get the help that you need so you can finally get your life back!

ALSO READ: I asked experts how best to prevent breast cancer after my own mass was found

This article was first published in theAsianparent.