April is 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 not fact, 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. (Updated with a study showing a potential link between severe PMS (PMDD) and Antenatal Depression) 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 women who suffer perinatal/postnatal depression may be at further risk for developing PMDD, and I can concur that the dip in hormones post pregnancy deeply affected me the first time around. With PMDD, age has been another factor which 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 altogether with seemingly no rhyme or reason. Antidepressant medication in particular SSRI’s can help manage symptoms, but again, in my experience for the treatment of PMDD long term, they tend to need changing, and finding the right type and dosage is a lot of trial and error.

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

PMDD shouldn’t impact your ability to conceive. However, trying for a baby whilst managing PMDD can be difficult. This is especially true if you’re taking contraceptives to manage your symptoms, and or antidepressants. Fluoxetine or Prozac as it’s also known, is one of the more favourable SSRI’s for PMDD treatment. However it’s 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 surgery as an option, which of course can put added pressure on timing, if you want to conceive and have a biological pregnancy. 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 PMDD.

Though classified as an endocrine disorder with severe psychiatric symptoms, PMDD has many physical symptoms also, including joint pain, migraine, and profound fatigue, that can often be mistaken or overlap with other illnesses. In my case I have fibromyalgia which is much worse during the luteal phase of my menstrual cycle, and I have heard of other people often get diagnosed with secondary conditions as a result of living with PMDD too.

Looking after your mental health must always be a priority. This means including during pregnancy, but it’s scary when you’re offered conflicting information, and promises of symptom relief aren’t necessarily helpful either.

‘At least you get a break from PMDD’ was something I heard, that unfortunately for me turned out to be incorrect. We know, and it is constantly proven, that even those of us with the same diagnoses will experience symptoms differently and hormonal changes will impact us all in very different ways. Pregnancy is one of the most obvious examples of this. Some women claim to barely know they’re pregnant, while others (like myself) find the process insufferable.

What’s important when seeking support is finding a healthcare practitioner that is aware of your diagnosis of PMDD and preferably one that is familiar with the condition.

When I found out I was pregnant this time, I specifically asked to be cared for by the Perinatal Mental Health Team. Though there was quite a lag from my reaching out to getting adequate support, when I did finally receive help it included regular discussions with a mental health gynaecological consultant who specialises in the crossover between mental and reproductive health. It’s been invaluable for me to know that I have people on my healthcare team that 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, as well as the likely need for me to be prescribed antidepressants again postpartum. Even if I don’t feel I need them, which is the outcome I’m hoping for, I’ll have a prescription ready and a doctor in the know who will help me monitor the impact.

Pregnancy is hard on our bodies, but when you have a hormone sensitivity it can be it’s equally as hard on our minds, if not harder. If you are someone who is prone to mental health problems, or somebody who lives with a mental illness already, the need to receive the right healthcare becomes even more critical.

https://iapmd.org/ the International Association for Premenstrual Disorders have a provider directory on their website, along with lots of other vital resources that can help you find doctors in your area that specialise in PMDD.

Finally, if you’re pregnant or considering pregnancy and you have Premenstrual Dysphoric Disorder and are prescribed SSRI’s as a treatment, it’s important not to stop taking your medicine without first discussing this with your doctor or midwife. Abrupt cessation of these types of medications can have a negative impact on you and your pregnancy and should always be done under the guidance of a physician.