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Alison Printz, LSW on Premenstrual Dysphoric Disorder

Alison Printz guides the latest issue of Waiting Room.

FROM ALISON PRINTZ
Are you someone who strongly sensed your Premenstrual Syndrome (PMS) was more severe than others? Maybe you experienced such intense spikes in anxiety, depression, or physical discomfort before your period that you were prescribed birth control pills or have often taken days off of work or school. The hormonal changes that come with your menstrual cycle can have a significant impact on mood and physical health because they cross our “blood-brain barrier,” thereby affecting all parts of the body. For some people, these hormonal changes are so impactful that they create intense distress. 

One of the classifications of hormone-related mood disorders is known as PMDD, or Premenstrual Dysphoric Disorder. A study from April 2021 found that 3-8% of menstruating women experience PMDD, which is categorized as a severe form of PMS. Symptoms typically occur between ovulation and the first day of menses, and can be physical or psychological, such as bloating, cramping, and breast tenderness; irritability, tearfulness, insomnia, and low mood. PMDD is thought to be caused by changes in hormone levels during the second half of the menstrual cycle, from the time of ovulation until one gets their period. Across gender identities, people with PMDD report worsening symptoms just before their period.  

If this resembles your experience or the experience of loved ones, know that you aren’t alone, and you don’t have to “just deal with it.” Tracking your cycle is a helpful first step to know which days you may not be feeling quite like yourself. Another step is writing down what you’re experiencing each day, both mentally and physically. This can include capturing any distressing events or thoughts; anxiety, depression, or insomnia; and bloating, cramping, constipation or diarrhea, to name a few. This can provide a better sense of what your symptoms are, and when they occur within your cycle. With this information, you can then consult with a therapist, gynecologist, and/or psychiatrist to determine whether PMDD might be an appropriate diagnosis for you, as well as next steps for treatment. When symptoms peak, remember to get plenty of sleep, be active, and make sure you’re taking the time to rest in whatever capacity works best for you. 

Remember that just because nearly half the population menstruates doesn't mean that your distress is a sign of weakness, or that you (or others) should minimize it. Society may not like to talk about periods, hormones, and menstruation, but you are not alone in this experience, and providers trained in reproductive health (mental or physical) can help.

TIP OF THE WEEK
Turning Down the “Noise”
Do you find that when you’re anxious before your cycle that you cannot seem to quiet your mind? A tip I give to all of my clients is dump journaling. When you find yourself in a space with many swirling thoughts, simply write them all down on paper. The act of writing and noticing your thoughts on paper has been proven to help manage anxiety and reduce the mental energy used to track and respond to them. In seeing them externalized, you can choose where to direct your attention—perhaps releasing some thoughts, or revisiting others to evaluate in relation to others. Writing can help make space between your thoughts and behaviors so you feel more relaxed, and in turn, less anxious.

Alison Printz is a Licensed Social Worker, an advocate for reproductive mental health, and passionate about women’s mental health among all life stages. Alison hopes to bring awareness and accessibility to mental health care to all those who identify as women.

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This article is not therapy or a replacement for therapy with a licensed professional. It is designed to provide information in regard to the subject matter covered. It is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, seek the services of a competent professional.

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