When extreme PMS makes life unbearable

Suffering without diagnosis and the constant question "What is wrong with me?". This is the reality for PMDD sufferers when they experience unexplained symptoms in the second half of their menstrual cycle. This is in the first day after the end of the period still all right. Only in the second half (the luteal phase ) does the horror begin again.

• Note: This article is about mental illness and suicide.

Suddenly the world around you turns "grey" , your partner is no longer capable of anything and is annoying, every child screaming becomes torture and the stress level at work is skyrocketing within seconds.

You just drag yourself through everyday life in the hope that the condition will soon be over. However, it is only "over" when the menstrual bleeding starts.
For PMDS sufferers, four days after the start of the period, the sun is shining brighter again and the romping children are adorable... And the cycle starts all over again.

This is the definition of the clinical picture PMDD, which has only recently received media attention, although (statistically) one in ten women of childbearing age suffers from it.

The PMDD symptoms

Premenstrual Dysphoric Disorder (PMDD) is a complex condition that combines physical and emotional symptoms. Depressive and manic moods are typical. The feeling of losing control, anxiety, panic attacks and "brain fog" can occur as well as physical symptoms. These include fluid retention, chest pain, fatigue, stomach upset, back pain or migraines.

With PMS, women tend to experience physical symptoms, while with PMDD, the focus is more on psychological symptoms," says the Viennese gynecologist Dr. Matthai in an interview.

PMDD is complex because the disease is triggered by a physical process in the body, but can have serious psychological effects and even lead to suicide. That is why PMDS has been listed by the WHO with the code GA34.41 since 2019, which classifies it under behavioral and neurodevelopmental disorders.

As the US TV star Gia Allemand shows, you should seek medical advice, especially in severe cases. Allemand took her own life in 2013 as a result of her PMDD disease. "The Gia Allemand Foundation" was founded in her name, which today operates as the "International Association for Premenstrual Disorders" and is dedicated to public relations and educational work for PMDD.

Things to know about PMDD

• The causes have not been definitively researched because they can be different. However, it is believed that hormonal factors are the main factor. One possibility is an abnormal brain response to the increased progesterone in the luteal phase and the neuroactive steroid allopregnanolone.
• A special drug is currently still in the development stage. If and when it will be on the market is still uncertain.
• For the PMDD diagnosis , it is important to recognize the temporal connection between menstruation and symptoms: Only when the symptoms are noted in a calendar (for at least two cycles) can it be recognized whether it is PMDD, according to US doctor Diana Dell in their guide "The PMDD Phenomenon".

The Viennese gynecologist Dr. Christian Matthai writes about PMDS in his current book " My Clinic ". L'Officiel Austria asked him for an interview.

dr Matthai, PMDD is a complex disease. What symptoms does she have?

dr Christian Matthai: "The premenstrual dysphoric syndrome (PMDD) is a complex of symptoms in which depressive disorders, anxiety and panic attacks are in the foreground."

What is the significant difference between PMS and PMDD?

dr Christian Matthai: "With regard to the symptoms, one can distinguish between the more frequent and somewhat milder form, classic PMS, and the extremely stressful premenstrual dysphoric syndrome (PMDD). This most serious form of PMS is present when at least 5 symptoms are present. With PMS, women feel More physical symptoms, while PMDD tends to be more about psychological symptoms.The classic physical symptoms include: breast tenderness and chest pain (mastodynia), bloated stomach and flatulence in general, water retention (edema), fatigue, ravenous hunger, headache and stomach pain, and sleep disorders. Classic psychological symptoms include irritability, lability and tearfulness, depressive mood, tension, anger, aggression, forgetfulness and difficulty concentrating."

What role do hormone fluctuations play in the female cycle? Is a lack of a certain hormone to blame?

dr Christian Matthai: "The exact cause of PMS is not yet entirely clear. A hormonal background is obvious, since the symptoms are always related to the female menstrual cycle. The following factors are the focus of science as possible causes: Permanent negative stress, chronic inflammation, progesterone and/or estrogen deficiency, a lack of the amino acid L-tryptophan and/or the neurotransmitter serotonin The GABA-A receptor, which is very important for the psyche, the sleep hormone melatonin, the stress transmitters dopamine, noradrenaline and cortisol are also present in discussion."

