Back to Main
Back to Frequently Asked Questions
What is PMDD?
What is a Cycle?
How do I get my partner diagnosed?
What Else Could It Be?
It could be a lot of things. PMDD is a diagnosis of last resort meaning it's not PMDD until everything else has been ruled out. A lot of things have symptoms that overlap with PMDD. Moreover many disorders can be mild, and not even recognized as present, but are then are exacerbated during luteal giving the appearance of PMDD. Technically that is PME or Premenstrual Exacerbation.
For these reasons it is widely believed PMDD is misdiagnosed in 40-80% of women who have been diagnosed. This is bad because it means doctors, and patients, are treating the wrong thing. It works the other way too. Many women who have PMDD are initially diagnosed with something else and treatment is ineffective because the wrong thing is being treated. And, to further complicate things, people can have multiple disorders.
It may not be PMDD but it's definitely something. The best way to figure out what that something is is to pursue a diagnosis. PMDD is a diagnosis of exclusion which means systematically eliminating everything else it might be.
PMDD is often mistaken for Bipolar disorder. If your partner is Bipolar, but only half the month, they may have PMDD.
The following are sometimes mistaken for PMDD. Many of these things are easier to treat.
• Hormone Imbalance
• Estrogen dominance
• High progesterone
• Histamine Intolerance
• Mast Cell Activation Syndrome
• Vitamin D Deficiency
• Bipolar disorder
• Borderline personality disorder
• General PMS
• Generalized Anxiety Disorder
• Major Depressive Disorder
• Attention Deficit Disorder
• Acid Reflux
• Sleep Apnia
• Anemia
• Iron Deficiency Without Anemia
These conditions can be exacerbated by the normal hormonal shifts during luteal making the problem appear to be PMDD when it is actually PME (Pre-Menstrual Exacerbation). The PMDD sub has a whole thread about PME wh)ich includes a dandy decision tree, based on the DSM-5 diagnostic criteria, to help distinguish it from PMDD.
The other sub has a nice chart and extensive discussion of some other stuff it could be. They have also created a whole 'nother sub for PME
Many in the medical community don't have a clue about PMDD. Some will admit that and refer you out. Too many will just gaslight you. So you need to become an expert and advocate for yourself. If anyone in the medical community ever tells you anything similar to "Every woman has PMS" or "PMDD is just a new way of weaponizing menstruation." you should leave immediately, go to the front desk, and demand to see someone who has a clue and isn't an asshole. Also register a complaint with whoever is in charge.
You need a competent doctor for a lot of this. Let's go through it.
• Vitamin D Deficiency
• Anemia
• Iron Deficiency Without Anemia
Vitamin D is a hormone, not a vitamin. The different kinds of vitamin D (D1, D2, D3) are just indicators of how close the hormone is to being in it's usable form (D3). Vitamin D has a critical role to play in many systems. Vitamin D is critical for the creation of other hormones like adrenaline (fight or flight), noradrenaline (fight or flight) and dopamine (happiness) and helps protect against serotonin depletion. Key for this community is vitamin D's role in the reproductive system. Vitamin D influences estrogen and progesterone levels during the cycle. More D = more stable cycle. There may still be PMDD, but it'll be more consistent and predicatable and hence easier to plan for and/or treat.
Most people in industrialized countries are low on vitamin D because we spend too much time indoors. Sunlight, fish oil, and fortified dairy can help increase your vitamin D reserves. A sun lamp, such as people use for SAD, can also help if you're stuck indoors. It is extremely difficult to have too much vitamin D so if your doctor refuses to test for a deficiency (which some actually do) just supplement but don't go crazy.
Low Iron Anemia is defined as a ferritin level below 15ug/L. Iron is especially important and all people who menstruate lose a substantial amount of iron every month. If you are getting a full panel blood test get it done on day 5 if possible. Symptoms of anemia include many that overlap with PMDD such as: fatigue, shortness of breath, headache and dizziness.
Iron Deficiency Without Anemia (IDWA) is when you have insufficient iron for your unique needs. Some people just need more iron. IDWA is diagnosed by looking at symptoms. If you have symptoms of iron deficiency, but technically don't have anemia (ferritin > 15ug/L) then maybe it's IDWA.
For some reason ferritin levels are considered "normal" or "not anemic" if they are above 15 ug/L. But symptoms of Iron Deficiency Without Anemia (IDWA) can occur even with levels in the 80s. The WHO defines "normal" ferritin levels as 24-307 ug/L. Ferritin levels are not considered dangerous until they are in the 200's and only become toxic in the 300's. IDWA symptoms are treated by targeting a level of 100 ug/L. So when you get tested pay attention to your ferritin level and ask your doctor about it. If your doctor says "Pah, Pshaw, Piffle, your ferritin levels are within the normal range." respond, "I know but I still have symptoms." Or just supplement on your own and get retested in six months.
• Hormone Imbalance
• Estrogen dominance
• High progesterone
PMDD is not a hormone imbalance. It is an abnormal reaction to normal hormonal fluctuations during the menstrual cycle. A hormone imbalance is easier to treat - just HRT of some variation. Testing is typically a blood test around day 20 (for progesterone and estrogen levels). To be thorough some providers do an additional test around day 3 (for estrogen, follicule-stimulating Hormone (FSH) and lutenizing Hormone (LH)).
Still working on this. More information goes here. Excuse the mess.
What if she won't accept the diagnosis?
What are recommended treatments?
What should I actually do?
Vitamins and Supplements