Premenstrual Dysphoric Disorder: Why We Need to Talk About It

Shelha Rashid spoke about possibly suffering from Premenstrual Dysphoric Disorder or PMDD. What is it?

A Twitter thread started by a young activist from JNU, Shehla Rashid, started a conversation about a condition that is rarely discussed and can be devastating for those suffering from it.

The young activist spoke about having suicidal thoughts a day before her periods hit, thoughts serious enough for her to go looking for means of taking her life on the internet. She stumbled across the term Premenstrual Dysphoric Disorder or PMDD.

There was an outpouring of response to her thread, with many women sharing their experiences. The thread is shared below.

Okay, so, I've decided to share a deeply personal story on Twitter, even though I know that Twitter isn't kind at all. But I'm sharing this personal story in public interest, hoping it might reach someone who needs to hear this. (1/n)

— Shehla Rashid (@Shehla_Rashid) September 23, 2018

Before We Understand PMDD...

Before we get into understanding Premenstrual Dsyphoric Disorder, let’s first try and understand what Premenstrual Syndrome or PMS is.

There’s an issue right there. PMS is not a clearly defined syndrome. Researchers have identified as many as 150 symptoms that fall in this category.

A 2011 study in the Journal of Women’s Health stated that 20 percent of menstruating women have PMS that affects their life enough for them to seek help for it. Most just live with the pain, dealing with the symptoms as they come.

In fact doctors themselves admit there is a lack of seriousness when it comes to dealing with patients who may have PMS.

So how do you diagnose PMS?

• If symptoms like depression, insomnia, and extreme fatigue are recurring (for at least two menstrual cycles).
• If the onset of symptoms is around ovulation and they significantly disrupt your life.
• If these symptoms disappear within five days after bleeding begins, you may have PMS.

What is PMDD?

There is a form of PMS that is more serious. Premenstrual Dysphoric Disease or PMDD has been recognised as a mental health disorder by American Psychiatric Association’s Diagnosis and Statistical Manual of Mental Disorders.

According to Mayo Clinic:

The cause of PMDD isn’t clear. Underlying depression and anxiety are common in both PMS and PMDD, so it’s possible that the hormonal changes that trigger a menstrual period worsen the symptoms of mood disorders. Treatment of PMDD is directed at preventing or minimising symptoms and may include antidepressants.

Is it possible that patients who have PMS, their condition may progress to become PMDD? In an earlier interview with FIT, Dr Nikita Sobti, a gyneacologist at Max Hospital, Gurgaon, spoke about lack of data and lack of treatment.

The problem is that we lack data in India. We, as doctors, are also not trained to deal with PMS as a serious condition that requires attention. If it’s left undiagnosed and untreated for long, if the feel good hormone (seratonin)  is not being secreted in the brain and cycle after cycle a person goes through this, it can progress to PMDD. Are we referring these cases to psychiatrists? Is there enough follow up?

While the exact reasons for PMDD are not clear, some studies say PMDD may be caused by low levels of seratonin, the chemical that controls mood, sleep, pain and attention.

These symptoms usually start a week before menstruation begin and end soon after, or along with the duration of the period.