‘It’s not PMS’: Shining a light on premenstrual dysphoric disorder

Evelyn Lewin

8/10/2019 3:23:50 PM

The disorder was recently added to the WHO list of diseases, yet latest preliminary findings show it takes an average of 12 years for an Australian woman to be diagnosed.

Distressed woman
Premenstrual dysphoric disorder affects around 5–10% of women.

Lynda Pickett was 35 when she realised something was wrong.
After having her first baby, she spent a year breastfeeding. It was when she weaned her baby and her periods returned that the problems began.
Lynda describes herself as normally being a high-functioning individual with a ‘pretty relaxed attitude’.
But when she was premenstrual, all that changed.
‘I was finding that for the couple of weeks leading up to my period I was keyed up and on edge, very irritable, highly strung, everything was intensified,’ Lynda told newsGP.
‘I would have a panic attack like clockwork on the day before my bleed each month.
‘I’d have uncontrollable crying that I could compare to the “baby blues”. It felt very hormonal.’
Lynda began tracking her moods along with her menstrual cycle and, when she saw a correlation, she booked in to see her GP.
‘The fact that I could function perfectly well for two weeks out of four, and there was a pattern to it, made me know it was biological,’ she said.
That said, Lynda did not think she had premenstrual syndrome (PMS).
‘I knew this was much more severe than that,’ she said.
And yet, after explaining her symptoms to her GP, that was the diagnosis she was first given.
‘I was told, “Everybody experiences PMS and that sounds like what you’re experiencing”,’ she said.
Lynda was then advised that, if her symptoms persisted, she should return in four weeks.
This pattern repeated for months, during which time Lynda’s doctor ordered blood tests, all of which came back normal.
‘My doctor explained to me that my results were normal and that was the end of the investigations,’ she said of the appointment she had with her GP six months after her initial presentation.
From there, Lynda was told she could be referred to a psychiatrist for her mental health, or go to see a psychologist.
‘And that was really going to be it,’ she said.
Distraught, Lynda began sobbing uncontrollably.
‘[My GP] said, “Why are you crying? Were you hoping that we’d find something?” And I said, “Yes. I truly believe this is a hormonal thing”,’ Lynda said.
It was at that stage that Lynda’s GP reached for a handbook and read aloud a description of premenstrual dysphoric disorder (PMDD).
‘And I said, “Yes, that’s got to be it”,’ Lynda said.

‘I would have a panic attack like clockwork on the day before my bleed each month,’ Lynda said of her symptoms of premenstrual dysphoric disorder.

While it took six months for Lynda to receive a diagnosis of PMDD, she considers herself lucky.
That is because, she said, preliminary findings from the 2018 Global survey of PMDs found it takes an average of 12 years for an Australian woman to receive this diagnosis. (While newsGP has viewed this data – developed by International Association for Premenstrual Disorders, Vicious Cycle and Me V PMDD – it has not yet been released for publication.)
‘Had I not persisted, and kept coming back and kept badgering and saying, “something’s not right”, I may have just been left to my own devices and I may have spiralled,’ Lynda said.
Since receiving a diagnosis of PMDD, Lynda has become passionate about sharing her knowledge of the condition.
She hopes to dispel many of the myths that surround PMDD, chief among them that the condition is just a form of PMS.
‘PMDD and PMS are not the same thing,’ Lynda said.
She said PMS is common (affecting 80% of women), mainly physical, and can be ‘bothersome’; PMDD, on the other hand, is less common (affecting around 5–10% of women), severe, mainly psychological, and can be ‘devastating’.
‘It will negatively impact on the person’s ability to function when affected,’ Lynda said.
‘They will have difficulty working, studying, maintaining interpersonal relationships and engaging in social interactions during the time they’re affected.’
Lynda said she understands how PMDD can be misdiagnosed, as it ‘mimics’ other conditions. But she also worries that women with the condition are being dismissed as ‘just having PMS’ or ‘just being stressed’.
In order to avoid misdiagnosis, Lynda hopes that every time a GP sees a woman with a mental health issue, they also enquire about menstrual cycles.
Lynda is glad to see that, in recent years, there has been growing recognition of PMDD as a medical condition.
This includes it being recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classification in 2013, along with its inclusion in the World Health Organization International Classification of Diseases and Related Health Problems (WHO ICD) in June this year.
As the condition gains recognition, Lynda hopes this information is used to help women who present with PMDD secure an earlier diagnosis and access appropriate treatment.
She also hopes healthcare providers who want to learn more information on PMDD seek out resources such as the International Association for Premenstrual Disorders.
‘PMDD is real,’ Lynda said. ‘We can no longer say there’s not enough research, or that it’s not real.
‘It’s time for GPs to have this included in their training and if they’re not trained in it, they need to upskill or train in it.
‘We need better treatment. We need better care.’

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menstruation PMDD premenstrual dysphoric disorder premenstrual syndrome

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Dr Peter James Strickland   9/10/2019 11:48:16 AM

This is an amazing decision. There has always been a backlash from women about considering PMDD as a "disorder" or 'disease'. It is the whole argument why there is actually a large variation between men and women biologically, and why certain employment and activities have to be limited on the basis of that biology. Frontline and elite soldiers (as an example) should not be women, and simply because of this cyclical dysphoria caused by hormonal variation, and also because the OCP also changes womens' behaviour and function. In many areas of responsibility PMDD would be frankly dangerous for the sufferer, and those around her, and as seen in patients by me over 50 years. PMS and PMDD actually are the same disorder --it is a matter of degrees of disability.

Dr Bahman Ranjbar   9/10/2019 12:37:16 PM

Despite my interest to involve women in all daily responsibilities and governing I beloved
Dr Peter James Strickland’s concern needs to be investigated.
It may change the method of consultation in family planing and partners argument managements.
More information to General practitioners will be helpful to provide a better explanation to affected patients. Now that We are aware of PMDD, We can understand better about few of patient’s condition. Therefore, we may be able to provide appropriate management to create a safer environment for children and prevent parents separations.

Dr Tawhid Mohamed Sayed Hassanien   9/10/2019 12:55:59 PM

I wonder if PMDD is just on the other end of a spectrum of PMS , or is it a completey different entity as the article implies ?

Dr Dominique Elizabeth Coleman   9/10/2019 5:37:04 PM

It is interesting that you , Dr Strickland, appear to have used the above article to fuel your prejudice about women holding certain positions.

Dr Emma Coldwell   12/10/2019 7:42:53 AM

It is Dr Strickland who needs to be investigated, not his "concerns".

However, his sexist comments are a nice example of my main concern with these ideas of PMS and PMDD. There is (not surprisingly) a lack of quality research in this area, and what research does exist suggests that 1. PMS is a cultural phenomenon and 2. women have legitimate grievances that are largely unheard and 'PMS' gives them the framework to vent.

Either women are irrational creatures at the mercy of hormones to such an extent that they are potentially a danger to themselves and others, or they are not. Hint: they are not.