Reviewed March 2017
Premenstrual dysphoric disorder, PMDD. Back when I was doing my training, PMDD did not exist as a diagnostic category in the DSM-IV, or the DSM whatever it is now. That is the diagnostic manual that all the so-called CPT codes come out of, and it’s how you bill for medical services. You know that the world changes depending upon what we call things, and PMDD is a disorder in which a woman literally becomes Dr. Jekyll before her period. And it’s not PMS. About 60% of women experience PMS, which is some mood changes and so on, and I’ll talk to you later about PMS and what it is and what to do about it. PMDD is far more serious, and it affects only 1-2% of women.
What happens is a woman will be walking along in the beginning phase of her cycle, which is called the follicular phase, when the egg is growing from the ovary, and her estrogen levels are starting to climb, and she’s feeling really good. And then at ovulation, the minute that the little body in the ovary called the corpus luteum, where the egg was, when that starts to produce progesterone, she then flips out and becomes like an entirely different person.
These are the women who are prescribed the psychotropic drugs like Prozac, Zoloft, Paxil, and it can even them out and make them feel better. I, personally, would prescribe bioidentical natural progesterone for this group, first of all, because what they have is a relative deficiency of progesterone. If you were to draw their levels, they would be normal, so I want you to know that, but there’s something about their brains that is different.
And here’s what I’ve found. Almost always to a person, they have a history of some kind of trauma, an alcoholic parent, sexual abuse, rape, anything like that, and what happens premenstrually, Eckhart Tolle put it beautifully, he said, the pain body comes up premenstrually, and it hits you between the eyes. How do you dissolve a pain body? You stay present with it. You simply breathe. It kind of goes back to learning how to love yourself. You feel like throwing dishes, you feel like running into a hole and crying, you feel like divorcing your husband, and instead of doing any of that, you simply get into your observer self and watch that part of yourself with compassion and curiosity.
If you have PMDD, by all means, get the treatment that makes sense to you, whether it’s progesterone, or whether it is an SSRI drug, but please, please, please don’t make the mistake of thinking that it’s just your hormones and the PMDD just ran out of the closet and hit you. It will respond very beautifully to a whole lifestyle program. The main part of it being that it is your job to be present with your pain body and dissolve it with the power of now, and dissolve it with your presence, and then over time, it will be less and less and less, and in due course, chances are very good that you’ll be able to get off your medication.
