That time of the month. A visit from Aunt Flo. Moon time. These are common phrases that you may have heard which refer to a woman’s menstrual period. Despite the ongoing research that has gone into the intricacies of the female reproductive system and the menstrual cycle, there is a darker side of the latter that has not been explored enough and that is Premenstrual Syndrome.

There are many different signs and symptoms of Premenstrual Syndrome (PMS), including mood swings, sensitive breasts, food cravings, exhaustion, irritability, and sadness. Most women – over 90% as outlined in the Office on Women’s Health’s website (An official website of the United States government) – say they experience some premenstrual symptoms and some of these have become a norm every month for most women. Clinically significant symptoms can be both somatic and psychological and occur during the luteal phase of the menstrual cycle, which is the second half of the cycle beginning on the day of ovulation and ending on the first day of a woman’s period.

Although the exact cause is unknown, hormone changes that occur during the menstrual cycle are most likely to blame. The severity of these symptoms spans a wide range, and on the extreme end of this spectrum lies Premenstrual Dysphoric Disorder (PMDD). It is a more severe variation of the PMS and has been classified as a mental disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There is not a lot of research on the area despite the debilitating impact that it has on the lives of women who experience it. An association between a history of trauma and PMDD has been documented in some research. According to one study by Axel Perkonigg and others, published in the Journal of Clinical Psychiatry, there is a strong link between childhood trauma and PMDD, with early sexual abuse making it 6.7 times more likely for a woman to develop the disorder.

Numerous symptoms of PMDD and PMS are similar, but the former’s symptoms are more severe. A Global Survey of Premenstrual Disorders that was undertaken in 2018 uncovered that 34% of women who have premenstrual dysphoric disorder had attempted suicide. This is related to the fact that one of the symptoms of PMDD is suicidal ideation. This is concerning given how frequently PMDD is misdiagnosed or not identified at all. Since it is a mood disorder, the use of blood tests and the like in directly diagnosing an individual may not be possible, but below is a guideline outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which may help in establishing the possibility of having the condition:

Between ovulation and your period, you must experience five or more serious symptoms (listed below).
These symptoms ought to disappear throughout your period and not reappear for at least a few weeks after your next luteal phase begins.
Your typical social activities, your connections with family, friends, and/or co-workers, as well as your ability to work or study, must all be affected by these symptoms.

You must have one of the following symptoms:
Very labile moods like mood swings, increased sensitivity to rejection, and/or sudden sadness or tearfulness
Marked irritability or anger
Depressed mood
Marked anxiety and tension

And lastly, you must have 5 of the following symptoms:
Difficulty concentrating
Lack of energy
Overeating or food cravings
Changes in your sleep habits
Feeling overwhelmed or out of control
Physical symptoms like breast tenderness or swelling, joint pain, muscle aches, bloat, or weight gain

A precise diagnosis can only be made by a medical professional. This will frequently require you to keep a record of your symptoms over several months in order to establish the relationship between them and your menstrual cycle. Additionally, blood tests could be used to rule out other potential causes of the symptoms. The first step to feeling better is getting an accurate PMDD diagnosis because the best course of treatment for treating the hormonal shifts and fluctuations that produce these symptoms is getting medication.

Due to the rarity of this condition, women frequently report feeling ignored and not being taken seriously when discussing it with their doctor; seeking a second opinion is always the best option in this situation. An article in The Recovery Village that was medically reviewed by Paula Holmes, reported that 6 million, or 1 in 20 women worldwide struggle with PMDD. Considering that the condition goes undiagnosed for plenty of women it is plausible that the numbers are higher. Raising awareness about PMDD is one of the ways we can help these women have their voices heard and kickstart their journey of learning how to live with Premenstrual Dysphoric Disorder.

Tell us: Are your PMS symptoms mild, moderate, or severe?