Understanding The Silent Battle Of PMDD
For many women, the severity of our menstrual cycle can make us feel foreign in our own bodies.
From physical symptoms like bloating and fatigue to emotional waves brought on by mood swings and irritability, 3 out of 4 menstruating women have experienced some form of premenstrual syndrome (PMS) in their lifetime. However, what separates normal PMS from a more debilitating variation of these conditions lies in the severity and impact of these symptoms and how it impairs a woman’s ability to function in their daily life — and such is the case of Premenstrual Dysphoric Disorder (PMDD).
WHAT IS PMDD?
Premenstrual Dysphoric Disorder (PMDD) is a severe type of premenstrual syndrome (PMS) that brings about a variety of emotional and physical symptoms during the week or two before menstruation. It is often recognized as 'severe PMS’ and typically occurs during the luteal phase of the menstrual cycle, which spans from ovulation to the onset of the period.
“PMS and PMDD are very similar but also very different,” says Dr. Ashanda Saint Jean, an associate professor of obstetrics and gynecology at New York Medical College.
“In terms of PMS syndrome, it is characterized by both physical and behavioral symptoms that occur prior to the onset of menstruation,” she tells xoNecole. “Whereas PMDD is the severity of the symptoms, which then can be characterized by depression, anxiety, mood changes, and sometimes even suicidal ideation. It's the severity of the symptoms which then require medicinal therapy.”
WHAT ARE THE SYMPTOMS OF PMDD?
One of the main distinctions between PMDD and PMS is how it impairs or disrupts the daily functions and quality of life of the women who experience this condition. “Some of the signs of PMDD can be depression, irritability, and anxiety,” Dr. Saint Jean explains. “You can have the severity in the form of breast pain, bloating, swelling, headaches, but once you have your period, these symptoms usually remit or stop occurring.”
While symptoms of PMDD may vary on an individual basis, they typically show up with PMS symptoms and can be broken up into two categories:
EMOTIONAL EXPERIENCES
- Mood swings
- Experiencing sadness or tearfulness
- Fatigue or decreased energy levels
- Crying spells
- Less interest in activities you normally enjoy
- Feeling hopeless
- Suicidal feelings
- Feeling angry or irritable
- Feeling anxious, tense, or ‘keyed up’
PHYSICAL AND BEHAVIORAL EXPERIENCES
- Breast tenderness or swelling
- Bloating sensation
- Changes in appetite, including overeating or specific food cravings
- Sleep disturbances
- Muscle and joint pain
- Headaches
- Increased anger or conflicts with others
- Strong emotional response to perceived rejection by others
Although the specific causes of PMDD are yet to be fully understood, research suggests that there is a connection between PMDD and heightened sensitivity to the typical hormonal fluctuations that take place throughout the menstrual cycle.
“It's your body's response to estrogen. There’s a cycle to how your brain sends out signals and that influences your ovaries to produce hormones,” she says, “It’s hypersensitive sensitivity to the elevation of the hormones that can make the body and mind experience symptoms of PMDD.”
HOW IS PMDD DIAGNOSED?
Women who suspect to have symptoms of PMDD can begin their self-screening by taking the International Association for Premenstrual Disorders (IAPMD)’s online screening assessment. Your medical provider will then look for five or more PMDD symptoms, including one mood-related symptom to determine the diagnosis.
Because PMDD is diagnosed based on recurring symptoms, it’s helpful to keep track of your symptoms for at least two full menstrual cycles by using a journal, notebook, or tracking app.
“One's agency is very important and our patients know their bodies,” Dr. Saint Jean says. “It can be something that you may suspect that you have, but I will always advise patients to then have that conversation with their provider (gynecologist or primary care physician).”
“If you’re having any of these symptoms, it’s always a good idea to bring them to the forefront and discuss with your provider and see together how you can arrive at the appropriate diagnosis for you,” she continues.
WHAT ARE TREATMENT OPTIONS FOR PMDD?
