Illustration: Christine Wang.
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Legitimizing the mental health impacts of PMDD

Growing up, I found periods often acted as both the butt-end of the joke, and an unspeakable biological function rivalling He Who Must Not Be Named. In high school, there was no shortage of dudes yelling “whoaaaa, PMS much?” to their friends who publicly expressed anger or sadness. To this day, I roll my eyes when my male family members use the phrase “lady things,” because apparently saying the words “tampon,” “pad,” or “Diva cup” is just too much to bear.

It’s almost comical, how we feel comfortable using PMS jokes to belittle people’s emotions, and yet none of us really want to talk about the subject of periods beyond that.

But when you consider the far-reaching impacts of premenstrual dysphoric disorder (PMDD), there’s good reason to put the PMS jokes and the period stigma aside, and get serious about understanding mental health in relation to menstruation.

I had actually never heard of PMDD before starting this article. In hindsight, that’s largely unsurprising given that there aren’t many researchers in Canada who study this disorder on any extensive level. Researcher Jean-Michel Le Melledo is one of the few who isn’t afraid of “lady things,” and studies PMDD at the University of Alberta. I caught up with him to shed some light on what PMDD means, and why this disorder is no joke. So, if you aren’t afraid of a little blood, let’s dive on in.

Savannah: First of all, what is PMDD, and how is it different from PMS?

Jean-Michel: Both PMS and PMDD involve symptoms that occur after ovulation … and the symptoms typically peak around two days before the menses, and disappear within a day or two of the occurrence of the menses. A lot of women show symptoms for their menses, but PMDD involves significant impairment of functioning, either at home, or at work, or while studying.

Women suffering from PMDD, their problem is not that their estrogen or progesterone is too high or too low … the women who suffer from PMDD have an increased sensitivity to changes in the hormones. So what we find is the women who are hypersensitive and suffer from PMDD are also more likely to suffer from postpartum depression, and are more likely to develop pre-menopausal depression.

It’s a very important group of women, with very significant consequences when we don’t detect or treat PMDD. And to give you an idea of the severity sometimes of the symptoms, I have some women who are very talented, happily married, but at the time of their premenstrual symptoms, the husband will leave the house and live in a different apartment … This is the extreme, but to show how disturbing it can be in terms of functioning.         

S: From my research, it appears there isn’t a consensus among researchers on whether or not PMDD is a legitimate mental health issue. In your mind, has PMDD gained enough recognition as a disorder?

JM: The (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) was released two or three years ago, and in that manual, PMDD was classified among emotional disorders. So it’s a new recognition for the disorder, and I had the chance to speak about this with someone instrumental in developing the DSM-4, and at that time PMDD was only in the annex of this DSM. We have well-defined criteria, we have treatment, blind and controlled studies show that biological treatment works. So all the criteria to make the disorder were already met at the time, but the guy told me that they didn’t put it in the DSM-4 because they were afraid what feminists would think about it. They were afraid there would be a political response against it.

S: Wow, that’s almost counterintuitive to what I would think today’s conception of feminism would argue.

JM: I was doing research in PMDD, and I actually had a lot of feminists participating in my study, because at that time, the thinking was that women are different from men … we therefore need to investigate the disorders that are specific to women.

In the past, the right strategy for feminists at the time was that women are equal to men anyway, so they should be treated the same. Now actually, when I apply for grant funding for a research project, I have to make sure that I have both males and females in my study.

S: When I mentioned doing this interview to friends, a lot of people had no idea about PMDD. Why do you think there’s this lack of knowledge in the general public about it?

JM: It depends …  a lot of people will say “yeah, I know what PMS is.” But the problem is that there are many jokes about PMS from stand up comedians and so on. It’s kind of taking it lightly, but for some women the symptoms are very extreme, and they really suffer a lot, so the mischaracterization of the term PMS has not helped recognize the significant influence of PMDD.   

The researcher also must raise their findings, speaking to committees, speaking to the media, maybe we should do more of that. I think that’s a good way to make sure women who suffer from these symptoms are comfortable talking about it and finding help for it. Sometimes when I speak to my patients, they say, “yeah I realize now I had PMDD a long time ago, but at the time I did not realize what it was.”

S: Anything else you think people should know about PMDD?

JM: They should know that some medications have been very well tested, such as the selective serotonin reuptake inhibitor, drugs like Cetaline or Zoloft for example. Not everybody responds to it, but it makes a huge difference for many women. And what’s unique sometimes is that if a woman’s symptoms are really limited to one week, instead of treating with the one medication for the whole menstrual cycle they can treat only for two weeks. The oral contraceptives with a high dose of progesterone or estrogen, typically they can induce changes and sometimes make PMDD worse. But there are two hormonal contraceptives … that can help PMDD, so there is another type of treatment.