What Is PMDD?

Against an emotionally tumultuous year, the only pillar of stability I could return to every month—my period—started to feel a lot less stable. While I tried to endure the pain, I couldn’t reconcile it with my unease. I consulted the altar at which I worship, Google, where I was confronted with an acronym: PMDD. Premenstrual Dysphoric Disorder, or PMDD, refers to a group of emotional and physical symptoms that begin a week or two before your period. While similar to Premenstrual Syndrome (PMS), sufferers of PMDD are often unable to function at their normal capacity while the symptoms are present. These range from each individual but are typically present during the week before menstruation and include: severe fatigue, mood changes, emotional sensitivity and crying, heart palpitations, paranoia, dizziness, fainting, sleeplessness, backaches, hot flushes, and muscle spasms. Given that the symptoms are so vast and varied, PMDD is difficult to diagnose—there’s no conclusive test. Instead, doctors must rely on patient history and careful recording of each individual’s cycle, particularly the week before it begins. Melbourne-based psycho-sexologist Chantelle Otten is a vocal, empathetic, and open health practitioner who has dipped and dived through the same ambiguity I did, before being diagnosed with the condition herself. I asked her what every uterus-haver should know about PMDD.

How did you come to be diagnosed?

I’ve suffered PMDD for several years unknowingly, but only really realized what was going on when my partner approached me about it. He could tell I was behaving in a way that was so different to how I normally do. He realized I was unhappy and just not feeling good in general. He encouraged me to consider going to the doctor to figure out what was going on. PMDD really wasn’t taught to me during my studies... I had been able to identify that the symptoms were coming up in the ten days before my menstruation.

"Since talking to my friends, I’ve been able to strengthen my support network and not feel guilty if my PMDD has its day."

I’m very fortunate to have a great female health practitioner. I explained to her my symptoms, that I didn’t feel like this full-time but definitely in the ten days leading up to my period. I explained I was having quite severe mood swings, irritability, bloating, and tender sore breasts and that it was driving me crazy. I wasn’t a very nice person. Right away she said: “I definitely think that you’ve got PMDD.”

PMDD isn’t widely understood by many specialists. How can someone approach their health practitioner feeling empowered, rather than fearful of having their suspicions dismissed?

Be mindful with what’s happening in your mind and to your body. It’s definitely worth downloading an app like Clue to track your cycle so you can start to notice what’s going on in your body in terms of your symptoms. Asking those close to you to tell you what they notice when it is that time of the month is another great way to keep track of what changes (if there are any) that happen. Start documenting all of the above to see if a pattern appears so you can approach your doctor with an arsenal of information.

What treatment has worked for you and what advice do you have for others considering alternative treatments?

Since being diagnosed, I have been able to remind myself that I can take action towards this and really seek help. In terms of medication there are antidepressants which you can take for ten days of the month, or there is the Pill. I chose antidepressants because most of my symptoms were really psychological and so it regulates those emotions slightly to make me feel more in control. It has changed my life and my relationships. I’ve also started seeing a kinesiologist and I’ve found this has benefited me immensely by helping to change my mindset and even out the way that I’m feeling. Lastly, I think the simple act of talking to those close to you is crucial. I didn’t really talk to my friends about how I felt before I was diagnosed. I had such an exhausting cycle mentally that led me to be very harsh on myself and so would hide away from those around me. Since talking to them, I’ve been able to strengthen my support network and not feel guilty if my PMDD has its day. I can have my family understand if I can’t make it over to dinner because I’m so tired, my partner can be here to help me and take care of me and know that it is his time to shine when I’m having a rough week. I always tell my patients: You can be kinder to yourself.

How can you continue to be kinder to yourself while maintaining sexual intimacy?

There are so many ways how you can keep your sexual intimacy going. First, tell your partner/significant other how you’re feeling. Communication is the way forward in every intimate setting and relationship (sexual or otherwise). If you want to have sexual intercourse, I think it’s great to have a good toy to use such as a good clitoris stimulator. When you have orgasmic experiences, you release a lot of endorphins that can reduce stress in your body, changing your mood. Lastly, I think it’s important to say to your partner, “I may or may not feel sexual desire this week but I will try to have responsive desire.” For example, “I would love it if you gave me a massage or maybe we could just kiss or maybe I can treat you this week.” Make sure you keep the focus on intimacy rather than on penetration or orgasm. It’s important to have sexual satisfaction and pleasure rather than having a goal-oriented point of view.