Once a diagnosis is made, there are a variety of treatment options that can be prescribed. Many patients may require a mood stabilizer such as a Selective Serotonin Reuptake Inhibitor (SSRI), which is a category of medication that increases the levels of serotonin in the brain. Dr. Saint Jean also shares that there is the option of continuous oral contraception, which “increases the intervals of your menstrual cycle,” and allows you to have fewer periods throughout the year.
In all, treatment solely depends on the severity of your symptoms is the advice from your medical provider.
“Not everyone requires to be on an SSRI, but it is helpful for some, especially some patients who have suicidal ideation,” she shares. There are also a variety of lifestyle changes, exercise, and dietary modifications that can aid in decreasing these symptoms. “You may crave salt and sugar, which then can contribute to bloating and water retention; so we advise you to stay away from sugary and salty foods prior to menstruation.”
Struggling with PMDD can feel like a silent battle when you’re experiencing it alone or never knew there was a name for the symptoms that you endure. Thankfully, with the proper tracking and advisory from your primary care physician, PMDD doesn’t have to be something that you suffer through unsupported or untreated — and with these tools, relief could be closer than you think.
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Aley Arion is a writer and digital storyteller from the South, currently living in sunny Los Angeles. Her site, yagirlaley.com, serves as a digital diary to document personal essays, cultural commentary, and her insights into the Black Millennial experience. Follow her at @yagirlaley on all platforms!
ItGirl 100 Honors Black Women Who Create Culture & Put On For Their Cities
As they say, create the change you want to see in this world, besties. That’s why xoNecole linked up with Hyundai for the inaugural ItGirl 100 List, a celebration of 100 Genzennial women who aren’t afraid to pull up their own seats to the table. Across regions and industries, these women embody the essence of discovering self-value through purpose, honey! They're fierce, they’re ultra-creative, and we know they make their cities proud.
VIEW THE FULL ITGIRL 100 LIST HERE.
Don’t forget to also check out the ItGirl Directory, featuring 50 Black-woman-owned marketing and branding agencies, photographers and videographers, publicists, and more.
THE ITGIRL MEMO
I. An ItGirl puts on for her city and masters her self-worth through purpose.
II. An ItGirl celebrates all the things that make her unique.
III. An ItGirl empowers others to become the best versions of themselves.
IV. An ItGirl leads by example, inspiring others through her actions and integrity.
V. An ItGirl paves the way for authenticity and diversity in all aspects of life.
VI. An ItGirl uses the power of her voice to advocate for positive change in the world.
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Less & Less Of Us Have Close Friends These Days. Why Is That?
German philosopher Friedrich Nietzsche once said, “It is not a lack of love, but a lack of friendship that makes unhappy marriages.” At close to two decades of working with married couples, I agree with this man 1000 percent. It’s actually the main motivation for why I once penned, “Are You Sure You're Actually FRIENDS With Your Spouse?” because, the reality is, if you’re not friends with the person who you vowed to share every aspect of your life with, for the rest of your life, it’s going to be very difficult (if not damn near impossible) to honor that level of commitment. Without question, I will now and forever die on the hill that if you like your partner, you can make it through the not-so-in-love-right-now moments. Vice versa? Eh…not so much.
A basis for why I feel this way? Another quote immediately comes to mind. Famed author Jane Austen once wrote: “There is nothing I would not do for those who are really my friends. I have no notion of loving people by halves, it is not my nature.” You know, back when I also wrote “10 Things You Should Absolutely Expect From Your Friendships” for the platform, I shared that some of the traits of a friend — a real friend — include loyalty, honesty and compassion. And if you can’t say that your spouse is this way (as they say the same thing about you), chile…what is y’all doin’ over there?
So, why am I talking about marriage when this article is supposed to be about friendship? It’s because, something that life has taught me, kinda sorta the hard way, is we should vet potential friends — especially close friends — almost like we would a spouse.
And if you keep reading, I think you’ll get why I framed the intro in the way that I did.
