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  • Writer's pictureGeorgina Sturmer

PMDD: What is it and how can counselling help?

Updated: Feb 3

Do you know what PMDD is? Premenstrual dysphoric disorder is often unknown or misunderstood. Maybe you've heard of it, maybe you've been diagnosed with it, maybe you're supporting someone through it – or maybe you've never heard of it at all. In this article, I'll explore PMDD, that is is, how it can impact on our emotional well-being, and how counselling can help. Click here to view my article about PMDD on the Counselling Directory website. I've also commented here in The Independent and here in Fashion North about PMDD.

Premenstrual dysphoric disorder is a very severe form of premenstrual syndrome (PMS).  Sufferers can experience a whole host of physical and emotional symptoms, during the lead-up to their period.  Mental health charity MIND offers some useful details here on the physical diagnosis of PMDD and the symptoms that you might experience. If you think that you are experiencing PMDD, your first step should be to seek medical advice from your GP.

Premenstrual syndrome can be extremely uncomfortable, painful or overwhelming.  But with PMDD, the symptoms can be debilitating, and can inhibit us from living our everyday lives.  Everyone experiences PMDD differently, but symptoms can include mood swings, hopelessness, depression, anger, anxiety, lethargy and severe headaches.  If we are unaware of PMDD or undiagnosed, then this can feel frightening or overwhelming.  And if we have sought a diagnosis, or if we are aware of PMDD, then it can bring a further set of feelings, including unfairness and frustration.  

It can be really hard to get a diagnosis of PMDD, and sufferers are often asked to track their physical and emotional symptoms as a way of noticing patterns.  This is partly due to the nature of PMDD, as it presents so differently in each person.  It’s also due to a lack of knowledge and understanding among health professionals. Like other areas of women’s health, PMDD has often gone under the radar.  Sufferers are beginning to share their experiences more freely now that we are beginning to lift the taboo of talking about menstruation, hormones and our physical and emotional symptoms. 

The symptoms of PMDD abate during pregnancy.  This can be a source of pleasure during pregnancy, but equally it can trigger anxiety or depression in the postnatal period, when a sufferer might experience or anticipate the return of their symptoms.  

What is the emotional toll of PMDD?

So, if it’s a medical issue, how can counselling help with PMDD? It’s important to remember that our physical and mental health are inextricably linked. Counselling can help us to cope with all kinds of physical and hormonal challenges. But in the case of PMDD, this is even more relevant. PMDD itself brings up a range of emotional ‘symptoms’ – or feelings.

This can include the following:

  • depressed, low mood, experiencing suicidal feelings

  • anxious, overwhelmed, helpless or out of control

  • numb or disinterested in everyday life

In some cases, this is directly due to hormonal shifts. In other cases, it’s a response to how we feel about ourselves and the impact that PMDD has on our lives. Everyone experiences PMDD differently, so there isn’t just one set response. But it can lead to isolation, withdrawal, and unpredictable outbursts.

How can counselling help with PMDD?

1. Unravelling and identifying our feelings

I’ve suggested PMDD can lead to all sorts of different feelings. But what if you don’t know what they are? Sometimes we feel anxious or low or overwhelmed or numb. In counselling, we can look at your emotional and physical responses, and start to unpick what they might be:

Anger and frustration

A sense of injustice or anger at our own bodies, at having to cope with PMDD, when others around us aren’t experiencing the same symptoms. Or anger if PMDD is misunderstood or minimised. This might seem like a sweeping generalisation and, of course, we will encounter friends, family and professionals who have a wealth of understanding about PMDD. But I have learnt that it’s a condition that is often overlooked, and misunderstood - even among healthcare professionals. This article in The Times explores this further.

Embarrassment or shame

This can be a response to the stigma around periods and the menstrual cycle, a topic that is often spoken about in whispers. It’s true that times are changing, and we speak more openly than we used to about the menstrual cycle. But it’s useful to notice whether a sense of embarrassment or shame still plays a role in how we feel about the menstrual cycle, and therefore how we feel about ourselves.

Think about the euphemisms that we use when we talk about periods and the associated hormonal and emotional changes. Think about the way that menstrual products are marketed and advertised. It’s only been about five years since advertisers started using realistic-looking red liquid in adverts for pads and tampons. Before then, we were offered the sight of a blue liquid, which was deemed more palatable by advertisers.

Grief and loss

PMDD can have a marked impact on our physical and emotional well-being. In turn, this might change our vision of what our life is like and what it might be like in the future. This can lead to a sense of grief, as we mourn the idea of what life was like before the onset of PMDD.

2. Voicing these feelings

Counselling can help with PMDD, as it offers us an opportunity to explore and unravel these feelings. It can also give us the space to voice them out loud, without fear of judgement or embarrassment. As well as exploring what we feel, we can also reflect on how these feelings impact our everyday life. Our relationships with others, our work, our sense of identity. It might also encourage us to seek support from other women who suffer from PMDD.

3. Exploring who we are and what we've been through

We might seek counselling as a way to help us to manage and cope with PMDD. But in counselling, you are a whole person, not 'just' someone with a diagnosis or set of symptoms. It's likely that counselling will offer a space for you to think more deeply about yourself, your relationship patterns and how you deserve to be treated. PMDD is often characterised by cycles of different feelings. When you're working with a counsellor, you'll typically attend weekly sessions, and they will give you the space to express how you're feeling, wherever you are at in your cycle.

I’m not a researcher, but I have learnt that there is a potential association between trauma and PMDD. Counselling offers a confidential, safe environment for trauma recovery in a number of different ways.

4. Everyday coping strategies

Counselling can also offer a space for you to learn and develop coping strategies to help you to manage your emotional well-being. One of the toughest elements of PMDD is a feeling of being out of control of our emotions, and at the mercy of our hormonal shifts. So when we work to develop coping strategies, it enables us to have a sense of regaining control. This might include breathwork, grounding techniques, visualisations and ways to challenge negative thoughts before they spiral.

Keen to explore more?

I love working with people to help them to understand themselves, and to explore what they are feeling. In counselling we build a relationship where we can look at your sense of who you are, so that you can feel more comfortable and confident in everyday life. If you’d like to learn more, click here to contact me or click here to book a free 30-minute introductory chat.

PMDD: What is it and how can counselling help

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