5 Tips for Living with PMDD (Premenstrual Dysphoric Disorder)


If you have had any type of illness at all, you’ve probably come to the realization that the experience of it is much different than learning about it from a book or hearing people talk about it. In a book, there’s distance, and it isn’t quite real, almost romanticized. But when it happens to you, it becomes strangely familiar, and somehow manages to take on the characteristics of you— so much so that it barely resembles the impression you had of it when you only read or heard about it.

You may have felt this way if you have PMDD or a milder form of it known as Premenstrual Syndrome (PMS). Most agree that symptoms of PMDD occur when our body has a wacky reaction to hormonal changes associated with the menstrual cycle. There are all sorts of literature on it and you can usually find it under a search of menstrual cycle and depression. You’ve likely heard of depression even before you hit puberty, may have experienced it in childhood, or at least claimed to have had it in one of your dramatic prepubertal moments. It’s an oftentimes overused term but more accurately reflects a constellation of clinical symptoms.

About 75% of us ladies know what depressed mood is like firsthand thanks to PMS. The sadness, irritability, breast tenderness, and bloating are all hallmarks of our monthly visitor we affectionately call “friend.” You may not have recognized it the first time, and just thought you had gone off your kilter (which is probably not far from the truth). Or, it may have reminded you of a mood disorder you’ve had. In fact, if you have a pre-existing mood disorder, you may experience an exacerbation of the illness known as Premenstrual Exacerbation or PME. At the very least, depressed mood associated with menstrual cycle is disruptive but if you have PMDD, it’s debilitating.

Without getting into specific diagnostic symptoms (‘cause if you’re like me, you tend to have everything you read about), one of the major issues of PMDD is the intense mood shifts, and interference with school, work, and relationships during the onset of menstruation. You’re reactions can feel out of your control like you’re watching yourself in a bad dream but have no power to change it. The way you express symptoms, the frequency and intensity with which you express it, and whether or not you seek help for it depend on social and cultural background, personal beliefs, and family perspectives to name a few.

Stress, history of trauma, and seasonal changes also impact the expression of PMDD, and makes the condition more complicated and difficult to sort through. If you suffer from PMDD or something like it, you may have read enough to know what to do about it—  exercise, eat right, rest, yada yada yada. All good things, yes!  But it can be really difficult to put those things into action when you feel stressed and in a negative mindset.

Here are five tips that may help you manage a little easier.

1. Think about what you’re thinking about.

Our thoughts are often so automatic that we barely notice them, but that doesn’t make us feel them any less. You know those times when you start to feel down but don’t know why? I’ll bet your mind just raced through hundreds of negative thoughts, but you’re not attuned to them because you’re so used to thinking them. During those days leading up to your menstrual cycle, what are you thinking? How do you explain negative or ambiguous events?  To help distinguish symptoms from normal functioning, keep a daily chart of symptoms for two months. If you find that you are experiencing increased mood swings, sadness, interpersonal conflicts, self-deprecating thoughts or other symptoms, write it down and include your thoughts, feelings, and responses. This way you can track your faulty thought processes and begin to do something about it.

2. Use your intellect to overcome your emotions.

If you took the advice from number one, you may have become more attuned to negative thought processes, but that does not necessarily mean you are going to change them. Old habits die hard and there is some comfort in the familiar even if it is not good for us. The trick is to use your strengths against your weaknesses. You already do this in other areas, like when you refuse to eat that strawberry banana cake you really want because you’re trying to be healthier, or you stay up late finishing up a project you’ve been dying to complete even though you’re exhausted. So it isn’t a stretch to use your strengths to improve your emotional life. You’re smart enough to know that your intense mood is largely hormonal and while that does not negate the fact that someone made you upset or disrupted your day, you know that you’re particularly sensitive during this time. So no matter how right you feel you are, take a step back and commit to doing nothing until you calm down and have thought about the consequences to your possible actions or reactions.  If you are used to just reacting, this takes time and effort, but it can be done.

3. Use your emotions to overcome your biology.

When you’re feeling moody and sad, you’re also more likely to feel anxious or on edge. Anxiety is great when you are in trouble because it signals a fight or flight reaction that prepares your body to fight danger. But when there is no danger, and your body is constantly in fight or flight mode, it is taxing and causes undue stress. In fight or flight mode, your mind shuts down as the body’s way of turning off what’s not needed so that you can mobilize your energy to react quickly. This is not so good during those moments when you are interacting with others at work or home. You are likely to react without thinking, and this can lead to interpersonal conflict and/or comments you didn’t mean that may have a lasting negative impact on those around you, including your loved ones. This is why relaxation techniques are so important. More than just a term used by people who are so “deep” they’re weird, relaxation makes you feel calm which in turn shuts down the flight or fight reaction, and allows you to think more clearly. This is important during those irritable moments. Meditation, deep-breathing, and visualization exercises are all different types of relaxation techniques. Pick ones that work best for you.

4. Lose control.

Think about how you’ve handled PMDD symptoms up until now. What’s worked and what hasn’t. If you have had trouble managing through it, it is possible that you have held on to negative, self-defeating habits that keep you feeling stuck. Holding onto these patterns is a lot like refusing to let go, and this usually signals an issue with control. For instance, if you are already aware that keeping track of your symptoms are a good idea, but never get around to it and frankly don’t have the time, perhaps you are not allowing yourself to break old habits because you are so committed to the familiar and don’t feel you have the energy to do something different. But in order for change to occur, the pattern has to be interrupted somewhere, and surrendering to different, positive ways of coping may be a good place to start.

5. To pill or not to pill.

Yes, antidepressant medication has been shown to be effective in treating PMDD. But medication is totally a personal choice that is best decided with a professional who can provide you with adequate information regarding the pros and cons. While medication is certainly helpful, it is not a be all end all cure. Rather, it is intended to help you function well enough so that you can begin to do the hard work to manage your condition.

Beyond these tips, know that PMDD is difficult to manage on your own, yet most women do not seek treatment or it may go unnoticed. If you have PMDD or suspect you may have it, consult with a therapist who can explain your treatment options, and help you determine the best course of action for you.