Premenstrual Dysphoric Disorder and Pregnancy: What You Need to Know

April is premenstrual dysphoric disorder (PMDD) awareness month and it’s something I’ve not talked about much since becoming pregnant again. PMDD directly corresponds with your menstrual cycle, so in theory you should gain relief during pregnancy. However (and this is merely my personal experience), since PMDD causes an abnormal reaction to normal hormonal changes, whilst you may receive some relief during pregnancy, it’s possible you still have a sensitivity to hormone fluctuations. As has been the case for me. Some symptoms are worse than ever before, particularly migraine and feelings of hopelessness.

The first trimester is often the worst for lots of pregnant women even in the absence of PMDD; the severity in hormonal changes tend to happen early in pregnancy and level out as your body becomes accustomed. It’s also thought that women who struggle with postpartum depression may be at further risk for developing PMDD. I can concur that the dip in hormones post-pregnancy deeply affected me the first time around. With PMDD, age is another factor that effects the severity in symptoms for me personally. The older I get, the worse my symptoms become. Often it has been the case for me where hormonal therapy such as contraception will provide short term relief, only to later stop working with no rhyme or reason. Antidepressant medication can also help manage symptoms, but again, long-term they often need changing, and finding the right type and dosage is a lot of trial and error.

After menarche, my PMDD was prominent, but back then at the age of just 11 nobody took my severe mood fluctuations seriously. At 13 after attempting suicide I was prescribed antidepressants. It was only later when I started recording my depression and severe mood swings that often included rage and toxic outbursts that I made the connection between them and my periods. Growing up, soon after enrolling in primary school and before menstruation, I was diagnosed with the hormone imbalance premature adrenarche (PA). Though there is no proven scientific connection between PA and PMDD, I feel this was all part of the same affliction; sensitivity to hormone changes affect me in a major way.

PMDD shouldn’t impact pregnancy in the sense that it alone won’t impact your ability to conceive. However, trying for a baby whilst managing PMDD can be difficult, especially if you’re taking contraceptives to manage your symptoms, and or antidepressants. Some of the more favorable SSRI’s for PMDD treatment are not recommended for pregnant women, and therefore you may be asked to switch to a safer antidepressant or come off of them all together. This in itself can be a life-altering (and in some cases life-threatening) change that could impact your mental health during pregnancy too.

If your PMDD is severe and not responsive to treatment you may have considered sterilization, which of course can put added pressure on you if you want to conceive. You might feel like you’re running out of time or you might feel forced to make the decision not to have children at all in order to manage your condition.

Though classified as a mental illness, PMDD has many physical symptoms including joint paint, migraine and profound fatigue, which can often be mistaken or overlap with other illnesses. In my case my fibromyalgia is much worse when PMDD strikes, and I know many others often get diagnosed with secondary conditions as a result of living with PMDD too.

Looking after your mental health must alway be a priority including during pregnancy, but it’s scary when you’re offered conflicting information and promises of symptom relief aren’t helpful either. “At least you get a break from PMDD” is one of the most useless reassurances I’ve ever heard. Surely we know by now that even those of us with the same diagnoses will experience symptoms differently and bodily changes will impact us all in different ways. Pregnancy is one of the most obvious examples of this. Some women barely know they’re pregnant at all and others (like myself) find the process insufferable.

What’s important when considering all factors is finding a healthcare practitioner that is aware of your diagnoses. If they aren’t up to speed on what it means, they need to be willing to learn. When I found out I was pregnant this time I specifically asked to be cared for by the perinatal mental health team. This has included regular discussions with a mental health consultant who specializes in reproductive health. It’s been invaluable for me to know I have people on my healthcare team who understand and are knowledgeable in helping me look after myself during pregnancy. My most recent appointment with the consultant included discussions around further specialist referral for PMDD post-pregnancy, and also the need for me to be prescribed antidepressants again postpartum. Even if I don’t feel I need them, I have a prescription ready and a doctor who is helping me monitor the impact.

Pregnancy is hard on our bodies, buts it’s equally as hard on our minds, and when you are prone to mental health problems or live with a mental illness already, specifically ones prone to intensify with hormone fluctuation, the need to receive the right healthcare is critical.

The International Association for Premenstrual Disorders has a directory that can help you find doctors in your area who specialize in PMDD, so do check them out.