'PMDD is like PMS on steroids. It drove me to a dark place.'

Content warning: This post includes discussion of suicidal ideation that may be distressing to some readers.

As I sat on the train on my way into the Mamamia office, silent tears rolled down my face. I stared bleakly out the window, the crisp blue sky taunting me as I sniffled into a tissue, hiding behind my sunnies and hoping everyone just thought I was having an allergic moment, rather than a complete breakdown on public transport.

As I dabbed at my face with my snotty Kleenex, I opened up my period tracker on my phone. 

“Three days until your next period!” the screen told me cheerfully.

I let out a sigh of relief.

I didn’t actually feel any better, but at least I knew I wasn’t going crazy. 

Because this wasn’t ‘me’; not really. This was hormonal.

This was PMDD.

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Premenstrual dysphoric disorder (PMDD) is a condition that affects around five percent of women, if not more, says holistic health expert Nat Kringoudis, who runs her own women’s health practice, The Pagoda Tree, in Melbourne.

And, spoiler alert: feeling this way isn’t normal.

“Women will say, ‘I just thought I was going crazy or I just thought it was part of just how I’m going to feel as I get older,” Kringoudis explained when we sat down to speak about the rude cousin of PMS – which goes largely undiagnosed.

“Women will say, 'Oh, I cope fine.’ But if you’ve got symptoms of PMS or PMDD, your body's telling you that it's not fine,” explained Kringoudis. 

“While it's really normal to feel a little hungrier before a period, a little bit more tired, and maybe a little bit moody for a day – that’s about it.

“PMS isn’t normal. It’s just so common that we’ve come to consider it normal.”

So what is PMDD, exactly?

Most of us who have a menstrual cycle are pretty familiar with PMS, right? You know how it goes – those few days before your period hits when you just feel like total s**t. Anxiety or nervous tension, irritability, mood swings, cramping, headaches… Then, boom, your period starts and the symptoms ghost you faster than that loser you met on Tinder.

It’s thought that most people who have periods (75 percent, to get specific) have at least mild premenstrual symptoms. But for 20 to 30 percent of us, those symptoms are severe – and for 3 to 8 percent, they tip into PMDD territory, according to Jean Hailes Women’s Health Centre.

“PMDD not only lasts longer [than PMS], but the symptoms are more intense,” said Kringoudis – and yep, that tracks. For me, PMDD has been like PMS on steroids. It’s all of the emotional baggage, with the intensity dialled up to 100 – and according to Kringoudis, anxiety or depression won't be the only symptoms for most women with PMDD. “Usually they'll have period pain, heavy bleeding, or there'll be some other issues that are all part of the same hormone imbalance,” she explained.

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If the only thing that happens in the days before my period is that I have a crying attack on the train, I count that as a win, because I’ve been driven to some pretty dark places during those premenstrual days in the past. 

At the height of my PMDD symptoms, sinister thoughts that didn’t feel like they belonged to me would curl their gnarled fingers inside my mind, as I sat sobbing on the couch in the dark (for no apparent reason).

A disembodied voice in my mind whispered to me again and again to just... end it. End everything. Because what was the point of... well, anything?

Then my period would arrive – and the demon would go back into hiding for another month.

I spoke to a fellow PMDD sufferer, Emma, who’s had similar experiences to my own.

“The way I describe it to people is, it’s like having supercharged depression,” she said. 

“Most people have some idea what it feels like to be depressed – you are down on yourself, you don't have any energy, you just want to stay in bed, you’re apathetic. But if somebody injected you with a bunch of adrenaline while you were feeling depressed, what would you do? You would start making poor decisions; burning your life down.”

For others, said Kringoudis, PMDD isn’t so much about the intensity but rather the length of time those symptoms plague them.

“Typically, PMS is something that you would say starts somewhere between three to four days before the period,” explained Kringoudis, and we often refer to symptoms during this time as ‘being hormonal’.

