Premenstrual tension is a popular topic: everyone knows that a few days before menstruating, you can face important changes in mood, disposition and even physique, with swelling and pain. The topic, which unfortunately is taken little seriously and serves as the inspiration for countless jokes, can become even more complex if this PMS fits into a mental disorder, called premenstrual dysphoric disorder, or PMDD.
The condition is in the latest version of the Diagnostic and Statistical Manual of Disorders, also known as the “bible” of psychiatry and which lists the main diseases related to the mind. People with the disorder suffer from at least five of these symptoms: depressed mood, irritability, anxiety, depression, difficulty paying attention, loss of pleasure, social withdrawal, fatigue, feeling overwhelmed or out of control, loss of appetite, breast tenderness , joint pain or weight gain.
For psychiatrist David Pinheiro, psychiatrist at IMIP (Institute of Integral Medicine) and professor at Faculdade Pernambucana de Saúde, for diagnosis, these symptoms must occur in most menstrual cycles. In addition, the next two cycles are observed in more detail and if in the week before the start of menstruation the symptoms begin to appear more intensely. “This temporal relationship is very important, in which the appearance of complaints is clearly observed before the cycle and their clear disappearance after the cycle”, he says.
Although less common, it affects 3 to 8% of people who menstruate. “About 80% have premenstrual symptoms. Fortunately, most have mild symptoms, which often with lifestyle changes can already be alleviated. A part, approximately 30%, have moderate symptoms. Now, dysphoric disorder is less common”, explains Joel Rennó Júnior, director of the Women’s Mental Health program at IPq-HCFMUSP (Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine, University of São Paulo).
Among the causes of this “worse PMS” are environmental factors (such as stress, history of trauma) and genetics. According to Júnior, there is possibly a polymorphism of the serotonin transporter gene (responsible for well-being), especially when this is associated with personality traits related to neuroticism.
The fact is that many people can suffer from it and not even realize it, or have been misdiagnosed. The following is the report of three women who discovered they had the disorder.
Cris Andrade, 26 years old, Mutuípe (BA)
“When I found out, I was still in college. Since I was a teenager I had a pretty intense premenstrual period, but in college it got stronger and stronger. In 2019 I started reading about the topic and saw that a psychologist recommended writing every month on a schedule during the premenstrual period. I did this and realized that it really was a time when my emotions were very upset.
The first symptom was always very strong irritability. As the years passed, I also became very sad. I didn’t feel like socializing, everything stressed me, small things took me off the axis, this interferes a lot with the routine. The most serious thing for me was in a specific week that I was unable to leave my room, I had one meal a day, I felt like disappearing, disappearing, dying. When it passes, it feels like you weren’t that person.
My first treatment started with therapy and gym, both helped me and relieved my symptoms a lot. In these last six or seven months, the PMDD has not shown so many signs. My psychologist sent me to see a gynecologist, I’ve seen three professionals, the first two didn’t pay much attention when I talked about the topic and the third indicated to spend six months on contraceptives amending the pack — because if I didn’t menstruate, I wouldn’t have these symptoms —but I didn’t want to use that method.
People really don’t take it seriously, not even the professionals I used to be. The issue of lack of support and thinking it’s freshness really comes from this culture of minimizing what people with a uterus feel. So they relativize menstruation, normal PMS and even more PMDD, which is not a thing of general knowledge. I knew because there really came a time in my life when I saw that it wasn’t normal to feel so irritable during my premenstrual days, so depressed and not wanting to do the things I had to do. It’s not even a simple not wanting, it’s you don’t really have the strength, your brain doesn’t work for you to be able to fulfill these obligations that you do quietly for the rest of the month.”
Larissa Biscotto, 23 years old, Governador Valadares (MG)
“I was about 15 or 16 years old when I realized that I was very affected by PMS, both from swelling, from having specific bras for that period, and emotionally. That’s when she saw that I had a very big imbalance in the premenstrual phase and explained to me what the disorder was.
I get very depressed, from lying in bed having horrible thoughts, very low self-esteem. My chest hurts a lot, I feel a lot of pain in my belly I don’t feel comfortable leaving the house. When I was younger, it was every month. Today, when she is older, she doesn’t come often.
My doctor even gave me a medication that is often used in menopause to control the hormone, but I didn’t adapt. Then she prescribed me an antidepressant and also I thought that not worth taking. Today I don’t take medication and I’ve gotten used to the disorder, since it doesn’t always come and when it comes, I already understand what’s happening. I also do therapy —which I didn’t do at that time— and I always try to exercise. If I I feel that dysphoria is coming, I’m going to run now, I’m going to do something to get myself out of that thought. prejudice in the family I I didn’t have it, because I have two cousins who also have it, they take antidepressants during crises.”
Gabriela da Silva cadamuro27 years old, Maringá (PR)
“My husband who found out I had the disorder. During the pandemic, I went to live with him and his parents and he began to notice. I always had depression, but he noticed that during my menstrual period my crises increased. I even had a panic attack during PMS and I told my psychologist, who suspected it was PMDD. I also looked for a psychiatrist and a gynecologist, to start treating. The first medicine didn’t work, but the second one is working, it doesn’t hurt me and controls my crises.
Since I already had a history of depression and anxiety, my symptoms didn’t come overnight. What became more serious were the suicidal crises, wanting to kill myself, having panic attacks, going into deep depression and not wanting to get out of bed or get up. The issue of being well in one day bothered me a lot and, just knowing that PMS was coming, my psychological completely changed. This implied my health and the health of the people around me.
Regarding prejudice, this happens every day. From the moment you have depression, regardless of whether it is related to the disorder or a separate diagnosis of depression and anxiety, you suffer from a type of prejudice. They think “she doesn’t want to get out of bed because she’s too lazy”, but that’s not how it works.
My husband passed away five months ago, so my PMDD got worse, as did my depression. But I have a very understanding family and friends who understand. But more than having a support network, you need to recognize that you need help. As much as the disorder was discovered by my husband, it was I who took the first step to seek psychiatrist, gynecological and therapeutic help. The step is ours.”
Is there treatment?
Because it is considered a subtype of depression, a multidisciplinary treatment is needed between a psychologist, gynecologist, psychiatrist and, sometimes, even an endocrinologist.
“It is a mood disorder and for that the first-line treatment is psychiatric. The problem is to convince those who have PMDD which is a disease. People think that looking for a psychiatrist is looking for a crazy doctor, you have the psychophobia. AND often women can go to the gynecologist, who will give a contraceptive – which is not the first-line treatment – and that will relieve a little, but will not really solve”, explains Joel Renno.
For science, the treatments considered first-line are antidepressants serotonergic, which regulate serotonin. “The dosage of antidepressants is generally lower than the standard that is used in depression. Furthermore, when there is a picture of depression, the drugs will only start to work in two to three weeks. In the case of PMDDthe onset of action is fast, two or three days, that’s what allows it to be taken only during the second period of the cycle”, says the doctor.
Sources: David Pinheiropsychiatrist at IMIP (Institute of Integral Medicine) and professor at Faculdade Pernambucana de Saúde; Joel Renno Juniordirector of the Women’s Mental Health program at IPq-HCFMUSP (Institute of Psychiatry, Hospital das Clínicas, Faculty of Medicine, University of São Paulo), coordinator of the Women’s Mental Health Commission at PBL (Brazilian Association of Psychiatry); Lourdes Cavalcantepsychiatrist preceptor of the residency in psychiatry at Hospital Ulysses Pernambucano and psychiatrist in Caps (Center for Psychosocial Care).