When I told my psychiatrist six months ago, he said it could be related to my anxiety, contemplated that it could be borderline or bipolar disorder. This prompted her to start maintaining a journal and noting down when she would have the peaks and dips in her mood. The 36-year-old had come across PMDD before while reading up on mental health. Malvika was diagnosed with PMDD three months ago by her therapist, about two years after her symptoms started showing. I would have extreme anxiety and depression,” she says. Everything that I worked towards would get derailed in that week. My crying spells would increase, especially before going to sleep at night… they’d sometimes last for an hour and a half or more,” she narrates. There would be no external trigger but I couldn’t help it. “I would go to sleep, feeling okay, and wake up the next morning to a feeling of doom – very immediate and very big – seven-eight days before my period. For instance, Delhi-based Malvika* felt that everything she had worked on and towards for the rest of the month, would fall apart during the week before her period. PMDD can affect menstruating teens and people at any age, and can disrupt people’s lives significantly.
Dr Aruna says that she has not seen more than six cases of PMDD in her 16 years of practice. However, a UK research suggests it affects 1 in 20 women. Comprehensive figures are hard to come by due to lack of research.
PMDD does not affect a large number of women. The experts caution however, that other hormonal and mental health disorders need to be ruled out before diagnosing one with PMDD. Both Dr Ashlesha and Dr Aruna agree that the symptoms dissipating as soon as one gets their period is a crucial factor in diagnosis.
The most telling characteristic about PMDD is what Lalitha perhaps described best: she felt like a cloud lifted from her head after she got her period. This makes PMDD quite interdisciplinary – it has strong aspects of, and repercussions on, mental as well as physical health. For some people, Bengaluru-based gynaecologist Dr Aruna Muralidhar says sleep cycles can be affected as well – people with PMDD may either sleep too much or significantly lesser than what is required on average. Up to two weeks prior to one’s menses, symptoms can present as intense fatigue, change in appetite, and so on. There can be extreme shifts in mood… people may find it difficult to manage day-to-day things, which can disrupt work and also affect personal interactions,” she explains. “For example, something that may not be distressing otherwise starts distressing you a lot more during the premenstrual period in PMDD. Crippling anxiety, increased irritability and/or overwhelmingly depressive or hopeless feelings are common symptoms. Bengaluru-based Dr Ashlesha Bagadia, a psychiatrist with specialisation in perinatal psychiatry and women’s mental health, explains that PMDD is different from PMS and is characterised by significantly more emotional distress and difficulty during the premenstrual time period.
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