“But anything that's going on for longer than four or five days starts to spill into what we would consider PMDD.”

What causes PMDD?

For me, things got particularly bad soon after I’d gone through a fairly devastating breakup – which makes sense, given that stress seems to be one of the key players in the onset of PMDD symptoms, Kringoudis told me.

It wasn’t just the breakup, though. I’d also lost my job (thanks, COVID) about three weeks before my ex ended things completely out of the blue. Oh, and another round of lockdowns had just been announced (and we all remember how fun those times were).

And while I’d been diagnosed with depression and generalised anxiety disorder more than a decade earlier, I felt I had it well and truly in hand, so I was genuinely shocked when I started to think along the lines of how sad my mum would be if I quietly bowed out of life, how my friends would surely get over it quickly, and whether my dog would be okay (yes, really) if I was no longer around.

This was when I was at my worst, but the insidious thoughts only slid into my brain the few days before my period – and dissipated like fog on a sunny morning when I clocked Day 1 of my cycle.

I consider myself fortunate, in a way, to have dealt with anxiety and depression for so long, as I had enough self-awareness and understanding of my own mental health and thought patterns that I was able to step back and acknowledge that these thoughts weren’t really 'me'.

Don’t get me wrong, the emotions were real, but they were so disproportionate to how I had been feeling in the days prior that I knew something wasn’t right.

After about three cycles, I noticed the pattern and visited my GP. That was the first time I heard of PMDD.

Emma has been in a dark place, too, she told me. “I have had my own journey with suicidal ideation,” she said, speaking about her PMDD, which was diagnosed in 2014.

“I was lying on the floor crying hysterically one night, and I thought it was because I was really sad for a friend who couldn't seem to have children and was going through a hard time. But I suddenly realised that I had been lying in the exact same place in the hallway, sobbing dramatically, four weeks prior.

“I got out my phone, still sprawled out on the hallway floor, and I scrolled back and saw that, yep, four weeks earlier I had indeed been on the floor, crying about something else completely different. 

“Four weeks before that I had run to the bathroom to have a cry about something else while I was out with friends. I realised there was a pattern. I went to my GP to tell them I seemed to have this weird depression that only seemed to peak every four weeks. 

“‘Sounds like you've got premenstrual dysphoric disorder,’ she told me.”

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According to Kringoudis, there’s a key hormone involved in all of this: progesterone. And its relationship with stress hormone cortisol may just be worth putting under the microscope.

“PMDD is somewhat a lifestyle condition, where it is responding to its environment,” Kringoudis explained.

“High stress is definitely a reason we see progesterone put on the back burner. This is because cortisol is bossy and it wants to make sure you're safe, so your body will prioritise your stress hormones over your sex hormones.”

And while that’s great news if we’re out there running away from sabre-toothed tigers and whatnot, it’s not ideal for modern life.

“We're not supposed to idle along with high stress,” said Kringoudis. “It impacts our sex hormones, and this is why I'm seeing so many busy professional women, in particular, experiencing PMDD – because they are stressed. 

“They are overextended and they're – unknowingly – not taking care of themselves.”

Stress isn’t the whole story, though. There may be a genetic factor, explained Kringoudis, and that, combined with just one or two stressors – say, a dramatic life event (ahem, a breakup or a job loss or a global pandemic), or not sleeping properly – can be enough to set things in motion. 

“There is a really big lifestyle element that needs to be looked at,” said Kringoudis. As well as stress, “pollutants, toxins, chemicals that upset our hormones that are definitely contributing factors.”

How do you treat PMDD?

Given that stress is the key factor, it’s no surprise that reducing stress in your life is going to help start to address the problem – and that’s exactly what Emma did.

“My doctor recommended antidepressants at first but I really wanted to see how I could manage it naturally,” she told me. 

“So I joined an amazing holistic gym, and they had everything I needed to fight PMDD symptoms naturally – low-impact cardio, Yin yoga infrared saunas, clean, filtered water, advice around supplements… They helped me track my sleep, even took my blood and helped me balance my hormones.