Why Friendships Are Still Hella Essential
GiphyOkay, so before I get into why it seems that people have fewer friends than they ever had before, let me just say that, even as an ambivert who enjoys my own company and has absolutely no problem with being alone a good amount of the time, every personality type needs friends. That’s not just my opinion;science makes it a fact. Not only do studies support thathealthy friendships help us to feel more satisfied with our lives, but they can also reduce our chances of experiencing depression, stress, and anxiety and they increase longevity overall.
This is why — without going too deep because it’s kind of another topic for another time — it’s important to not allow past hurts and disappointments from former friends (or folks you thought were your friends) to cause you to build up walls as you declare that you don’t need anyone. When you do that, all you’re really doing is working against your own health and well-being. The saying that “no man (or woman) is an island”? It is absolutely true.
That said, even if it’s just a couple of people, make sure that you’ve got individuals in your life who you can call a friend and, in turn, they can say the very same thing about you, okay?
Are All of Those People Your Actual Friends? Or Do You Just Happen to Know a Lot of Folks?
GiphyAight but what if you happen to be someone who swings on the other side of few? Meaning, if someone were to ask you how many friends you had, you’d quickly declare that you’ve got too many to count. Listen, not to patronize or anything yet, but whenever I hear folks (especially if they are over 35) say something along those lines, it takes me back to high school — a time when so many of us thought that so long as we knew a ton of folks and/or we were popular, clearly, we had many friends.
Wisdom and pure ole’ dealing with humans on a consistent basis will teach you that an article that I wrote a few years back for the platform has a title that is spot-on: “According To Experts, We Only Have A Few Friends — Here's Why.” According to it, the average American (based on a survey that was conducted) has somewhere around 16 friends. Oh, but wait. Last fall, I wrote another article for the platform entitled, “What's The 'Five Friendship Theory' All About?” According to it, if you’re someone who takes the word “friend” and the responsibility that comes along with it very seriously and quite literally, as an adult, you can probably only maintain about five close friendships.
Why? Well, that brings in another article that I once wrote: “Life Taught Me That True Friendships Are 'Inconvenient.'” Chile, I don’t know about y’all but my friends know that if I call you that, you can call me in the middle of the night, and you can have money towards your rent (I’m not your mama but we all have hard times sometimes) and I’m gonna have your back in a way where you’ll wonder where you stop and I start — and no, I don’t have a lot of bandwidth for a ton of those people.
Okay, but what if you’re someone who is like, “I know that I have more than 16 and definitely more than five friends, no question”? The next thing that I would encourage you to explore is a theory by Aristotle (check out “According To Aristotle, We Need ‘Utility’, ‘Pleasure’ & ‘Good’ Friends”). Without even realizing it, many of us have people who we use the word “friend” for when…it’s kind of like how social media apps say “friend”: we’re familiar with one another and enjoy some of the same things, we might even have some of the same goals; at the same time, though, we’re not “all-encompassing friends.” We just get along really well at work (utility friends) or like to go to brunch at the same spots sometimes (pleasure friends).
Taking all of this into account, are you sure that you have a ton of actual friends? Or do you just happen to know a lot of people and you use that word for the lack of having another?
And that brings me to my next point.
There’s A LOT of Space Between “Friend” and “Enemy”
GiphyIf you read a lot of my friendship content, something that you will notice me saying quite a bit is that there is quite a bit of space between friend and enemy. It needs to be mentioned, as often as possible, because there are some people who get offended if you don’t consider them to be a friend — and that is unfortunate. I say that because the conclusion shouldn’t automatically be that they are your enemy just because “friend” isn’t what immediately comes to your mind.
They can be an acquaintance. They can be “cool people.” There is someone in my life who, while we’re not friends in the traditional sense, we are each other’s confidant; years ago, we agreed that we would be the place to tell each other whatever and it would stay between us — that is the main purpose that we serve in each other’s lives. Some people, you may consider to be spiritual family in the sense that you care for them and have some deeply profound things in common and still, they are not exactly a friend (I mean, a lot of blood relatives aren’t “friends” with each other).
