Don’t dismiss or play down severe PMS symptoms, warns psychologist Dr Rizwana Roomaney

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Tracking your menstrual cycle and symptoms during your luteal phase and sharing this info with your doctor can help them diagnose PMDD.
Tracking your menstrual cycle and symptoms during your luteal phase and sharing this info with your doctor can help them diagnose PMDD.
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If you’ve experienced a few menstrual cycles, you know what to look out for.

The peckishness, mood swings, the sore back, skin breakout and fatigue. These symptoms are all part of premenstrual syndrome (PMS). And if your PMS is a little more hectic than others’, it may mean you find yourself having to take painkillers to ease the cramping in your abdomen.

But if you are someone who suffers from premenstrual dysphoric disorder (PMDD), your PMS can have a devastating impact on your psychological well-being, relationships with others, and affect your day-to-day living.

“PDMM hasn’t been recognised for very long because it’s related to PMS and so a lot of the times people normalise it,” explains Dr Rizwana Roomaney, research psychologist and senior lecturer at the Stellenbosch Department of Psychology.

“In our general conversation, we say, ‘I’m just having PMS’, when what we could be experiencing is far worse.

“It’s the worst type of PMS. It’s totally different from it. It’s PMS on steroids. It’s just on a totally different level.”

“And it’s not really part of our everyday conversations, but it should be,” the senior lecturer tells Drum.

One of the most concerning symptoms that someone may experience when they have PMDD is suicide ideation when they go through PMS. Some of the psychological symptoms of PMDD can in fact make many health practitioners mistake it for bipolar disorder. But, quite puzzlingly, the symptoms immediately vanish once you’re done menstruating.

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“PMDD often starts in your early 20s but these symptoms sometimes get worse for some women as they approach menopause. But when they reach menopause, the PMDD symptoms magically disappear,” explains Dr Roomaney.

“The symptoms only exist for certain period of time, so it’s about a week before your period and they call it the late luteal phase and during that time that’s when symptoms start and they are severe. And then a couple days after your period starts, the symptoms just disappear like magic. 

“The rest of the month, you’re sort of okay. But then a week before your period, you start experiencing these symptoms again. So that’s really a key defining feature of PMDD.”

“There are quite a few symptoms of PMDD,” explains Dr Roomaney.

“There are physical symptoms and then there are your psychological and emotional symptoms. Your physical symptoms are those sort of PMS symptoms. You get the bloating, the breast tenderness, headaches, joint pain and weight gain.

“And then in terms of the psychological symptoms, sometimes you experience extreme sadness and there may be an acute, sudden onset of sadness. You may feel like you can’t control the world, you feel anxious about things and have this total sense of loss of control; a sense of hopelessness; self-deprecating thoughts; tension, and mood swings. You lose interest in things that usually interest you and may notice changes in your eating and sleeping patterns.

“There is a certain kind of volatility in your emotions. You might find yourself often in conflict with people and that you can’t maintain a relationship with someone because of these moods swings. Things become extreme.

“And so what we’re really looking for is five of these symptoms to appear to make a diagnosis. If you look at your periods over maybe six months and you see that almost half of those symptoms occur in the late luteal phase, then go to psychologist or your GP,” advises Dr Roomaney. “Tell your healthcare professional, ‘I’ve been tracking my period. I’ve been checking my symptoms. I think this may be PMDD. Can we investigate this?’

“So you do have to be quite proactive. It’s not that the psychiatrist and psychologists don’t know about it, it’s that if you don’t report that cyclical event in terms of your PMDD or in terms of your mood, they can’t pick it up."

International statistics put the prevalence of PMDD at between 2-8%, says Dr Roomaney but the number of sufferers may be far greater. It’s just that this disorder is relatively obscure to many.

“Just because it’s not diagnosed a lot doesn’t mean that it’s not happening. We see that about 90% of people with PMDD actually go undiagnosed because we don’t talk about it because we don’t know it’s out there.

“A few years ago, we did a study at Stellenbosch University, and we surveyed about just over 1 300 of the female population at the university. And we found that actually 10% met the criteria for PMDD.

“So the students weren’t diagnosed, but they met all the symptom criteria and the clusters of symptoms that you need to be diagnosed with PMDD. This is shocking that many of us don’t know it’s there just because we don't talk about it and we can’t really see it.”

As a research psychologist interested in women’s issues, Dr Roomaney became devoted to learning as much as she could about this syndrome, especially as it wasn’t one of those sexy topics that everyone researches and talks about.

In the beginning she wanted to know, why isn’t there more information about this syndrome out there?

“So there’s a bit of controversy with PMDD,” she tells Drum in a Teams interview. “I think it was first discovered as sort of like a cluster of symptoms. 

“That was called something like premenstrual tension way back in 1951. Right then it was labelled PMS. And then after that, it was called late luteal phase dysphoric disorder. And then after that, it was called premenstrual dysphoric disorder. So there are different terms.

“And if we look at the diagnostic and statistical manual, you’ll see that PMDD is there in the third version of the DSM. But in the fourth version of the manual, they took it out. 

“They said that this disorder needs more investigation and they sort of put it in an appendix. And then in the last one now it’s come back in. So in the latest manual, the DSM 5, PMDD is back in and it’s labelled as a depressive disorder, which means it’s now getting the recognition it needs.”

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There are also some feminist critiques regarding PMDD, Dr Roomaney adds.

“The feminist critique of PMDD and diagnosing it is that they say that this is pathologising women’s bodies when having PMS symptoms is something quite normal. So there is that view out there. But in my work in speaking to women with PMDD, I ask them, ‘So what do you think about this view?’” 

“And the response I get over and over again is how useful a diagnosis actually is, because a diagnosis helps us to treat. So if we say we are just pathologising women’s bodies, what’s the answer? How do we help someone get better?

“But if we look at PMDD as a disorder, then we can find ways to deal with it. There are treatment options available to you and that’s what really helps. So we label in order to get the proper treatment.”

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