“I did try the antidepressants, to see how they would work, and I got some really bad headaches and lowered libido, but I did feel less depressed. So I knew that I had them in my tool belt as an option, but I've only ever used that option like once or twice since.”

Me? I chose to increase the dose of the antidepressants I was already on (on the advice and under the supervision of my doc, ofc) and can confirm: things have been much better since. I still get those emotional symptoms, but they’re not nearly as intense as they have been.

“If you need to take a break in the weather and antidepressants are going to help to do that so that you can actually function on the daily, great,” said Kringoudis. “We're so lucky that we live at a time where we have these options. But what's the long-term plan? This is why I think looking at the long game is very important when we're treating things like this, to obtain sustainable results.”

So what does that look like, exactly?

First, said Kringoudis, if people are noticing they’re experiencing PMS and PMDD symptoms, check in with lifestyle factors – addressing things like sleep and nutrition. 

“Prioritise sleep, because if you're not sleeping, that's part of the problem. Sleep is how our body rejuvenates and detoxifies our hormones, which is super important. If you're not detoxifying hormones, they're just getting recycled, throwing off the balance more and more.

“We also need to make sure that we're moving our bowels daily. This has a fundamental impact on our hormones, because our hormones are eliminated from the body through the bowel. And if they're left sitting in the bowel, they get reabsorbed as well, which adds to that imbalance. 

“So if I said to people to sleep better and poo better, that would have actually a profound impact for many people.”

Kringoudis also suggests trying a magnesium supplement. “Magnesium will definitely help people and it's very safe,” she said.

One thing that’s been a game changer for me, weirdly, is simply knowing what’s causing these wild emotional rollercoasters. Because honestly, in the throes of the out-of-nowhere deep depressions (plus anxiety attacks, bursts of anger… it’s a wild ride), I have definitely thought, more than once, that I’m going completely batshit. So being able to glance at an app and see what time of the month it is reminds me that this too shall pass (in a few days) and that I can ride it out like I have before.

Having a diagnosis was a sigh of relief for Emma, too. 

“It did help to have the diagnosis – to know the reason I was having these thoughts during my luteal phase and never outside of my luteal phase. I’ve learned over the years, with self-development and practice and lots of ups and downs, to identify my negative thoughts. And I can do that now during the rest of my cycle as well, which is super handy.”

Getting a handle on her energetic hygiene has also been a game-changer for Emma – and that includes speaking her truth (“so it doesn’t boil over when I have PMS”) and freeing herself from toxic relationships, too. 

“I've learned to use it as a way to keep me on track with my mental, physical, and spiritual health and wellbeing.”

PMDD: Where to get help

At the end of the day, explained Kringoudis, there's no ‘perfect way’ to manage PMDD. “It's just going to be about helping [people] to look outside of the condition itself and explore what else is contributing to it, so they can start to make some really safe lifestyle changes that could really help.” 

If this is all hitting a little close to home, it might be time to start monitoring your symptoms – Kringoudis recommends noting down how you’re feeling every day.

“You're going to know if it's PMDD if it's cyclic. If you start to see symptoms at the same time every month, that's how you know. See if there's a pattern, and if there is, you can take that to your health provider and say, ‘This is what I'm noticing. I've watched it over two months or three months or four months, and I've been hearing about certain diagnoses, and I would like your opinion.’ 

“It's really important that people get the answers they need, to motivate them to implement changes because, ultimately, they don't have to feel that way.”

If you’re experiencing symptoms or think you may have PMDD, speak to your healthcare professional. 

If you think you may be experiencing depression or another mental health problem, please contact your general practitioner. If you're based in Australia, 24-hour support is available through Lifeline on 13 11 14 or beyondblue on 1300 22 4636.

Alix Nicholson is Mamamia's Managing Editor. Follow her on Instagram or read more of her work here.