PMDD and Menopause: What is it and why is it worse in perimenopause?

Premenstrual dysphoric disorder (PMDD) and menopause can be severe enough to disrupt work, daily life, and relationships. Emotional, bloated, quick to anger, insatiable appetite for sugar or carbs … the signs of premenstrual syndrome or PMS are probably pretty familiar to most of us. 90 percent of us may deal with the monthly roller coaster of PMS, and most of us are able to ride it out with ibuprofen and some quality alone time.

However, around 5 percent of women have a much rougher time with a more aggressive form of PMS called premenstrual dysphoric disorder or PMDD.  

What’s PMDD and what does it do to my body?

After ovulation, hormone levels decline. This week or two before the period are known as the “luteal” phase. This decline of hormones can trigger the physical and emotional symptoms that are the hallmark of PMS and PMDD.

During this phase, women may experience menopausal fatigue, irritability, sadness, anxiety, mood swings, poor concentration, sleep issues, and food cravings. Physical symptoms can include getting bloated, cramps, sore breasts or tenderness, hormonal acne, and headaches.

Usually the onset of menstruation signals the end of PMS or PMDD for now, and the cycle begins again.

How are PMS and PMDD different?

PMS and PMDD are very similar in the symptoms women can experience. What differentiates them is a matter of degree.

For most women, PMS is uncomfortable and unwelcome, but it’s manageable. Over-the-counter medications like Midol plus a hot water bottle and some patience are often enough to ride it out.

PMDD is characterized by the severity of symptoms and the disruption it causes in a woman’s life. Women suffering from PMDD are far more likely to need to miss work due to symptoms or to have difficulty in their relationships.

While the exact mechanism of PMDD isn’t really known, it’s thought that a small percentage of women are more sensitive to the hormonal changes going on in their bodies.  

If you know someone with PMDD symptoms

Thank you for taking the time to seek out information. PMDD sufferers are often dealt a double blow: heightened hormone sensitivity and dismissal from friends, family, even doctors. It's important that you listen carefully to what this woman in your life is telling you. 

You may feel helpless every month, but you're not.

1. Be empathetic. Try to imagine going through this yourself and what you'd want from your partner or friend.
2. Try not to draw extra attention to her symptoms. Definitely don't do this in front of others, but probably avoid it even if it's just the two of you. Though it shouldn't, PMDD can make women feel humiliated and ashamed. If she's eating odd foods, dealing with bursts of anger or sadness, feeling overwhelmed and unsocial, you can be sure she knows it and doesn't need it pointed out. Depending on the woman, making jokes may or may not help, so let her take the lead and follower her example.
3. Gently offer help. If you think she may not be aware of PMDD, it could be really helpful for her to get a diagnosis. If she has PMDD now, her perimenopause and menopause could be worsened, so awareness and treatment now could be even more critical later. Email her this article or better yet, suggest she connect with a menopause-specialist OB/GYN to help her understand her options (lifestyle and/or medication) that can really help alleviate her symptoms. 

How is PMDD diagnosed?

There aren’t really tests that tell a woman she’s experiencing PMDD; generally it’s diagnosed by the presence of symptoms and whether or not those symptoms occur regularly and at particular points in her cycle.

If a woman experiences at least five of the following symptoms, during “most” menstrual cycles, for one year, she is suffering from PMDD. [quoted from HopkinsMedicine.org]

• Depressed mood
• Anger or irritability
• Trouble concentrating
• Lack of interest in activities once enjoyed
• Moodiness
• Increased appetite
• Insomnia or the need for more sleep
• Feeling overwhelmed or out of control
• Other physical symptoms, the most common being, breast tenderness, headache, menopause gas and bloating

Additionally, symptoms interfere with a woman’s social, home, or work life and are not caused by or worsened by another medical condition, such as thyroid disease.

Perhaps the most important thing to understand is that PMDD is real and it is biological as well as psychological. Women with PMDD may have an issue with neurotransmission during parts of their cycle. Feel-good neurotransmitter serotonin appears to be compromised in women with PMDD, and other brain chemicals are also suspected to play a role in the development of PMDD.

Is it really worse in perimenopause?

Both PMS and PMDD can worsen during the years of perimenopause. The symptoms may be more severe, and as periods become increasingly irregular, symptoms can be more frequent and certainly much less predictable, making PMDD harder to manage.

Fortunately, PMS and PMDD generally resolve in menopause, when hormones finally level out and the body adjusts to its new normal. However, that doesn’t mean women have to suffer with disruptive symptoms for years, waiting for the end of periods.

How to treat PMDD

There are lifestyle changes that help women with PMDD symptoms, and they’re the usual line-up: good sleep, no smoking, exercise (this is particularly important), and reducing alcohol, coffee, sugar and salt. Women are also encouraged to track their PMDD symptoms against their cycles, though in perimenopause, that may not be as useful as it is for women whose periods are still regular.

According to the MGH Center, adding supplements of calcium, Vitamin B6, magnesium, and Vitamin E may help ease symptoms. For those looking for herbal remedies, chasteberry seems to be the most useful.

For medications, the first option may be SSRI antidepressant, which can be effective against physical and psychological symptoms, even in low doses.

Alternatively, many women find relief with oral contraceptives like the Pill. As a last resort in very extreme cases, a doctor may recommend a hysterectomy with an “add-back” of the hormone estrogen.

If you’re experiencing new or worsening symptoms, and they’re impacting your quality of life, talk with a doctor. PMS and PMDD are very real medical conditions, and PMDD really should be diagnosed properly by a menopause specialist so you can determine a course of treatment.

Talk to your doctor or make an appointment to consult with one of Gennev’s physicians via our telemedicine service.

We can help you manage PMDD

• Meet with a Gennev board-certified gynecologist who is a menopause specialist - There are treatments and behaviors that can make a real difference to a woman’s experience of PMDD. Our doctors can offer a trusted opinion, determine if medication is right for you, and provide prescription support.  
• Try Vitality – the #1 daily multi-vitamin supplement for women aged 40+. It is packed with nutrients that support your whole body including mood, energy, stress response, immune health, joint pain, and inflammation. 96% of women report having more energy after just 2-weeks with Vitality.
• Magnesium is super-power supplement for women in menopause. It can help support your PMDD symptoms. It relieves joint pain, muscle cramps, Restless Leg Syndrome, headaches, depression, fatigue, anxiety and supports better sleep.

 The information on the Gennev site is never meant to replace the care of a qualified medical professional.  Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev's telemedicine doctors before beginning any new treatment or therapy.