What You Need to Know
What is PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a hormonal condition characterized by severe emotional and physical symptoms that occur in the week or two before menstruation and significantly interfere with a woman’s daily life.
Symptoms may include:
extreme mood swings, suicidal ideation, the urge to self-harm, irritability, depression, anxiety, and physical symptoms like muscle pain, bloating, and fatigue.
How is PMDD different from PMS?
PMDD is less common and is distinguished from PMS by its intensity and the degree of impairment it causes.
What the Research Says That You Need to Know as and ADHD Women
- Studies indicate that over 45% of women with ADHD experience PMDD symptoms.
- The hormonal changes of the menstrual cycle can exacerbate ADHD symptoms due to the impact of estrogen and progesterone on neurotransmitters that affect mood, attention, and emotional regulation issues that are different in ADHD women.
Diagnosis of PMDD
Diagnosing PMDD and differentiating it from other mood disorders involves careful tracking of symptoms across at least two menstrual cycles.
This can be so hard. The Daily Record of Severity of Problems (DRSP) is a widely used diagnostic tool that helps chart daily symptoms, linking them specifically to the menstrual cycle and distinguishing PMDD from other conditions.
The International Association for Premenstrual Disorders has more information to learn about diagnosis and support, and I recommend it.
What All This Means For You
ADHD and PMDD occur together!
ADHD women may encounter intensified challenges during their menstrual cycle.
Do you have trouble during the same time every month?
You might be able to help yourself by Identifying this, sharing it with your medical provider, and asking for help to address these symptom patterns related to hormonal changes.
Self-advocacy is critical here! Many professionals don’t know about, understand, or even believe in PMDD! Even if they do, they may not be aware of the connection between PMDD and ADHD.
What You Can Do
Make sure you have a doctor whom you trust. You can bring some literature to your doctor that discusses the relationship between ADHD and PMDD to help them understand if they don't.
Here are some studies for you give to them to review:
Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage.
Adjusting the dosage of stimulants helped combat the premenstrual worsening of cognitive and emotional symptoms.
Prevalence of hormone-related mood disorder symptoms in women with ADHD
Women with ADHD experience high rates of PMDD and PPD compared to the general population.
Additionally, it suggests that female ADHD patients suffer from significant PMDD symptoms, experience PPD during the first childbirth, and face more severe climacteric symptoms.
What kinds of medication options are available to help me with PMDD?
Consult healthcare providers about the interaction between PMDD treatments (SSRIs) and ADHD medications, adjusting as necessary.
- Continuous Dosing: Antidepressants are taken daily at the same time.
- Intermittent Dosing: Medication is taken only during the luteal phase if periods are predictable, though it may be hard to remember to take it.
- Luteal Phase Bump Up: A dose increase during the luteal phase may be prescribed if PMDD exacerbates other conditions, such as anxiety.
- Some doctors may also increase your stimulant if you take one.
Other medications:
- Oral Contraceptives: Certain contraceptives, especially those based on drospirenone, have been effective in double-blind trials. They can be taken continuously or with a placebo break.
- GnRH Agonists: For severe cases, these induce a reversible medical menopause by stopping hormone production. They're not the first choice and are administered via nasal spray or subcutaneously.
Natural Remedies for PMDD
- Mood Charting: Helps recognize and accept symptoms, predict exacerbations, and plan for less stressful times.
- Lifestyle Changes: Includes reducing caffeine and sugar intake, exercising, and getting more sleep.
- Vitamin Supplements: Calcium (1200 mg) shows effectiveness against PMDD symptoms.
- Other recommended supplements include Vitamin B6 (50-100 mg), Magnesium (200-460 mg), and Vitamin E (400 IU), though their efficacy specifically for PMDD is not explicitly proven, they may help with underlying symptoms.
Tailoring Treatment
For my clients, I recommended charting their cycles and scheduling low-stress days, accommodating themselves, and practicing self-care and compassion during the times when they usually struggle due to PMDD.
Advocating for Yourself
- Educate: Understand ADHD and PMDD interactions to advocate effectively for your needs.
- Communicate: To refine your treatment plan, update your healthcare team on symptom patterns.
Self-Care Practices
- Mindfulness and Relaxation: Practice meditation, yoga, or deep-breathing exercises for stress management.
The Importance of Self-Awareness and Compassion
Understanding how hormonal fluctuations affect your ADHD symptoms is key.
Practice self-compassion, acknowledging the strength in seeking help and adapting strategies.
Friends and Family: How to Support and ADHD women with PMDD
Provide empathy and accommodations, acknowledging the unique challenges faced during challenging times of the month.
Further Information
Additional Actions Needed
Staying informed, self-monitoring, and seeking specialized care are essential for those navigating both ADHD and PMDD. Discrimination often affects how you will receive treatment for this condition. It’s been hard to get PMDD recognized, even though it is accurate.
Conclusion
Women with ADHD and PMDD face unique challenges requiring a nuanced approach to diagnosis, treatment, and self-care.
Understanding the available symptoms and treatments and the importance of advocacy and support allows for more effective navigation of these complexities. With the right strategies and support, managing symptoms and improving quality of life is entirely achievable.
De Jong, M., Wynchank, D. S. M. R., van Andel, E., Beekman, A. T. F., & Kooij, J. J. S. (2023). Female-specific pharmacotherapy in ADHD: premenstrual adjustment of psychostimulant dosage. Frontiers in Psychiatry, 14, 1306194. https://doi.org/10.3389/fpsyt.2023.1306194
Dorani, F., Bijlenga, D., Beekman, A.T.F., Van Someren, E.J.W. and Kooij, J.J.S., 2021. Prevalence of hormone-related mood disorder symptoms in women with ADHD. Journal of Psychiatric Research, 133(3), pp.10-15. doi:10.1016/j.jpsychires.2020.12.005.
Petrillo F. L.Psychiatric Disorders in Women: Diagnostic and Treatment Considerations Across the Female Lifespan (February 2020) PMDD https://mghcme.org/