What is PMDD?

PreMenstrual Dysphoric Disorder (PMDD) is a hormonal health condition that causes severe periodical mood and functioning disruptions, and disproportionately affects people with ADHD/Autism.

Premenstrual Dysphoric Disorder (PMDD) is a hormonal health condition that causes clinically significant and impairing depression, anxiety, mood swings, and physical symptoms in the week leading up to a period. PMDD symptoms improve during or following a period and are minimal, if not absent, in the following weeks. PMDD disproportionately affects people with Autism and ADHD.

Autism, ADHD, and PMDD

PMDD disproportionately affects people with ADHD and autism, with up to 92% of autistic women and 46% of women with ADHD experiencing PMDD, though estimates vary. There is no agreed-upon cause of PMDD, nor is it known why it affects certain populations more than others, though there are various theories. Possible explanations include:

Genetics: PMDD is highly hereditary
Childhood trauma: Eighty-three percent of women with PMDD had experienced early life trauma, with emotional abuse being the most common (71%)
Hormone sensitivity: Autistic women have heightened sensitivity to hormonal fluctuations. During the menstrual cycle, levels of estrogen and progesterone fluctuate, which can affect neurotransmitter systems (e.g., serotonin, dopamine) that are already atypical in autistics. This increased sensitivity dramatically increases the odds of PMDD.
Sensory Sensitivities: Autistic people generally have acute sensory sensitivities which increases their emotional and hormonal vulnerability.

PMDD Symptoms

To reach a PMDD diagnosis the symptoms below must periodically cause distress or interfere with daily activities. Note that PMDD is much more severe than PMS.

Unstable and easily influenced mood
Irritability, anger
Depression or hopelessness, suicidal ideation
Anxiety or tension
Decreased interest in usual activities
Self-critical thoughts, increased sensitivity to rejection
Difficulty concentrating
Fatigue, lethargy
Appetite changes
Sleep difficulties, either insomnia or hypersomnia
Feeling of overwhelm
Physical symptoms: breast tenderness, joint or muscle pain, a sensation of bloating, or weight gain

PMDD vs. PMS

While PMDD shares symptoms with premenstrual syndrome (PMS), PMDD is less common and more severe. PMS may occur in up to 48% of people who menstruate, while PMDD only occurs in 3 to 9%. In addition, PMDD symptoms interfere with daily functioning, and often requires accommodations. People with PMDD have an increased risk of developing suicidal ideation and studies suggest that it also negatively affects pain sensitivity . Some people who do not meet the criteria for PMDD may have severe PMS and benefit from similar treatment.

Treating PMDD

There are various options to treat PMDD. Some health practitioners will suggest selective serotonin reuptake inhibitors (SSRIs) or selective serotonin and norepinephrine reuptake inhibitors (SNRIs) to treat PMDD but these tend to be ineffective in autistics. Little research has been done on the effect of antidepressants on autistic women of reproductive age.

Menstrual neuromodulation therapy: This is a drug free and hormone free none-invasive innovative treatment targeting PMS and PMDD symptoms.
Contraceptives: Hormonal contraceptives regulate hormones and can alleviate both physical and psychiatric PMDD symptoms.
Cycle tracking: Increased menstrual awareness through astute tracking will allow the person to organise their lives to work with their cycles (e.g. avoidance of certain stressors and foods around the 21st day of your cycle)
Supplements: Vitamin B6, vitamin E, calcium, magnesium supplements etc. can help to support the body and ease PMDD symptoms.
Herbal remedies: Chasteberry, evening primrose oil, gingko and St. John’s wort can be used to manage PMDD naturally. Never mix St. John’s wort with SSRIs/SNRIs.