Psy-Q: How can behavioral health providers help women with premenstrual dysphoric disorder (PMDD) manage their quality of life and related stigma?

Kimberly A. Yonkers, MD

Kimberly A. Yonkers, MD

Answer: To start, clinicians can help decrease stigma for all mental illness, stresses Kimberly A. Yonkers, MD, Katz Family Chair, Department of Psychiatry at the University of Massachusetts Medical School/Mass Memorial Medical Center. “Patients do not ask to be ill and to be symptomatic… We need to stop language and other behavior that leads them to feel blamed for their illness,” she says.

While premenstrual syndrome (PMS) can cause an array of physical symptoms, PMDD causes severe emotional symptoms including mood swings and depression that can lead to impairment in the patient’s life. “Sadly, many women are made to feel like their symptoms are ‘only in their head’ or they do not feel like a practitioner appreciates her symptoms,” says Dr. Yonkers.

Behavioral health providers can play a key role in supporting patients with PMDD and helping to improve their experience. Dr. Yonkers points out that practitioners can start by obtaining a detailed history to understand what the patient is experiencing and rule out other problems that might promote PMS (eg, exogenous hormone preparations and hypothyroidism). “Ideally, a patient should document symptoms for one or two cycles to show the ‘cyclicity’ of symptoms. This is because some treatments are taken for only part of a menstrual cycle,” she explains.

There are also some simple, yet effective, behavioral strategies providers can also explore to help support and validate women who have PMDD. “Just keeping a daily calendar can help a person manage her symptoms. For example, a person may notice that she is eating potato chips and salty foods that contribute to bloating. She may notice that she has arguments with someone during the day before menses and maybe should just avoid that person if possible. She may notice that the days she exercises she feels better,” says Dr. Yonkers.

Such insights can lead to lifestyle changes that may help a woman feel more in control of her situation. And when it comes to the specific stigma around premenstrual symptoms and PMDD, “reassuring the patient that we have treatments for PMDD can also be validating,” she adds.

Related: A recent study looked at a selective progesterone receptor modulator called ulipristal acetate (UPA) as a potential PMDD treatment.


Last Updated: May 20, 2021