The onset of puberty can be traumatic for many reasons and negatively affect one’s mental health.  Those who begin menstruating in adolescence find themselves at the mercy of their cycling hormones and can experience a large range of symptoms that come and go, and are difficult to make sense of. The menstrual cycle itself does not typically settle down into a regular pattern for a couple of year’s post-menarche, and the jumble of symptoms can be very confusing. It is difficult to know what is ‘normal’ and should be happening, and what is not, and this can lead to delays in presenting extreme symptoms to health care professionals, and even greater delays in getting diagnoses.

Menstrual disorders, like Pre-Menstrual Dysphoric Disorder (PMDD), take about 7 years to get diagnosed. PMDD is a very severe form of Pre-Menstrual Syndrome (PMS). Like PMS it is cyclical and starts in the days leading up to a period and ends soon afterwards. Those that experience PMDD find that their daily functioning is severely impaired; they are frequently irritable and angry, and they may suffer from severe depression and fatigue which makes getting out of bed and going to school, university or work a struggle. It can also negatively affect relationships with friends, family and partners. Some PMDD sufferers also have suicidal thoughts but the shame and stigma around these feelings means that many do not seek medical help or support. For these reasons, PMDD is listed as a mental health problem in the DSM-5 manual which doctors use to categorise and diagnose mental health problems.

The causes of PMDD are not well understood but researchers believe it is an endocrine disorder, meaning it is hormone related. Sufferers appear to be hypersensitive to some of the hormone fluctuations of the menstrual cycle. In particular, serotonin (the happy hormone) pathways are affected. Physical symptoms such as breast tenderness, joint pain, acne and skin problems and gastro-intestinal issues also occur which may be due to the effect of hormones on blood vessels to these organs. These things need to be considered as well as the mental health symptoms when seeking a diagnosis and it is helpful to health care professionals if sufferers can track their can their symptoms over several cycles to get a more holistic picture of the problem. The use of smart watches and menstrual cycle tracking apps may make this easier.

April is PMDD Awareness Month, an important time to highlight the impact of PMDD and call for greater investment in research into menstrual disorders which have long been neglected. It wasn’t until 2019 that the World Health Organization (WHO) added PMDD to the International Statistical Clarification of Diseases and Related Health Problems, formally validating it as a medical diagnosis, but much more research is needed. The MeJARa project aims further our understanding of the menstrual experiences of adolescent girls in Nepal and Guatemala including the impacts on physical and mental health. This involves exploring experiences of menstrual pain and developing and testing an intervention to address menstrual pain and injustice in low- and middle-income countries (LMICs) in the hope of reducing the negative impacts of menstruation.  

Written by:

Josephine Mcallister