Written by Nadine Evans, Registered Psychotherapist
Nadine Evans is a psychotherapist dedicated to helping those with menstrual-related issues, including PMDD. Her book, Mastering the Monthly Madness provides a DBT framework for PMDD and severe PMS management. She is the founder of Impart Therapy, a virtual therapy service that offers PMDD, ADHD, anxiety, and depression treatment.
Yesterday, a sufferer reached out to me, wondering if I can diagnose her for suspected PMDD. Unfortunately, due to licensing restrictions, I cannot diagnose, and I sent her some self-screening information. She let me know she has taken every online assessment she can, including the one I had sent her. Despite positive self-screening results and her regular cycle tracking, her doctor refuses to accept her suspected diagnosis.
Alas, she is not the only one.
When I ran my first PMDD support group in February of 2023, one of our participants had just been to the doctor earlier that day, who informed her that PMDD was not a thing. When I advertised for my second group offering, I had a comment from a therapist admonishing our work as “pathologizing” something as natural as menstruation, questioning if this group was funded by big pharma (We are not. As mentioned, therapists do not diagnose, and you can be very certain we cannot prescribe medication of any type).
Disappointing, to say the least.
PMDD (Pre-menstrual dysphoric disorder) is a severe form of PMS that causes anger, depression, anxiety, irritability, tension, and suicide ideation, as well as physical symptoms such as fatigue, migraines, and body aches, that occur in the luteal phase of one’s cycle (the time between ovulation and the start of one’s period) and generally disappears by day four of onset of menstruation. This disorder severely disrupts one’s quality of life during this time, impacting sufferers’ ability to work and function. When Premenstrual dysphoric disorder was added to the DSM-V in 2013 (upgraded from the Appendix of the DSM-IV), and then to the International Classification of Diseases (ICD) in 2019, it further legitimized the disorder, or so we thought.
While more awareness and understanding are out there than even existed a few years ago, women’s health conditions continue to be challenged by patriarchal healthcare norms, including that women’s cycle-related mood fluctuations are absolutely normal and to be endured.
Trivializing PMDD is dangerous
The International Association of Pre-Menstrual Disorders (IAPMD) reported a recent UK based study of nearly 600 sufferers, noting that suicide ideation was at 86% of respondents, and a shocking 30% had made a suicide attempt, which they report as 50% higher than those that suffer from major depression. Further, respondents share that as a direct result of their PMDD, they have lost romantic relationships (57%), experienced issues with parenting (42%), and been fired/laid off from their jobs (17%). Astoundingly, they shared that the average time to receive a diagnosis was 12 years.
When medical professionals are indifferent to PMDD sufferers, it minimizes our struggles, sending us a frustratingly familiar message: our health struggles do not matter.
Sadly, I was no different. When diagnosed in 2016, just three months shy of my 40th birthday, I grumbled a little and refused the antidepressants offered to me, convinced mood medications would make me weak and even worse, a cliché. The doctor explained this PMDD thing was in the DSM-V, some term I’d vaguely heard before. I left any curiosity and questions I had at the doctor’s office, taking no initiative other than a birth control pill. When blind rage overtook me three to four times a year, I opted to indulge in self-loathing and shame until my follicular phase (the good part of my cycle) came and brought me blissful emotional relief.
My reckoning came three years after my diagnosis, during one desperately difficult luteal phase, amidst a bout of physically and mentally draining period of work-related travel and stress. On a rough fall morning, my suicidal ideation graduated to planning, as I contemplated drowning myself in my backyard pool. In those brutal hours, I couldn’t see the future, any reason to remain here, or tap into any logical part of my brain.
Days later in the safety of my follicular phase, safe from harm but shaken by the knowledge that my PMDD symptoms had very nearly taken my life, I swore to myself I would finally take it seriously. This led to medication (a daily SSRI – taken throughout my entire cycle, rather than during my luteal cycle which is a common option for PMDD treatment), holistic treatments like vitamins and supplements, talk therapy, regular exercise, and most of all, finally understanding that I have a life-threatening illness that needs to be understood and managed.
It is time for everyone – the medical community, employers, and even sufferers themselves – to give PMDD the respect it deserves. It is a debilitating condition causing significant distress to those who suffer. While inroads are being made in awareness (social media groups are now plentiful, and a quick PMDD group search on Facebook shows dozens of groups including PMDD groups in Ireland, Australia, and Scotland, as well as spousal PMDD groups, and even a Christian women PMDD support group. The largest group hosts more than 23,000 members), and workplace support and advocacy is starting to emerge, but we have so far to go. PMDD, while a new(ish) term, is not new, and given its correlation with ADHD and ASD menstruators, is likely going to grow in diagnoses as more and more of us are taking our mental and physical health seriously.
Read more from Nadine Evans
Nadine Evans, Registered Psychotherapist
Nadine Evans spent 25 years in the corporate marketing world, but since her diagnosis of PMDD, she has transitioned into psychotherapy to help. She is a registered psychotherapist trained in DBT, CBT, ACT, and EMDR, and her book, "Mastering the Monthly Madness," offers practical advice on how to deal with pre-menstrual dysphoric disorder (PMDD) and related premenstrual issues.
