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Key Takeaways
- Premenstrual dysphoric disorder (PMDD) is a much more severe version of premenstrual syndrome (PMS).
- PMDD is more common among autistic individuals and can present unique challenges for autistic people.
- Several treatment options can help a person manage PMDD, including stress management skills, psychotherapy, lifestyle changes and medication.
No one loves getting their period––but for people with PMDD, periods can be debilitating. PMDD affects up to 10% of people who menstruate, and for autistic individuals, that rate is even higher. PMDD presents unique challenges for autistic people, but there are several options for treatment and support that can help them reduce and cope with PMDD symptoms.
What is PMDD?
Premenstrual dysphoric disorder (PMDD) is a very intense form of premenstrual syndrome (PMS). Symptoms of PMDD can vary but commonly include:
- Heightened emotions
- Mood swings
- Interpersonal conflict
- Changes to sleep and appetite
- Lethargy
PMDD is considered an endocrine disorder as well as a mental health condition. It’s classified as a depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Prevalence
PMDD is less common than PMS, which affects between 75 and 95% of people who have periods. Around 5 to 8% of people with periods report severe premenstrual symptoms that align with PMDD.
PMDD is more likely to affect individuals with a family history of PMS or PMDD, as well as those with a personal or family history of mood disorders like depression.
Symptoms
Symptoms of PMDD can make it difficult or nearly impossible for a person to function the way they normally do. Symptoms typically show up around a week before a person’s period and may not subside until a few days after their period starts. They can include any of the following:
- Depression, sadness and suicidal thoughts
- Anxiety and panic attacks
- Irritability and anger
- Feeling overwhelmed
- Emotional dysregulation and mood swings
- Feeling out of control
- Interpersonal conflict
- Fatigue
- Changes in sleep (trouble sleeping or sleeping more than usual)
- Changes in appetite
- Headaches
- Joint or muscle pain
- Breast swelling or tenderness
- Bloating
Though symptoms only last for a limited phase of a person’s menstrual cycle, their impact can reach into the rest of the month. It can be difficult for a person with PMDD to cope and reconcile with their symptoms after the fact. Some report that it feels difficult to recognize themselves when symptoms are active and may find themselves trying to resolve conflict with the people in their lives that emerged while they were symptomatic.
Stigma
PMDD is widely misunderstood and often stigmatized. Broader awareness of PMDD is still limited, and others don’t always understand why a person with PMDD is behaving or feeling the way they are. They may see symptoms like anger, executive dysfunction and interpersonal conflict as an active choice or a reflection of a person’s character. This gap in understanding reflects a long history of stigma and taboo around periods. PMDD is, however, a legitimate, severe and treatable diagnosis.
PMDD and autism
Although research on PMDD in autistic people is currently very limited, studies suggest that PMDD is more common among autistic individuals. On the low end, the prevalence of PMDD among autistic people who menstruate is estimated at 14.3%, and on the high end, 92%. PMDD can present unique challenges for autistic individuals, who may already struggle with the symptoms that can come with periods.
Overlapping traits
PMDD and autism have several traits in common. Autistic people and those with PMDD can both experience:
- Executive dysfunctioning
- Difficulties with emotional regulation
- Irritability
- Sleep differences
- Differences in social approaches and communication
- Anxiety and depression
These shared traits might compound, increasing their intensity for autistic individuals with PMDD. It’s also possible this overlap predisposes autistic people to PMDD and contributes to its increased prevalence among autistics. Research has not revealed much yet about the relationship between autism and PMDD, and further research is warranted to help us understand their connection better.
Sensory overload
For autistic individuals, periods can create a number of sensory stressors—seeing and smelling menstrual blood and touching menstrual products can be distressing, along with physiological symptoms like cramping, joint and muscle pain and headaches. Since PMDD can come with particularly intense physical symptoms, it can cause sensory overload for some autistic people.
Increased meltdowns
PMDD symptoms can increase the frequency and intensity of meltdowns for autistic people. Common meltdown triggers for people with PMDD are:
- Increased emotional dysregulation
- Heightened sensory sensitivity
- Difficulty communicating symptoms
Changes to routine
Periods and premenstrual symptoms can force changes to a person’s daily routines. Periods may require a person to make changes, like using public restrooms or changing when or how often they shower. They may affect how much or when an individual sleeps, too. Though these stressors aren’t specific to PMDD, they can compound with the challenges PMDD presents.
