“I had become very emotional.” Disha, 27, elaborates on why she wrote a five-page note, intended to be a farewell message before she hanged herself. “Reading it again, however, made me want to get help.”
She texted her friend, who took her to a psychologist. A few sessions later, she was diagnosed with Premenstrual Dysphoric Disorder or PMDD, a disorder that is described as a severe form of premenstrual syndrome (PMS). It causes extreme mood swings disrupting everything in life — from work to relationships — and sets in a few days before menses. While estimates on how many people actually suffer from PMDD is sketchy, the fact that there is no clear line that distinguishes it from PMS, makes it go undiagnosed even by doctors.
“While internal stress often manifests itself in the form of intense mood swings and irritability, when it is coupled with hormonal changes before the start of menstrual cycles, it aggravates,” explain gynaecologist and obstetrician Dr. Vaibhavi Indulkar. “Inherent stress and exterior situations surrounding an individual only further add up to a patient’s symptoms. In PMDD, thought process and hormones are intertwined thus affecting one’s mood and stemming dysphoria.”
Katy, a 40-year-old Canadian, was diagnosed in 1998 and still has difficulty coping. She has had to make plenty of lifestyle changes — sugar, caffeine and alcohol are out, and in came whole-grain and protein-rich diet. “It is a nightmare, those few days before my periods,” she wrote in an email. “So much so that when my periods arrive, it is actually a blessing!”
Medication for PMDD come in two forms: the “regular” medicines, like mood stabilisers, and the “SOS” medicines to control impulsivity. Together with these are lifestyle, dietary changes and more therapy.
“While psychiatric medicines and antidepressants work well, these should be your last resort. It is necessary to make some serious lifestyle changes initially like a change in diet, regular exercise and eating right. These along with some hormonal medicines could work initially, and are the right way to begin coping with PMDD,” says psychologist Sanskriti Jithani.
While medicines can help, Dr Ashima Srivastava, clinical psychologist at Max Patparganj, says what is actually needed is more conversation. “Family and public awareness about such issues which are less-spoken can go a long way for the patients. We are well-aware about PMS, thanks to the internet and social media, but there still is an under-recognition of PMDD. We should bring up such taboo topics and create an environment sustainable for patients to come out and seek help,” she says.
Most women remain unaware about the disorder just like Disha, who did not know of the symptoms that she was suffering was not PMS, but PMDD. She shares, “I did not know about the ailment until I read Shehla’s tweet. I thought it was a coincidence that I was PMSing and feeling terrible about myself. So no medicines.”
Explaining her relationship with her family after coming out about the disorder, she says, “I’ve damaged a lot of relationships over the years and had to give up on my career as a teacher due to the disorder.” On her relationship with her daughter, she comments, “The condition puts a strain on my husband but we fight it out. I have, however, made it a point to share my experience with my daughter. I think I have protected her by being open.”
While Katy’s family is fully aware about her ailment, Disha has still kept it under the wraps, hidden from her family. Working and spending time at the gym have helped Disha in maintaining a work-life balance. Though she complains about the ailment making her a little distant from her family, she has found her solace in talking to her friends which is reflective of the inhibitions that the Indian society carries towards mental health issues.
PMDD is as much a mental disorder, as it is physical and often psychiatrists have to come into picture when therapy doesn’t work for women. An extension to mood disorder, the treatment differs and is affected by serotonin dysregulation, explains psychiatrist Dr. R K Srivastava, Head of Department, Mental Health and Max Patparganj.
However, this ailment brings us to a larger question of whether women should be given paid leaves during their menstrual cycles or ‘menstrual leave’. Most countries and corporates are yet to implement such a leave option. Nike, is one of the bigger brands that has included ‘menstrual leave’ in their Code of Conduct in 2007. One of the recent Indian firms to roll out a similar structure of leave is a Kolkata company that introduced period leave as a gift to its women employees, this new year.
Though a cure to PMDD is still unexplored, psychologist Sanskriti Jithani says technology is also aiding women to keep track of their menstrual cycles and working towards making the symptoms less painful. She shares that different applications help in assessing monthly cycles, blood flow and also bust myths relating to menstruation. “Psychology is evolving and treatments for disorders are also changing according to the advancements in science, which is evident in the way that mental health is being spoken about today,” she explains, implying that with time, a cure for PMDD might be on its way.