Is PMDD Silently Destroying Your Relationships?

Editor's note: Some names have been changed to protect the medical information and privacy of sources.

Imagine every month, two weeks before your period, you start to lose who you are. Your favorite activities don't feel the same anymore, your behavior changes and you feel almost constant anxiety.

This is premenstrual dysphoric disorder, or PMDD.

What is premenstrual dysphoric disorder? Premenstrual dysphoric disorder is a more severe form of premenstrual syndrome (PMS) where PMS symptoms can take a dark turn. PMDD is classified as a DSM-V disorder.

Both PMS and PMDD share similar physical symptoms, such as cramping, dizziness, breast tenderness or bloating, alongside mental health problems that mimic mood disorders, making PMDD sometimes difficult to diagnose.

The emotional symptoms of PMDD may include:

• Severe anxiety
• Depression
• Mood swings
• Rage fits
• Suicidal tendencies
• Crying spells
• Sleeping issues

Globally, five to eight percent of menstruating women have PMDD, according to Harvard Health. But in many cases, PMDD is referred to as severe PMS or not properly diagnosed at all.

The underlying causes of PMDD are still up for debate. Some people believe it's a hormone disorder, while others speculate it may be a reaction to hormonal levels fluctuating in the body during the luteal phase, or the first stage of the menstrual cycle occurring after ovulation.

It wasn't until 2019 that the World Health Organization (WHO) added PMDD to its international classification of diseases.

How PMDD affected my life

There is no test to diagnose PMDD. But knowing your own medical history, getting familiar with any family history of unusual PMS and tracking your menstrual cycle for two or three months is a start.

In my case, I spent more than a year tracking my cycle and symptoms before discovering I had PMDD. Premenstrual dysphoric disorder not only impacts my body but also the relationships with my loved ones.

Changes in mood and increased irritability can make communication and intimacy more difficult.

I turned resentful towards some relationships and then felt guilty for feeling that way as soon as the PMDD symptoms wore off. I joined PMDD support forums on Facebook and Reddit and learned I wasn't alone.

As I scrolled through posts on broken marriages, destroyed friendships and heated arguments, I felt heard.

I may not be able to relate to everyone's story, but I knew I wasn't the only one whose relationships were impacted by this disorder.

Real women affected by PMDD

Alicia, 38, from Liverpool, UK, struggled with PMDD symptoms for twenty years until she was diagnosed.

"The general practitioners from the NHS and private doctors barely gave me any support and told me it was all in my head," she said.

Alicia's PMDD had started to take a toll on her marriage.

"We had absolutely no sex life; I was struggling with a short temper, couldn't hold down a job, and I could barely contribute to household chores," she said. "I felt very reliant on my husband and felt almost as if he was caring for me, rather than us caring for each other. I started to feel like a burden to him."

In 2020, when the pandemic hit, Alicia left her husband and lived in complete isolation in a separate apartment for a year.

"I hit my worst—I was on the brink of suicide. Without any treatment or support, I just convinced myself he couldn't love me and that he'd be better off without me, even though he didn't feel that at all and tried his hardest to support me." Alicia said.

Alicia received a PMDD diagnosis and started counseling with her partner, which she says helped rebuild the blocks of their marriage.

Amanda, 26, from Pennsylvania, describes PMDD as the "hardest and most exhausting journey" she's been on. "My husband was walking on eggshells around me; he never knew if he'd come home to a happy wife or his suicidal-stuck-in-bed wife. I almost lost my marriage to this illness."

Women with PMDD are 60 percent more likely to attempt suicide and 70 percent more likely to experience suicidal ideation than women without PMDD, suggested a 2012 study. "PMDD can significantly impact romantic relationships. The changes in mood and increased irritability can make communication and intimacy more difficult. Women with PMDD may also feel less connected to their partners and less interested in sex," Nicole Derish, M.D., a reproductive psychiatrist based in Coral Gables, Florida, said.

That's not all. PMDD can also impact how you feel about yourself, Derish said.

