Depression is a widely discussed and prevalent mental disorder worldwide. It is classified as a mood disorder. There are different subtypes of depressive disorders, such as Major Depressive Disorder, Persistent Depressive Disorder, Seasonal Affective Depression and Postpartum Depression. However, one subtype that is less talked about is Premenstrual Dysphoric Disorder (PMDD), which is a severe form of premenstrual syndrome in women.
Premenstrual Dysphoric Disorder or PMDD is a severe form of premenstrual syndrome (PMS), which is common with around 90 percent of women experiencing mental and physical changes, such as hormonal imbalances, mood swings, abdominal pain, bloating and acne, around seven to 10 days before their menstruation.
PMDD is identified when the severity of PMS symptoms begins impairing daily functioning. It shares a common causal factor with other subtypes of depression: the loss of serotonin. Women with PMDD are unable to produce enough serotonin during the premenstrual phase, leading to abnormal decrease of interest in normal activities, extreme self-critical thoughts, and persistent depressed mood. These symptoms occur alongside other physical symptoms, increased anxiety and often lead to conflicts with others as a social consequence.
A report by Harvard Medical School reveals that 15 percent of women with PMDD attempt suicide and are eager to get hysterectomies, surgical procedures to remove the womb. The suicidal thoughts are also accompanied by occasional thoughts and acts of violence that stem from the negative thinking patterns. Premenstrual issues, including PMDD, have been brought up in legal defenses in various criminal cases. A notable example is the 1981 case of Sandie Craddock in London, who was charged with manslaughter instead of murder after stabbing a co-worker. Her defense argued diminished responsibility based on cyclical violence due to severe premenstrual hormonal changes.
Physically, PMDD is associated with hormonal imbalances involving estrogen and progesterone, pivotal hormones regulating menstrual cycle and pregnancy. These imbalances lead to increased anxiety as well as intense fatigue. Along with amplified fatigue, sleep disruptions and heightened pain sensitivity are characteristics of PMDD. While the pain sensitivity is often linked to abdominal cramps caused by the shedding of the uterine lining, the heightened pain also adversely affects women’s mental well-being. Although unrelated to fertility, some studies link PMDD to irregular and erratic ovulation patterns.
Even though PMDD significantly affects women’s mental health worldwide, Nepal has very limited research on these conditions due to cultural menstrual taboos and general misunderstandings about PMDD. Available data reveal a high prevalence of premenstrual symptoms among young women in Nepal. A study of medical students at Kathmandu Medical College reported that 94 percent of females aged 17 to 22 experienced at least one premenstrual symptom, with 20.1 percent meeting criteria for PMS including insomnia. These findings underscore the true extent and impact of PMDD in Nepal, emphasizing the urgent need for targeted research and culturally sensitive health education.
A BBC report describes the case of a 33-year-old woman who suffered from severe depressive symptoms for two weeks each month when she often clashed with loved ones. The remaining weeks, she was cheerful and outgoing and tried to amend her relationships. This stark behavioral shift led to a misdiagnosis of bipolar disorder, highlighting how PMDD can be misinterpreted, while endangering both their mental well being and their reproductive health.
Despite its serious impact, the misunderstanding tied to this disorder, even by healthcare professionals, invites the lack of awareness and standardized screening protocols as one of the major challenges in treating PMDD. Many women suffer in silence, attributing their symptoms to ‘normal’ PMS or being misdiagnosed with disorders, such as bipolar disorder or generalized anxiety disorder. However, new developments have led to more precise diagnostic tools, including daily symptom tracking and hormonal assessments. Treatment approaches now include a combination of lifestyle adjustments, cognitive behavioral therapy (CBT), and selective serotonin reuptake inhibitors (SSRIs). Changes in lifestyle are also recommended by experts, such as incorporating yoga, nutritious and healthy diet and appropriate reproductive care into one’s life.
While PMDD shares similarities with PMS and mood disorders, it stands out as a distinct and serious condition that profoundly affects a woman’s mental, emotional, and physical well-being. PMDD demands broader recognition, diagnostic practices and specialized care. As awareness grows and more women come forward with their experiences, it becomes clear that addressing PMDD is evidently a matter of reproductive health but also, a pressing mental health priority.
Meghana Saud
St Xavier’s College, Maitighar
