48.2% of India’s population is women (World Bank Survey, 2017) and it is estimated that roughly 20% of any given female population will suffer from premenstrual syndrome (PMS) and a smaller percentage will receive the diagnosis of premenstrual dysphoric disorder (PMDD).
PMDD may be defined as pre menstruation symptoms, which cause emotional and physical symptoms, like PMS, but PMDD results in symptoms which are debilitating, and often interfere with their daily quality of life, including but not limited to work, school, social life, and relationships.
Typically, symptoms of PMDD emerge a week before your menstrual cycle is due to begin, and some symptoms include mood swings; feeling anxious and irritable, low moods i.e. feeling hopeless and out of control, muscular pain, fatigue, issues with sleep and bloating among other things.
“Husband left me, and six months later I was diagnosed with PMDD… I remember once just before I got my period I was very irritable and he was trying to fool around and cheer me up and I just lost it. I picked up a plate and threw it at him… I don’t know why I did it. After I did it I broke down and cried for hours. He was kind and tried to console me but he never forgot that incident. I don’t think he ever fully forgave me for it.” (Madhu, 40).
Science is unclear about what the exact cause of PMDD is. While some studies have linked it to oestrogen, other research suggests that individuals with PMDD have lower levels of serotonin, which further decreases when premenstrual hormonal changes occur. Thus, resulting in symptoms of depression or anxiety.
Many women believe that it is okay or “normal” to feel this way, particularly before their periods and for some like Madhu, things escalate drastically before help is sought.
“Two days before my period I would be really worried, I would overthink conversations with friends, make silly mistakes at school and just generally feel awful. Whenever I would bring this up with mom she would say it’s just PMS, every woman has it and must go through it to have babies. For years I suffered then one month before my final board exams it all got too much, I knew I was about to get my period but something felt worse than normal. My mom asked me a casual question like what I wanted to eat for dinner and I broke down. I sobbed for five hours straight… I cried myself to sleep. The next day my mom took me to my family physician, who referred me to a gynecologist. My mom was hesitant to take me to the gynecologist because I was too young but she was scared I would mess up my exams. But we still went. She diagnosed me and put me on medication and I am much better now.” (Ananya, 17).
Many parents and young women are reluctant to seek help because of the fear of either finding out something is seriously not right or because they believe this is part and parcel of what it means to be a woman. Many medical professionals believe that PMDD is under-diagnosed because of the lack of awareness surrounding it. Like Ananya, many young girls struggle with feeling like something is wrong but are unable to understand what. Perhaps including PMS and PMDD in sex education will be a good start in bringing awareness to this condition.
Unfortunately, experiences like the ones described by Madhu and Ananya often remain as lasting memories for those who have lived through them. They often are the starting points of anxiety and depression and require not only medical intervention but also talk therapy.
There are other lifestyle changes which assist in reducing the symptoms of PMDD like regular exercise, reduction of unhealthy foods, restraint from recreational drugs and alcohol consumption, which will help prevent PMDD or assist in reducing its symptoms.
Within the complex fabric of Indian society, the narrative of being a woman is filled with expectations, tradition and complicated contradictions. Female goddesses are worshipped for their many attributes yet the temples in which these goddesses reside continue to consider menstruating women a taboo. Why is it that being a woman today continues to involve hiding or being embarrassed by the very biological function (menstruating) that makes you a woman? Couple this with the already existing stigma of mental health, women-specific diagnoses like PMDD are unlikely to be given the importance and understanding they require. This leads us to the question- where do we start to change this narrative? Do we work on reducing the taboo surrounding menstruation or do we work on stamping out stigma for mental health? Perhaps we need to start by understanding that diagnoses such as PMDD exist and that while they may not get society’s support and understanding, awareness is the first step to changing all that.
By Tanya Vasunia, Psychologist & Case Coordinator at Mpower