PMDD erodes your self-worth

"One of PMDD's symptoms is having self-deprecating thoughts. As the mood changes and negative thoughts increase, these can lead to feelings of self-doubt, low self-esteem and even self-harm," Derish said.

But PMDD isn't only outward-focused.

"Women with PMDD may struggle with feelings of guilt and shame related to their symptoms, which can further impact their relationship with themselves. It can make it challenging to interact with others, leading to conflict and misunderstandings," Derish said. 

Roughly 34 percent of people who suffer from PMDD have tried to attempt suicide, according to a 2022 study.

How do you manage relationships when you have PMDD?

So how does one manage conflict in relationships while dealing with PMDD? The first step is to acknowledge that the conflict exists, said Peggy Loo, Ph,D., a New York City-based licensed psychologist.

"If you're in a relationship where PMDD is trivialized or misunderstood, it can result in unfair judgment and misunderstanding. On the flip side, if it can be recognized and validated, partners are more likely to be able to provide compassionate support and even plan for it in a proactive way," Loo said. A lack of open communication between partners can also lead to more bitterness and conflict. It's easy for both partners to become resentful of the situation—and each other. But there is a way out.

"First steps in this case may be acknowledgment that PMDD symptoms are difficult to manage for both sides of the relationship and that there are aspects that aren't within total control, but some are," Loo said.

It helps to take a team approach to the problems PMDD can cause. But after weeks, months or years of dealing with the ups and downs of PMDD, finding a baseline and a way to reconnect may seem impossible. Where should these couples begin?

"Establishing some empathy and optimism is necessary for later problem-solving. Thankfully, unlike so many other sources of conflict in a relationship that aren't as predictable, PMDD symptoms can be," Loo said.

Acknowledging the situation isn't always enough. Although it's possible to recognize when your emotions and mood aren't the best, there are other treatment options, such as medication.

"I do encourage partners to consult with their primary care physician or a reproductive psychiatrist to see if medication support may assist in managing symptoms. Follow-up steps can then include active brainstorming," Loo said.

The following tips could help a couple determine their best course of action. These tips, as suggested by Loo, include the following questions:

• Does your partner need space during certain days of the month?
• Does your partner need help managing more practical tasks?
• Does your partner need a moratorium on big conversations?

"Every partner's needs are different and the conversation should be open and flexible to consider both sides of the relationship," Loo said. Amanda and her husband keep track of her cycles and do monthly check-ins with each other during her menstrual phase, or right after. Her husband has come to understand that PMDD isn't something Amanda can control, but his feelings are valid too.

"For the sake of our marriage, he knows it's best to let me decompress alone," Amanda said.

How is PMDD treated?

Women of childbearing age won't see their PMDD symptoms stop until they reach menopause. Until then, there are options.

"PMDD can be treated through a variety of approaches, depending on the severity of the symptoms and the individual's needs," Derish said.

"Treatment options may include lifestyle changes, medication, therapy or a combination of these approaches. Certain medications like antidepressants and hormonal birth control can be prescribed to manage PMDD symptoms. It's essential to talk to a healthcare provider to determine the best treatment plan for PMDD," Derish said.

Selective serotonin reuptake inhibitors (SSRIs) are also an effective treatment option for many women, suggested a 2012 study. For Alicia, the only solution was oophorectomy, or the complete removal of ovaries.

"It was expensive, but I found a private doctor who performed an oophorectomy on me, which included the removal of ovaries and fallopian tubes," she said.

Ovaries produce estrogen and progesterone, two hormones which shape your reproductive and menstrual cycle. Once the ovaries are removed, the side effects that occur with a woman's period do too.

The bottom line

Alicia and Amanda's stories highlight an understudied gap between PMDD and relationships. When an invisible disorder can give you PMS from hell, it's also capable of ruining your relationships.

"PMDD gets in the way of everything for me: how I love my husband; how I care for my home, my pets and myself; how I manage family and friendships; how I manage work—everything," Amanda said. "I have lost so many friendships and relationships to my PMDD and to no fault of other people. I guess my husband loves me enough to see me through it."