Tired, depressed and irritable? How to deal with severe PMS

14 Nov 2012

You're tired, depressed, extremely irritable and generally unpleasant to be around yet your dark side only seems to rear its ugly head at certain times of the month.

You hate the person you become just before your periods are due yet you can't seem to control your fluctuating moods no matter how hard you try.

Other women seem to cope reasonably well with their monthly cycle so what's wrong with you?

It's possible are you are suffering from a severe form of premenstrual syndrome (PMS) also known as premenstrual dysphoric disorder (PMDD) which is said to affect up to 8% of women.

PMDD is a more severe form of PMS

Unlike the bothersome physical symptoms associated with the common or garden variety of PMS, your severe form of the condition is manifest almost totally in psychological symptoms. PMDD is a brain syndrome more than a hormonal problem and can be extremely debilitating.

That's not to say PMS is a walk in the park either. Breast tenderness, abdominal bloating and cramping or headaches are common with PMS, usually combined with mild to moderate moodiness.

Thankfully though it can be easily treated with non-steroidal anti-inflammatory medications and it all goes away at the end of your period.

However, with PMDD it can be a miserable existence for at least half of every month – until you reach menopause.

Dealing with PMDD sceptics

Associate Professor John Eden, who is a gynaecologist and reproductive endocrinologist with the Women's Health and Research Institute of Australia, says one of the worst aspects of PMDD is that many sufferers are wrongly maligned, with their fluctuating moods often attributed to a lack of control and their excuses for bad behaviour not taken seriously.

"I have a big box of tissues in my clinic for those who are not believed by women who should love them," he says.

And it's the same thing with childbirth and menopause. Doubters say, 'I'm OK so you should be OK', but for them to take their own personal experience, whether that's with childbirth, menopause or PMS, and project it on to others is unfair."

PMDD is very real indeed

At pains to point out that PMDD is a very real biological condition, Eden explains it's like a supercharged PMS that tends to get worse as women age, cured only by menopause.

"Teenage girls may get period pain but they rarely get the severe mood disorders associated with PMDD."

While Eden describes PMDD as "quite a different condition to depression" in that it's cyclical subsiding with the onset of a period, nevertheless, he says it can be treated in a similar way to depression with the use of antidepressants.

A dose of SSRIs goes a long way

"Lovan [Prozac] works better than other modern antidepressants that we call SSRIs so it's our drug of choice. It seems to treat both the physical and the psychological symptoms and it can be used from day 12 of your cycle and stopped as you get your period.

"The difference is that when used for depression, SSRIs like Lovan take 2 to 4 weeks to work but when used to treat severe PMS [PMDD] they take only 2 days to work."

Some contraceptive pills make it worse

Another treatment commonly used to treat a range of premenstrual symptoms is the contraceptive pill although Eden suggests that some of the older pills such as Nordette and Triphasil usually make any depressive symptoms worse.

"Some women find that the modern pills such as Yaz can help and oestrogen patches are also good for symptoms, combined with a Mirena device which will protect the uterus from cancerous changes and reduce period bleeding by around 90%."

Natural therapies can be the first line of treatment

While treatment for PMDD is usually based around antidepressants, Eden is not averse to trying natural therapies as a first line of treatment, citing research findings that confirm the efficacy of Premular (an extract of the berries from the chaste tree) which he says has been successful in relieving a variety of premenstrual symptoms commonly experienced by women.

"Natural therapy is a no-brainer when you look at the management of premenstrual conditions, even in PMDD," he says. "Calcium and magnesium have also been shown to help and I usually recommend they are taken together to avoid constipation from the calcium and diarrhoea from the magnesium.

"Elemental calcium up to 1200mg per day and Elemental magnesium up to 400mg daily would cover both calcium and magnesium requirements, and vitamin B6 in doses up to 100mg daily is also worth trying."

Vigorous exercise, a diet low in salt and high in fruit and vegetables and relaxation therapies such as meditation are also beneficial for PMS and PMDD, Eden says, explaining that anything that relieves life's stresses is a good thing.

Ignore the sceptics and seek help

So, to all those women who have been unfairly maligned by friends and family due to a misunderstood biological condition that is beyond your control, Eden reckons you deserve better from your fellow man (and woman).

"These are shattered women," he says of those suffering from untreated PMDD, "who feel absolutely terrible during their menstrual phase and not being believed makes it even worse."

For more information on managing PMS and PMDD go to the Women's Health & Research Institute of Australia website.

Last modified on Wednesday, 14 November 2012 11:02
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Amanda Davey

Amanda Davey is journalist and columnist with a particular interest in health and social issues. Over the years she has worked as a restaurant reviewer, motoring writer, business journalist and lifestyle features editor.

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