with Perinatal Psychiatrist Dr. Nichelle Haynes
WHAT YOU’LL LEARN
- PMDD Vs. PMS
- Mood Disorders Impacted by Hormones
- PMDD Onset
- PMDD During Postpartum
- Seeking Help
- Best Treatment Forms
Do you find that you get irritable the week before your cycle? Do you find that your mood or anxiety fluctuate depending on where you are in your cycle? You are not the only one, it is not a secret that our hormones play an important role in our overall mental health. Dr. Nichelle Haynes, a Perinatal Psychiatrist who focuses on mental health during infertility, pregnancy, postpartum, and parenting will help us understand when those mood swings might be premenstrual dysphoric disorder.
PMDD Versus PMS
“PMDD stands for Premenstrual dysphoric disorder, and if you kind of break the name down, you can understand what it means,” Dr. Haynes said. “Essentially it’s before your period, having significant systems related to your mood or anxiety causing significant problems.”
“The main difference is the severity, meaning that PMDD is more severe,” Dr. Haynes explained. “The most defining characteristic when you’re looking to distinguish PMS from PMDD would be the mood swing category.”
Sensitivity to rejection, mood swings, crying spells, sudden onset sadness aren’t typical of PMS. These mood swings can be irritability, depression or anxiety.
PMDD mood shifts usually occur 1 to 2 weeks before the menstrual cycle. Dr. Haynes explained that this happens because female hormones are so cyclical. Cycles vary from 25-30 days long. “2 weeks before we menstruate there should be an ovulation and that is caused by an abrupt increase then decrease in certain hormones.”
The drop in hormone levels can be hard for some people, and it has more to do with the individual’s sensitivity to changes in their hormone levels than it does the amount of the drop. Your hormone levels can be in clinically normal ranges and if you’re very sensitive to the change it can still affect you.
“It’s important to remember that our reproductive hormones are closely related to our mood, because we have receptors in our brain for our reproductive hormones,” Dr. Haynes explained. They regulate serotonin and norepinephrine, and gaba has been connected to the reproductive hormones.
Sensitivity to hormone changes and mood swings can be weaponized against us or blown off, and that makes it hard for some people to get help. But if you’re experiencing this, it’s okay to ask for help.
Mood Disorders Impacted by Hormones
“A lot of psychiatric illnesses can be worsened a week or two before the period,” Ms. Haynes said. There have been several studies that proved this as well.
People with PMDD have no symptoms outside of this period of time. “That’s kind of one of the differentiating features of PMDD,” she explained. But a lot of people notice changes during this time and even when their hormones are level, they meet criteria for major depressive disorder or general anxiety.
What these people are experiencing isn’t PMDD, but the shift in hormones really stirs it up. These experiences are legitimate, but PMDD doesn’t present symptoms for about two weeks.
PMDD can create interpersonal problems during the 2 weeks of symptoms, so you may notice friction in your relationships during these 2 weeks and spend the next 2 weeks of the cycle trying to repair those relationships. And by then the cycle is starting again.
Having your whole life become a series of rupture and repair to important relationships can obviously be draining. When trying to decide if we’re dealing with a more generalized depression or PMDD, it’s like determining if this is a guilt hangover from the two weeks of symptoms or are there other symptoms as well.
I see a lot of clients who may have symptoms during the two weeks you’d expect symptoms of PMDD, but the more we work together, I can start to see signs of an underlying condition just being exacerbated by hormonal changes. Looking back on it, I think I always had some anxiety or was just a tightly wound person.
PMDD can start at any time, but we see it a lot as people approach their late twenties and early thirties. “Anecdotally, people will say it gets worse toward the period of time you’re approaching menopause,” Dr. Haynes said. But she thinks the data indicates it’s related to the reproductive years.
PMDD should go away during menopause and postmenopause, because we’re no longer experiencing the cyclical hormonal shifts that cause PMDD.
