By Dr. Gbonjubola Abiri

When Adaeze walked into my office, her complaint was very specific. “Doc, every month, just about a week before my menstrual period, my usual composed, dependable, inspiring self appears to disappear.”

She described the changes as starting subtly: they included heaviness in her chest, bloating, intense mood swings, severe irritability, anxiety, sadness, fatigue and difficulty concentrating in the days leading up to menstruation.

She would become very edgy at work, shout at colleagues and take permissions off meeting to go into the bathroom to cry.
What was quite concerning were often the dark thoughts that crept in: “You are not as awesome as you thought, are you?”, “You have only been able to pull these off because you were lucky”.

Interestingly, the symptoms will lift just a few days as the period started. She would then start to feel like her usual self again and would hardly recognise the person she had been just days before.

On her visit, I asked: “Do these symptoms occur around the same time every month?” Her response was a resounding “Yes” as she had identified the patterns month in, month out.

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome which cause symptoms intense enough to significantly affect mood, behaviour and thinking. While many women complain of mild premenstrual symptoms, PMDD is a more intense disorder as the symptoms vary significantly affecting the daily functioning and quality of life of the individual.

It occurs during the luteal phase of the cycle, and is linked to hormonal changes during the menstrual cycle especially those that occur a week to two before the period begins. The women who have PMDD do not have abnormal hormone levels but instead, 7have their brains more sensitive to normal hormonal shifts and their effects on brain chemicals such as serotonin which influences mood, sleep and emotional regulation.

The condition affects 3-8% of menstruating women, even though many are undetected and untreated. Unfortunately, many women believe that they have a difficult personality, are unable to cope with normal stress or that they are weak.

The condition is diagnosed usually by tracking mood and physical symptoms across at least two menstrual cycles, so that the cyclical pattern becomes clear.
PMDD can be treated via various options including lifestyle adjustments such as ensuring adequate sleep and exercise, reducing caffeine and alcohol and managing stress.

Professional talk therapy in form of psychotherapy, alongside use of medications such as hormonal treatments and antidepressants that influence serotonin can also be used.

When women become aware that their experiences are likely to have a biological and cyclical basis, it replaces years of confusion and self blame with clarity and support.
Remember there is no health without mental health.