Dr Michelle O'Driscoll: Let's talk about premenstrual dysphoric disorder

MANY women can relate to the term ‘pre-menstrual syndrome’ to a certain extent – the time leading up to your period when you may feel irritable, tired, and low in mood.

Hormonally linked, the body adjusts to the rapid change in levels around this time, and within days of our period starting, we’re generally back to feeling productive, energetic and lively.

Some degree of this experience is normal. Some women can experience it mid-cycle also, around the time of ovulation. It’s expected and understandable.

But, like everything, the clincher is when it’s impacting adversely on how you live your life. How bad are the mood swings for you? How low does your mood go? How intrusive are the negative thoughts? There comes a point where continuous experiences like this, when parts of each month are written off due to not being able to function in work or at home, are just not sustainable, particularly if symptoms are very severe.

Premenstrual dysphoric disorder is like premenstrual syndrome, but much worse. It occurs between the time you ovulate and when your period starts, known as the luteal phase. It causes anxiety, depression, fatigue, difficulty concentrating, and physical symptoms such as bloating, headaches and breast tenderness. Skin and the tummy can also be affected.

This disorder typically affects women from the ages of 15 to 35, and can worsen over time until the menopause. 

It is thought that genetics play a role, and that it’s over-sensitivity to the hormonal change that leads to the symptoms.

Tracking symptoms in a diary for a few months can reveal the link between the mental health impact and your cycle. Urgent medical attention is needed in these cases where low mood or anxiety become a significant issue.

Lifestyle changes and sometimes medication can help keep the symptoms under control, and the appropriate mental health supports should be sought.

Reaching out to a specialist organisation such as the International Association for Premenstrual Disorders (IAPMD) can provide helpful information, or finding peer support in online groups can make you feel less isolated in your experience.

Changes in diet to boost the amount of protein and carbohydrates available to us, and decreasing sugar, salt, caffeine and alcohol intake can help to re-establish some hormonal balance. 

Exercising regularly is key for mood boosting, and minimising stress where possible helps.

The types of medications that can be considered include birth control pills for their hormonal effects, or selective serotonin reuptake inhibitors daily, or just during the luteal phase, to increase the amount of serotonin available for helping with mood. Whether or not these are suitable options for you should be discussed with your doctor or pharmacist.

Dosing can change throughout the course of treatment. Trials of different approaches can be taken to see what works for you.

PDD is a serious condition, and often a life- altering one. It’s vital to seek the appropriate support and treatment, to prevent up to half of every month being hijacked by it, and improve your quality of life.