by Mia Costales

For the better half of my teenage and young adult life, I’ve dealt with intense bouts of sadness in the days leading up to my menstrual cycle. These episodes usually only lasted around a week and were characterized by heightened irritability, anxiety, fatigue, decreased interest in activities and in the most extreme cases, suicidal ideation. Due to these symptoms, I chalked it up to being some form of major depressive disorder that was exacerbated by the hormonal shift during that week. However, thanks to a couple Google searches and several trips to my doctor, I was diagnosed with Premenstrual Dysphoric Disorder (PMDD) and was able to start taking the steps to learning to live with PMDD. 

According to Dr. Alison Palacios, a physician at the Cal Poly Humboldt Student Health Clinic, PMDD is considered the most severe form of Premenstrual Syndrome (PMS) as maintained by the American College of Obstetricians and Gynecologists. 

“Patients’ symptoms must include behavioral symptoms and often include physical symptoms. The most common behavioral symptoms are mood swings and frequently include irritability, anxiety/tension, sad or depressed mood, increased appetite/food cravings, sensitivity to rejection and diminished interest in activities,” Palacios said. “The most common physical manifestations of PMS are abdominal bloating and an extreme sense of fatigue.”

While PMS symptoms and PMDD symptoms can look extremely similar, PMDD differs in that feelings of sadness, hopelessness, and anxiety are almost consistently present. Both may include symptoms such as bloating and intense mood swings, but PMS is not considered a mental disorder and is typically pretty manageable. PMDD on the other hand, is considered a mental disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and can be debilitating in some extreme cases. 

In order to be diagnosed with PMDD, at least five of the symptoms presented in the DSM must be present in the week leading to menstruation, start to improve with the start of menses, and be minimal to gone by the end of the menstrual cycle. These symptoms include marked depression, anxiety, affective mood, irritability, decreased interest in activity, difficulty concentrating, lethargy, change in appetite, hypersomnia or insomnia, and physical symptoms such as joint or muscle pain. This criteria presented in the DSM must have also been met for most menstrual cycles that occurred within the last year. Yet despite PMDD being a recognised mental disorder, it is an underrepresented condition. 

“It is not well reported, but worldwide prevalence is 2%, and in the U.S., it was 2.9% among Black females versus 4.4% White females,” Palacios said. “It is probably quite underdiagnosed and especially so in Black females and other people of color. Some with the diagnosis assume their symptoms are ‘normal’ for menstruating people or seek healthcare for years to decades before receiving the correct diagnosis.” 

As per Palacios’ advice, moderate to severe symptoms can be treated with antidepressants, hormonal birth control and cognitive behavioral therapy. Milder symptoms may be treated with exercise, herbal remedies and supplements. Bilateral oophorectomy, the surgical removal of the ovaries, is reserved for the most extreme cases of PMDD. 

There are resources on campus for those who may think they are experiencing PMDD. The Student Health Clinic can help address symptoms and provide diagnostics and treatment for the condition. They can also refer to specialists if needed. TalkNow sessions with TimelyCare and the Counseling and Psychological Services line are also helpful resources for managing PMDD symptoms. If you are experiencing any thoughts of harming yourself, the Suicide and Crisis Lifeline (phone number 988) is available 24 hours. 

PMDD can be extremely hard to live with, but like most conditions, finding coping mechanisms and support can help dramatically. For LJ Ferris, coping looks like realizing that PMDD shouldn’t affect their self-worth. 

“In the midst of it, it seems like it’s never going to end. Then, your period comes and you realize you indeed are still a human deserving of love,” Ferris said. “It is not supposed to be normal to want to die leading up to your period. It is not supposed to be normal to have such severe physical and emotional pain around periods.”