General News — 05 February 2014
Is extreme premenstrual syndrome a mental disorder?

For two weeks of the month, Teaki Page feels suicidal. It’s so precise, she can track it on her calendar. She’s felt this way since she was 13, when her periods first started. “I get these terrible thoughts,” says Page. “A voice in my head says I’m a hopeless loser, terrible mother and useless friend. I genuinely believe everyone would be better off without me.”

For those two weeks, the 36-year-old says it’s a “constant battle” not to act on these feelings. Then, right on schedule, the darkness passes, perfectly in synch with her menstrual cycle. “I say I have ‘predictable unpredictability’,” says Page. “When that time comes around, I can’t control my behaviour or my emotions. It’s odd because, when I’m not in that bad place, I’m actually a very logical person.”

According to Monash University’s faculty of medicine, nursing and health sciences, 90 per cent of women experience at least one symptom of premenstrual syndrome (PMS) every month, including fluid retention, bloating and weight gain. Although inconvenient and uncomfortable, for most sufferers it’s not debilitating. Yet 3 to 9 per cent of women experience symptoms so severe they cannot get on with their daily lives. This is known as premenstrual dysphoric disorder (PMDD), sometimes referred to as “PMS on steroids”. In a controversial move, last year the condition was formally recognised in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

So, should this extreme version of PMS be classed as a mental disorder? According to the manual’s guidelines, sufferers of PMDD experience symptoms including “marked mood swings, feeling suddenly sad or tearful or increased sensitivity to rejection, markedly depressed mood, feelings of hopelessness or self-deprecating thoughts, a subjective sense of being overwhelmed or out of control, and a marked change in appetite.”
There may be countless women who think, “I tick all those boxes.” But, according to the criteria for PMDD, these symptoms must be severe enough to interfere with relationships or work, school and other usual activities.bigstock-Mental-Health-Warning--32532146

A 2009 Indian study claimed that a woman’s menstrual cycle could increase suicidal tendencies. Researchers autopsied the bodies of 217 suicide victims and found nearly 54 per cent were menstruating at the time, compared to just 6.75 per cent of a control group who died of other causes. This is why sufferers say the effect of the menstrual cycle on mood should be taken more seriously.

For Page, a writer and mother of five, the roller coaster started when she was at school. “I was threatened with suspension because I had so many sick days. I’m sure my teachers thought I was just sitting at home watching TV but, in fact, I was bedridden. As well as mood swings, I had crippling cramps in my stomach and legs. I’d be crying out in pain.”

In later life, the physical pain eased but the mental turbulence has become more severe. She has been prescribed antidepressants to try to regulate her mood swings. It’s also common for sufferers to be put on the Pill, although experts warn this only masks the problem.

Fertility specialist Nat Kringoudis says the danger with classifying PMS or PMDD as a mental disorder is that antidepressants may be overprescribed. “Rather than just trying to fix it with medication, we should be looking at the root cause, as lifestyle factors are often to blame.”

According to Kringoudis, everything from the food we eat to excessive stress and the beauty products we use can contain toxins that mimic oestrogen and cause a hormone imbalance. She advises clients to reduce their stress levels, drink only filtered water, reduce sugar in their diets and add therapeutic fats such as coconut oil and avocado. “Our hormones are made from fats and proteins and we need to fuel them,” she adds. Some sufferers also recommend gentle exercise.

As for Page, she simply hopes that the next generation of sufferers will be taken more seriously. “My oldest daughter is 15 and has the same extreme mood swings. It’s sad, but I’m hoping that, as she gets older, there will be more awareness. This is a serious illness.”

This article first appeared on ‘Daily Life’ on 2 February 2014.

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