PMDD During Postpartum
The first period after having a baby can be really hard for a lot of reasons. Your hormones are changing. There are other changes in your life happening at the same time, and if you had painful periods before the baby, it can triggering.
Sometimes you’re weaning off breastfeeding at the same time and that’s another hormonal change happening at the same time. Basically, the first period back can be both unexpected and also happening at a time we’re already struggling with a lot of other things. That doesn’t mean it’s PMDD, but you may notice PMDD at this time even if you hadn’t before.
With each of my 3 kids, my first menstrual cycle after baby happened around 8-12 weeks even though I was exclusively breastfeeding. And about a week before it happened I would say things like, “I just don’t feel like myself,” which is indicative of postpartum depression. Then a week or two later, my hormones would level out again, and I’d be okay. If you notice something like this, you might want to talk to your provider.
“We definitely don’t want to be making this kind of diagnosis in the first few weeks postpartum,” Ms. Haynes explained. We need to rule out postpartum depression and postpartum anxiety before making a PMDD diagnosis. But later during the postpartum once you have your cycle back, the diagnosis can be made.
If you’re wondering if you’re experiencing PMDD, you can track your mood throughout your cycle. PMDD has to happen over months. If it’s just a rough month it’s not PMDD.
You can also track your physical symptoms like bloating or nausea too. When you go to a clinician, one of the first things they’ll ask you to do is track how you feel, so if you think you need help with PMDD just track it and take it in with you.
“Lower your threshold. It doesn’t have to be the worst of the worst of the worst to go get help,” Dr. Haynes said. If it’s impacting you, your relationships, or your life, it’s worth investigating. It is worth exploring even if it’s not PMDD.
Best Treatment Forms
“If we’re conceptualizing PMDD as a continuum, I would definitely place PMS on the continuum,” Dr. Haynes said. Like with everything else some people will experience worse than others.
But understanding your baseline mood is really important. Some people might not notice much of a difference in how they feel during the symptomatic 2 weeks as opposed to the rest of the month if their baseline is already very low. But what if we improved that baseline? The symptomatic 2 weeks might be a huge shift then.
Therapy and medication work well together too, because you’re coming at the problem with different approaches.
Consistent exercise is scientifically proven to help with PMDD. We don’t have data to know how it helps, but we know it does. Cognitive behavioral therapy is being used for so many things and it’s an evidence based treatment form. Some clinicians recommend staying away from caffeine and a healthier diet, but there isn’t a lot of evidence that this makes a difference for PMDD.
You can use typical antidepressants during the 2 weeks of symptoms. Most of the time, antidepressants need 2-4 weeks to work but there is evidence that for PMDD this approach makes a real difference.
You can also just take them on days you experience symptoms, not all days you expect to experience symptoms. “I’m less inclined to do that, because we’re not that great about knowing how bad we feel often,” Dr. Haynes said. Especially, if we don’t know our baseline. I had no idea my baseline was low until I got treatment for postpartum anxiety.
It can be helpful to use an antidepressant to get your baseline up so that you feel good during those 2 weeks without symptoms, and then we can use a little bit more medication during the weeks of symptoms. That works well to treat both any underlying conditions and the PMDD.
Another treatment option that can be used is an oral contraceptive. This can balance your hormone levels so that you’re not experiencing the huge shifts in hormones that cause PMDD.
If you feel like you’re experiencing these mood swings related to your hormonal cycle, don’t be afraid to ask for help. And if you’re having a baby soon, please check out my FREE Postpartum Prep List. Being prepared can really help you distinguish postpartum mood issues from other issues. This is your mommy support list.
Nichelle Haynes is a perinatal psychiatrist with special interest in pregnancy and early parenting. She works as a psychiatrist at Reproductive Psychiatry Clinic of Austin where she also serves as CEO. She is a wife and mother of 2 energetic young boys who keep her busy. She has also recently co-founded Aluma, a self-discovery workbook for moms.