A silent struggle

Q. Doc, I am a 29-year-old unmarried girl who was recently diagnosed with PMDD. I've been dealing with mental and physical health concerns for as long as I can remember, ever since my periods started, but no one paid attention until I recently met with a psychiatrist who heard me out completely. I feel both thrilled and saddened by this diagnosis. I wish to raise awareness about it so that others can benefit from the information. Kindly offer your feedback and recommendations.

Facts: PMDD affects up to 6 per cent of women of reproductive age. It is often undiagnosed and overlooked.

That time of the month can be dreadful for many. Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS) that causes a range of emotional and physical symptoms every month during the week or two before your period. It is sometimes loosely referred to as ‘severe PMS', and is now diagnosed as “PMDD”.

When: PMDD develops during the luteal phase of the menstrual cycle. This is the time between when one ovulates and when the menstruation begins. Most people experience the luteal phase for around two weeks, but it can last longer or shorter.

Why: Although the specific etiology of PMDD is unknown, hormonal variations are thought to play an important role. Estrogen and progesterone changes during the menstrual cycle might affect neurotransmitters such as serotonin, contributing to mood problems in PMDD.

The impact on individuals: PMDD is a genuine diagnosis. PMDD patients experience PMS symptoms (bloating, headaches, and breast tenderness) as well as affective disturbances (extreme anxiety, despair, and mood swings). Some people with PMDD become suicidal.

PMDD criteria as per ICD-11:

Over the course of a year, during most menstrual cycles, five or more of the following symptoms must be present:

· 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 belly bloating, breast tenderness, and headache

· Symptoms that disturb your ability to function in social, work, or other situations

· Symptoms that are not related to, or exaggerated by, another medical condition.

What to do?

PMDD is a severe, chronic illness that requires treatment. Several of the following therapy options may help to alleviate or reduce the intensity of PMDD symptoms:

• On your own: working on a balanced lifestyle is key.

• Specialist: A gynecologist may aid with the first diagnosis. Even MHPS (mental health professionals), such as psychiatrists, play an important role in gathering histories and making diagnoses. The former's management may center on OC tablets and lifestyle modifications, while the latter may recommend a combination of medicine (such as SSRIs), therapy, and lifestyle changes.

• Physical: Regular exercise, including yoga, weightlifting, and aerobics, can improve physical health.

• Diet: Change the diet to enhance protein and complex carbohydrates while decreasing sugar, salt, caffeine, and alcohol.

• Mental health: seeking therapy for mental health needs.

Controversy with the diagnosis of PMDD: In 2022, PMDD was added as a true diagnosis to the ICD-11. On the one hand, patients, psychiatrists, and the drug industry pushed hard for this diagnosis. On the other hand, a few psychologists, feminist scholars, and generalists were against it because they thought it would over diagnose and pathologize normal hormonal changes. They thought it was an unfair way to silence women and to label normal parts of life as mental disorders and that a diagnosis of PMDD could be used against women and hide the real reasons why they are upset and angry.

Giant leap for womankind: In 2022, Congress MP from Kerala introduced The Right of Women to Menstrual Leave and Free Access to Menstrual Health Products Right in a bill that proposed paid leave and absence from work for three days during menstruation in any establishment registered with the government. This was the first of its kind in India. Major MNCs in our country have also considered offering female employees this leave.

April has been celebrated since 2013 as PMDD Awareness Month to raise awareness and build advocacy for Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME) of underlying disorders. Let us try our best to be inclusive and empathetic towards all.

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