Periods can also be unpredictable. Between 14 and 25% of people who menstruate experience irregular periods, and some research suggests that this rate is even higher for autistic individuals. Even regular periods can sometimes start a little early or late, introducing unpredictability that can cause stress for an autistic person.
Communication
Many autistic people find it difficult to identify and communicate both emotions and physiological symptoms. When you confront a barrage of destabilizing symptoms during each menstrual cycle, it can feel incredibly frustrating not to be able to pinpoint what you are experiencing. It can also make it difficult to get support and treatment.
Autistic burnout
All of these factors can also contribute to autistic burnout—the state of sustained fatigue autistic people can experience from prolonged sensory overload, communication challenges, chronic stress, masking and other stressors.
How autistic people can manage PMDD
Multiple interventions can help individuals reduce and manage PMDD symptoms. For autistic individuals, who may struggle to identify and verbalize symptoms, it can feel difficult to get help with PMDD. As always, it’s best to see clinicians who specialize in working with autistic patients and know how to support their needs.
Diagnosis
For some people, self-diagnosis can go a long way to help them reckon with and seek support for PMDD. Others may want to pursue a diagnosis from a clinician with whom they can discuss treatment options.
PMDD can be diagnosed by a mental health professional, gynecologist or general physician. It’s diagnosed through a clinical interview, where a clinician asks questions about the individual’s menstrual symptoms. They may ask patients to track their symptoms for a few months before formally diagnosing them. Clinicians typically also ask about the person’s medical and mental health history to get a clearer picture of their health and rule out other conditions that may be causing their symptoms.
Psychotherapy
Psychotherapy, also called “talk therapy,” can be an important intervention for autistic people with PMDD. Therapy can help autistic individuals identify, communicate and process PMDD symptoms. It can also help them develop stress management, downregulation and coping skills to manage PMDD symptoms that come around each month.
Lifestyle changes
Some clinicians may recommend lifestyle changes to help manage PMDD symptoms. These can include making dietary and lifestyle changes such as:
- Increasing protein and carbohydrate intake
- Reducing caffeine intake
- Taking vitamins
- Physical exercise
It’s important to see a provider who takes a holistic approach to your well-being and can support you in adapting this advice to meet your needs. For example, some autistic people eat limited diets or have difficulty swallowing pills, so they may need flexible guidance on adjusting their nutrition.
Medication
Antidepressant medications like selective serotonin reuptake inhibitors (SSRIs) are often prescribed to help reduce and manage PMDD symptoms. SSRIs treat symptoms of depression and anxiety by increasing the available amount of serotonin in the brain. SSRIs are taken every day and build up in a person’s system over the course of several weeks, so it may take a couple of cycles before they begin to work.
Birth control pills are also commonly prescribed to help with PMDD. These pills are taken every day, and contain hormones that can help regulate some of the symptoms associated with PMDD.
While birth control can be a great help for some, it isn’t the best option for everyone. It’s important, when possible, to work closely with a doctor who is experienced in supporting autistic individuals so they can help effectively monitor how birth control is affecting your symptoms, overall mood and quality of life.
For those who experience physical pain such as headaches, sore muscles, cramps or tender breasts, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen can also help. These drugs can be prescribed by a physician or purchased over the counter, though it’s best to consult your doctor if you use or plan to use these medications frequently.
How Prosper Health can support
If you are autistic and struggling with PMDD, Prosper Health can help. Prosper Health’s therapists specialize in supporting autistic adults. They are experienced in navigating challenges autistic adults commonly face and can help you manage the emotional dysregulation, executive dysfunction, sensory sensitivity and other difficulties that can come with PMDD. Prosper therapy sessions are conducted entirely over telehealth and are covered by insurance.
PMDD is stigmatized and often misunderstood. It can feel isolating––but it doesn’t have to. Prosper Health can be a part of your journey to managing PMDD and truly thriving.
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