Premenstrual dysphoric disorder is highly underdiagnosed. Here's what to know about PMDD

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Many people who menstruate experience classic PMS symptoms before their period begins: irritability, mood swings, food cravings, fatigue — the list goes on. These symptoms aren't exactly enjoyable, but they're typically manageable enough.

But for some women, such as Guelph, Ont.-based body acceptance content creator Sarah Nicole Landry, known online as The Birds Papaya, the symptoms leading up to her period are unbearable.

"My symptoms are extreme anxiety and thoughts of self-harm, feelings of hopelessness and lack of purpose," Landry said. "It's taken me a long time to admit just how much it impacts my life."

Despite the severity of her symptoms, Landry only recently discovered she suffers from premenstrual dysphoric disorder (PMDD). Like PMS, PMDD is a reaction to the hormone fluctuations that occur before menstruation, but the symptoms are far more severe, often causing severe anxiety, depression and even suicidality. It impacts approximately four to nine per cent of women in Canada.

What are the symptoms of PMDD?

PMDD can cause a range of symptoms that will typically appear about a week before an individual's period starts, and they'll usually resolve within the first few days of menstruation. These symptoms include anger or irritability, feeling on edge or overwhelmed, anxiety and panic attacks, depression and suicidal thoughts, difficulty concentrating, fatigue, food cravings or changes in appetite, headaches, insomnia and mood swings.

"This is not just PMS," registered nurse and licensed psychologist Kelsey Latimer, whose work focuses on women's issues, told Yahoo Canada. "PMDD affects people's lives. It will impact functioning in areas of social, romantic and potentially occupational functioning."

Latimer said people with PMDD often have an inability to effectively regulate their emotions during a symptom flare-up, and they often feel shame and guilt over these experiences.

How can I tell if I have PMDD?

Many PMDD symptoms resemble those of PMS. But the difference, Latimer said, is the extent to which these symptoms tend to impact someone's life.

PMS symptoms are typically mild and manageable, whereas PMDD can often turn someone's life completely upside down, causing intense suffering during this short period.

"The keys here are that the person's personality really seems to change in relation to where they are in their cycle," she explained.

Landry, for example, suffered from these symptoms for a long time without knowing the root cause. But after seeing other influencers share stories about their experiences with PMDD on social media, she began tracking her symptoms with her menstrual cycle.

"Suddenly those random bursts of anxiety and depression weren't so random, they were in a cycle," she said.

After tracking her symptoms and cycle for some time, Landry began experiencing suicidal thoughts, pushing her to finally seek out the help she needed. She spoke with her naturopath first, who was quick to suspect PMDD, and she then spoke to her general practitioner who diagnosed her.

Daisy Cobos, a 25-year-old living in Orlando, Fla., also struggles with severe PMDD symptoms. Each month after she finishes ovulating, Cobos said she experiences intense brain fog, hot flashes and migraines.

She also often feels very ​​short-tempered, paranoid, down and unloved during this time, usually resulting in conflict with her loved ones. While this has been ongoing for years, Cobos only received a PMDD diagnosis about a month ago, following a suicide attempt.

Why it's underdiagnosed

According to Latimer, PMDD is sometimes difficult to identify because it can be challenging to decipher whether the depressive episodes are specifically associated with one's menstrual cycle, or if it's just general depression. This can prevent women from receiving accurate diagnoses and proper treatment.

"Part of what's hard about seeking a diagnosis is because after PMDD passes, I experienced almost euphoric joy and positivity," Landry added. "It was hard to feel like anything was 'really' wrong — I just didn't realize the swings could be so large."

Societal stigmas surrounding mental illness also remain, deterring some women from acknowledging problems and seeking help.

"I didn't seek out help because I grew up in a family that did not believe in mental illness, so I was scared of being labelled as crazy," Cobos noted.

That's precisely why Landry decided to share her experience with PMDD with her 2.3M Instagram followers following her diagnosis. After researching and realizing the disorder is common, she hoped that posting openly about it might help others seek the help they might need.

"It can be hard to be honest about this stuff or to feel like you can't grow in your career, have a family or be a good wife and mom when you struggle," Landry said. "But the truth is, some of the best and most successful women I know struggle with mental health — and so do I."

Getting help for PMDD

The first step to getting help, Latimer said, is letting go of the shame associated with it.

"This is not your fault," she added. "You have a true condition that deserves help and assistance."

For one, it's important to talk to your physician, ideally an OB-GYN, who can medically assess you and rule out any other possible health issues.

While it depends on the person, Latimer also said the best treatment for PMDD is often to work with a therapist who can provide coping techniques.

This might include keeping a diary and tracking how your mind and body feel, and giving your body plenty of rest, nutrition and physical activity that feels good. Meditation, mindfulness and visualizations can also help, and there are many free apps that can help you learn these practices.

Speaking to a professional may also help reframe your thinking, Latimer said, because disorders can change the way we see ourselves. You may be thinking, "I'm such a burden," "there's something wrong with me" or "why me," and these kinds of thoughts only make us feel worse.

"If we have a disorder, we are still ourselves and we are still good enough, we just have something that requires understanding to manage," she said. "Self-compassion is going to be key here. Invite your partner or close friends into this conversation because the people around you can help support you and reduce the stress in your life when you are feeling overwhelmed.

"With treatment, life can be so much better."

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