This article was originally published on underdark magazine.
For one week every month, I spend a very depressing day. My back hurts so much that it’s hard for me to stand up straight. My mood fluctuates from crazy to dark. my concentration flag. Sending an email is difficult.Then my period begins and the curse is lifted. I felt okay again.
like some 1 To 7 Percentage of menstruating women I meet criteria for premenstrual dysphoric disorder (PMDD). According to the latest version, Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TRPeople with PMDD experience significant emotional changes, such as sadness, anger, and anxiety, as well as physical or behavioral changes, such as poor concentration, fatigue, and joint pain, during the week before their period. PMDD can also affect menstruating trans men and non-binary people.
When I first heard about PMDD, it was a revelation. Here, I specifically explained the pain and stress I felt every month. Even better, there was an easier way. effective treatment: Common antidepressants called selective serotonin reuptake inhibitors (SSRIs) are prescribed to be taken only two weeks before your period. Oral contraceptives, cognitive-behavioral therapy, and calcium supplements also help.
Then I heard about the controversy surrounding this diagnosis. When the American Psychiatric Association added his form of PMDD as a candidate disease to its diagnostic manual in the 1980s,DSM-III-R—Some scholars pushed return. They viewed the diagnosis as part of the historical oppression of women in the name of mental health. The controversy revived when PMDD remained in 1994. DSM-IV, It was also listed here under “Depressive Disorders Not Specified”. Critics argued that defining this as a mental illness could have profound personal and social consequences because many menstruating people experience emotional changes during their cycle. 2002 psychology monitor article, “Is PMDD Real?As the late psychologist and author Paula Caplan put it: “Women should be cheerleaders,” she said. “If a woman does otherwise, she and her family immediately think something is wrong.”
Ultimately, the APA considered these concerns and added and promoted the PMDD. DSM-5 But I was uneasy with the criticism. Would I have accepted the modern diagnosis of hysteria? Were the symptoms I experienced real?
Researchers have investigated hormonal differences between those who experience severe premenstrual discomfort and those who do not. In some cases, we have found: 2021 meta-analysis People with PMDD tend to have lower levels of estradiol, a type of estrogen, between ovulation and menstruation.but Other research Little or no difference in hormone levels is shown. “There are no biomarkers. There are no tests to help identify people with PMDD,” says Lindsey Matthews, who studies PMDD at the University of the West of Scotland.
Instead, those experiencing premenstrual distress should observe their minds and bodies in order to receive treatment. Diagnosis of PMDD is based on symptom diaries recorded over multiple menstrual cycles.
Symptoms recorded in these diaries can be severe. In the 2022 survey, 34 percent A percentage of people with PMDD report having attempted suicide in the past. More than half reported self-harm. “If someone had suicidal thoughts, self-harming, or attempted suicide every month for 30 years, that’s not a normal female response to the menstrual cycle,” Matthews said.
there is evidence Researchers do not fully understand that SSRIs are effective in people with PMDD. “Some people feel significantly better within hours of taking an effective SSRI,” Matthews says of PMDD sufferers. In contrast, people with depression usually need to take SSRIs for several weeks before they feel their effects. Researchers know that the drug’s mechanism of action is different in PMDD, but just don’t know why. “Once people know it, they’ll be convinced it’s a medical condition,” Matthews said.
Tamara Kayari-Brown, a bioethicist at Deakin University in Australia, agrees that some people experience significant distress during the week before their period. i disagree We call it mental illness.
“The core of the problem seems to be that we are in a patriarchal society, where women are treated very differently and many women are under severe and disproportionate stress,” Brown said. To tell. That disproportionate stress starts early. 83 percent Among a sample of PMDD patients in Australia, some reported trauma during childhood. It continues into adulthood. A Swedish study of 1,239 PMDD patients found that: child rearing was associated with higher rates of premenstrual distress.
Many people experience physical and emotional sensitivities during ovulation and menstruation. They may feel unwilling or unable to deal with stressors such as a crying baby or a messy partner for the rest of the month. “Is this month the time for the truth to come out?” suggests Brown. From this perspective, irritability, anxiety, and depression are not symptoms of mental illness, but understandable reactions to stressors in life.
there is long history The number of doctors who label women as insane. There is also long history Percentage of doctors who dismiss female doctors pain. The debate about premenstrual disorders is divisive.
When critics question PMDD or less severe premenstrual syndrome, it may feel ineffective. “It’s time to stop questioning whether women’s experiences are real and start making women’s experiences a real priority,” said journalists Emily Crockett and Julia Bellous. I have written In response to an article suggesting that PMS is culturally constructed.
At the same time, if left unchecked, casual sexism can permeate medical discourse around PMDD. An early pharmaceutical ad selling his SSRI for PMDD shows how this really works.in the year of 2000Eli Lilly packaged fluoxetine hydrochloride in pink and purple capsules and branded it. Sarafem. The advertisement for this drug featured an incompetent and unreasonable woman. One fight shopping cart, another quarreling person with her (male) partner. “Do you think it’s PMS? Think again. It could be PMDD.”
What if we could question the structural factors that make life difficult for women while providing medical assistance to those who are suffering? , will it increase?
Medical intervention may save the lives of PMDD patients. But they are silent about a society that places a heavy burden on the shoulders of those assigned to be female at birth.
Brown likens severe premenstrual pain to a broken leg. “If you break your leg, you really need pain meds because you’re in pain,” she says. “But if you don’t address whatever the underlying cause is, it won’t help you in the long run.” A person with PMDD should spend her week before menstruation on a life stressor to deal with for the rest of the month. can feel unbearable. These life stressors can and should be addressed alongside conventional medical treatment.
One common stressor is the burden of caregiving. “Parenting is not only a huge trigger, but it’s also the biggest burden, or the biggest guilt, of having PMDD,” says Matthews. “Not only are you giving yourself a hard time every month, but you feel like you’re ruining your kids every month.” Co-parenting can help ease this burden.when father By spending more time with their children and doing child-related chores, mothers tend to be less stressed about parenting.
Another stressor is relationship problems. Emotional changes that accompany menstruation can make you more prone to conflict with your partner. You can also encourage the PMDD patient’s partner to ignore their feelings. “Even now, your partner might be tempted to say, ‘Wait a minute, it’s time again.’ You’re just being overly sensitive,” says Brown. Women in relationships tend to do this. more understanding They reported more pronounced premenstrual changes than men and a more positive experience during the week before their period.
Researchers are doing the great work needed to understand PMDD, and that work should continue. How do people who experience premenstrual dysphoria differ biologically from those who do not? Can we find new, more effective drugs to treat the affliction?
In the meantime, we must build a better world for those who experience premenstrual distress.Doctors can prescribe medicines, but administrators can make them hotel at work. Co-parents can take on more caregiving responsibilities. And partners can offer love and support.