All I’m trying to say here is we’re all too old now to only put folks in two boxes when it comes to this particular relational dynamic: friend or enemy. So, take some time out to seriously reflect on what you consider the various people in your life to be. I can promise you from personal experience that the sooner you know and the clearer you are, the easier it will be on everybody — because needs and expectations will be clear to you (and them once you articulate them) too.
What Got Folks to Having Less Friends? The Pandemic Plays a Significant Part.
GiphySo finally on to what inspired this piece to begin with. A part of it was an article that was published last year by Big Think entitled, “Americans more than ever have no friends. Here are 5 steps to make more friends.” Another was something that The New Yorker published back in 2021; it’s entitled “What COVID did to friendship.” Y’all don’t have enough time and I don’t have enough space to get into the fact that, just because the media may be talking about it less, that doesn’t mean that we’re not still in a pandemic.
In fact,one article stated my thoughts on it quite well when it said, “The real question, then, is not whether COVID is still a pandemic, but how much COVID illness and death are we willing to accept?” SMDH. And one of the things that has come with experiencing COVID is an interesting type of PTSD: detachment. There are plenty of articles out here to support the fact that my saying that is not merely my opinion.
Even according to the American Psychological Association, loneliness damn near skyrocketed, especially during lockdown and, unfortunately, a lot of people have not recovered from it. That’s why it did not surprise me at all when I read that more than ever, many people do not consider anyone to be a best friend; fewer people are relying on friends for any type of real support, and there is a semi-steady decline in people having friends, especially quality friendships, overall.
In fact, as far as close friends go, currently, close to 50 percent of Americans say that they only have three or fewer, and a relevant contributor to that was what the pandemic revealed as far as people’s proactive participation in other individuals’ lives (I actually read that young women were the ones who lost touch with friends during the peak of the pandemic the most). I also thought it was interesting that some studies cite that 12 percent of Americans say that they don’t have any friends at all.
Is the pandemic the only cause? No. So are things like people working more hours and spending more time online than they probably should (which also increased due to the pandemic, though). To that, Teen Vogue once published, “Social Media Is Impacting IRL Friendships” and Healthline once published, “Social Media Is Killing Your Friendships.” Then we also have to factor in having families of our own which can also take up a lot of time, and that sometimes can cause us to forget to nurture our friendships; so, before you know it, they fade to black. Not due to a fallout or anything, just…life.
And all of this? Some people are saying that it has led to what is known as a “friendship recession.” A huge flag about that is there are reports that a drop in close friends can cultivate a type of loneliness that is just as health hazardous as smoking a whopping 15 cigarettes a day. Not good, y’all. Not. Good.
Quality over Quantity Is Key. Just Make Sure That You Have a Friend or Two.
GiphyOkay, so what is my overall point? That’s a fair question. Just like sometimes “life life-ing” can make us forget to tend to our friendships, if you don’t stumble across content like this, you might not even realize that you’re feeling mentally stressed, emotionally strained, or super isolated and it’s all because you need to prioritize your friendships — because your mind, body, and spirit need them. Again, science has proved it.
At the same time, if, like a client of mine, you find yourself getting a little bit paranoid because you have noticed that over the past several years, your close friend count has been far less than what it used to be, this article proves that you are absolutely not (pardon the pun) alone. Honestly, there’s nothing wrong with having a very small circle of friends because quality is gonna beat out quantity every time; you just need to assess when it happened and why so that you can be sure that you are choosing it to play out that way and it’s not due to some underlying cause that you hadn’t taken into consideration — until now.
An Italian priest by the name of Thomas Aquinas once said, “The happy man in this life needs friends.” Even if it’s just one or two people, please make sure that you have folks who aren’t just your friend but your very close friend. You need them. They need you.
Everyone else, figure out where they fall and nurture accordingly. Life is a lot. We all get by with the help of our friends. Real talk, y’all. Thank goodness for them.
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