Does PMDD persist until the transition or can other hormonal changes, such as childbirth, change or even stop the symptoms?

dr Christian Matthai: "One of the advantages of getting older is the fact that postmenopausal women who no longer have a cycle and therefore no longer have a menstrual period are no longer affected by PMS. A woman's hormonal situation can also change after childbirth."

What life circumstances can make PMDD worse?

dr Christian Matthai: "Science focuses on the following triggers: Permanent negative stress, chronic inflammation or exposure to hormonally active, harmful substances that we ingest through food. These include, for example, plasticizers such as bisphenol A. "

The WHO has categorized PMDS under the behavioral and neurodevelopmental disorders in the ICD-10 with the code F32.81. Should one now turn to a gynecologist or a psychiatrist?

dr Christian Matthai: "Basically, both specialists can help. I see gynecologists as the primary contact persons. In severe cases in which psychotropic drugs are used, the patients are then referred to psychiatrists. For some women, the symptoms can be so strong that suicidal thoughts occur. Classic therapy with antidepressants then becomes unavoidable."

Is there another way to use hormones?

dr Christian Matthai: "For women who do not need hormonal contraception or do not want to use it, a bioidentical hormone therapy with progesterone can be used . Progesterone therapy starts from the middle of the cycle and is usually applied cyclically over 10 to 14 days. Doses between 100 and 400mg is usually effective. Since progesterone can make you tired, it is recommended to use it in the evening before going to bed."

Which foods should you avoid and which should you prefer with PMDD?

dr Christian Matthai: "In the second half of the cycle, those affected should avoid sugar and simple carbohydrates . Whole grain products are the best substitute. Coffee and alcohol should also be avoided , as their consumption can worsen symptoms. Furthermore, the consumption of animal fats and salt should be reduced .The saturated fats found in meat, sausages and fatty dairy products in particular promote inflammation and salt promotes water retention.Omega-3 fatty acids are among the healthy polyunsaturated fatty acids and act as natural anti-inflammatories.Think about them in capsule form or as an oil. Dosages between 1 and 2g per day have an anti-inflammatory effect. And weight can also play a role: women who are overweight usually also benefit from weight loss with PMS."

Which vitamins are particularly helpful for PMDD?

dr Christian Matthai: "The B vitamins are involved in numerous metabolic processes. Since they are of great importance both for the psyche and for the hormone balance, the use of a vitamin B complex is beneficial for many PMS patients. An analysis of the B It makes sense to take vitamins before starting therapy [via blood count, note]. Like the B vitamins, magnesium is also involved in numerous metabolic processes. On top of that, magnesium and vitamin B6 are essential cofactors of the body's own serotonin production. Magnesium also has an antispasmodic effect and can therefore also help with lower abdominal complaints Bring relief. Daily doses between 300 and 450 mg are effective. The daily amount should always be divided into 2 to 3 individual portions. A magnesium analysis before starting intake is not absolutely necessary, since magnesium can hardly be overdosed."

In contrast to the USA, why is there still so little awareness of PMDD among medical professionals in Europe? If you google "PMDS" and e.g. at Wiener Gynäkolog:innen there are only a handful who mention it on the website ...

dr Christian Matthai: "Just because you rarely read it online doesn't mean that we medical professionals don't address this topic or don't take it seriously. Nevertheless, the number of women who feel left alone with their complaints is still too large. You're right."

What can women do who now recognize the symptoms themselves and think they may have PMDD?

dr Christian Matthai: "In any case, those affected should talk about it and get help from doctors or pharmacists if necessary . It can also be helpful to talk to friends and other people affected - there are also self-help groups for that. Even the realization that If you are not alone, it helps many. However, I know from experience that there is a solution for all PMS or PMDD complaints. At this point I would also like to take away all women's fears and give them confidence."