PMDD & Neurodivergence (Autism and ADHD)

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) affects 5-8% of woman and gender diverse people. It causes debilitating emotional and physical symptoms, impacting quality of life and the ability to function. PMDD shares symptoms with premenstrual syndrome (PMS) however PMDD is less common and much more severe. PMDD was added to the DSM in 2013 so it’s only been an official diagnosis in the last 10 years.

PMDD occurs during the Luteal Phase of the menstrual cycle. The luteal phase begins after ovulation and ends on day 1 of the menstrual cycle (day 1 of the period).

Recent studies show that those with PMDD may have an increased sensitivity to sex hormones. Increase sensitivity to progesterone may impact neurotransmitters like GABA and cause increased activity in the emotional center of the brain. GABA is important for soothing and calming the Nervous System, however when it is low it can cause irritability and insomnia.
Too high levels of oestrogen versus too low levels of progesterone may be a cause for PMDD. This condition is referred to as Estrogen Dominance and may have a direct impact on the dopamine detox pathway leading to feelings of rage, aggression and irritability.

Image credit: Clue

PMDD Symptoms

Extreme feelings of depression, anxiety, irritability, fatigue, appetite changes, bloating, insomnia, pain in muscles, joints, and headaches and more.

PMDD and Neurodivergence Research

There hasn’t been much research looking into PMDD and Neurodivergence. However PMDD can co-occur with ADHD and Autism and research suggests that statistics may be high.

It is estimated that up to 92% of Autistic and 46% of ADHD women and gender diverse people experience PMDD.

Lever and Gertz (2016) reported that 21% of autistic women and gender diverse people, compared with 3% of non-autistic women and gender diverse people suffered from PMDD.

The impact of PMDD

It is helpful to be aware that a person with PMDD’s abilities and needs might fluctuate and change during the luteal phase of the menstrual cycle.

For example:

• Executive function may increase or decrease.

• Interest in usual activities may decrease.

• It may be even harder to focus, or concentrate on study or work.

• There may be a lot more fatigue then usual.

• Sleep might become disrupted or feel impossible.

• Sensory overwhelm may increase.

• There may be an increased need for comfort, safety and predictability.

• There may be an increased sensitivity to sounds

• Safe foods might not feel safe anymore.

• Decrease or increase in appetite.

• Reduced capacity to try new foods.

• Increased intolerance to certain foods.

• Increased digestive symptoms.

A couple of support ideas for someone with PMDD

1.One of the best things you can do to learn more about your menstrual cycle and support yourself through PMDD is to start tracking your cycle. You can do this by tracking your basal body temperature (track your temperature upon waking) or via an app like Clue or Flo. However please use caution with apps as they are not always as accurate as other methods.

2.Create a safety plan for yourself during the luteal phase, this will be very individual but might look like:

Scheduling appointments with your psychologist during the luteal phase.

During follicular phase cook meals and freeze, so that you have them available during luteal phase.

Adjust work/social meetings during luteal phase, don’t put pressure on yourself to socialise or do extra work during this time.

Shift your mindset- reduce expectations on yourself during luteal phase.

Be aware that your eating habits might change during luteal phase and this is okay!

Asking for help from a loved one during the luteal phase.

PMDD will present differently in each person, and the root cause and drivers behind PMDD will also differ. Because of this an individualised approach is so important.

References

https://link.springer.com/article/10.1007/s10803-016-2722-8

https://journals.sagepub.com/doi/10.1177/147323000803600208

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9344571/

https://pubmed.ncbi.nlm.nih.gov/33302160/

https://www.sciencedirect.com/science/article/abs/pii/S0022395620311134?via%3Dihub

https://www.medscape.com/viewarticle/812792?form=fpf

Written by Margo White, your Melbourne-based neurodiversity affirming clinical nutritionist and Neurodivergent advocate.

This article is intended as general advice only and does not replace medical advice. It is recommended that you seek personalised advice specific to your individual needs.