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Extreme PMS Symptoms: Are they Normal? | Laura Murphy IAPMD

P-M-S. We all know what that stands for, and so do those around us. But what if leading up to that time of the month, you're suffering from panic attacks, mood swings, frequent crying, anxiety, despair, or even thoughts of suicide? Enter premenstrual dysphoric disorder, otherwise known as PMDD. Laura Murphy, Director of Education and Awareness at the International Association of Premenstrual Disorders (IAPMD) shares more about this condition, how to properly get diagnosed, and treatment options.


Laura Murphy is the Director of Education & Awareness at the International Association of Premenstrual Disorders (IAPMD), which offers a lifeline of support, information, and resources for women and AFAB individuals with Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME).

Laura and I answer the following questions:

  • What is PMDD?

  • What triggers PMDD and who gets PMDD?

  • How can you find the right doctor and get properly diagnosed?

  • What are the treatment options?


Georgie Kovacs: What is PMDD?

Laura Murphy: PMDD is a hormone-based mood disorder, but is not a hormone imbalance affecting one in 20 women and those assigned female at birth (AFAB). This is of the women we know because many will go misdiagnosed or undiagnosed. It's a severe form of PMS. The symptoms only occur in the time between ovulation and around the time of your period. People will often complain of PMS that makes them feel suicidal, or perhaps they're diagnosed with bipolar, that rapid cycling bipolar that kind of comes and goes.

Georgie Kovacs: Who tends to get PMDD?

Laura Murphy: We often see women who have a pregnancy or miscarriage who are then diagnosed with postnatal depression and that depression kind of keeps coming and going in waves and no words and kind of pick up the timing exactly the fact that the symptoms are ending around the site around the time of menstruation. Symptoms can worsen over time and or around reproductive events such as menarche (the first menstrual cycle), pregnancy, birth, miscarriage, and perimenopause. And I have to say, it affects everyone differently.

Georgie Kovacs: How is PMDD diagnosed?

Laura Murphy: There are diagnostic criteria, but we're really noticing how limiting they are. The main symptoms include depression, anxiety, feeling of being overwhelmed, changes in eating habits, so perhaps completely losing your appetite or overeating, craving certain types of food, panic attacks, suicidal thoughts for some people. Some people get rage and anxiety, but not everyone does. Some people also get physical symptoms such as bloating, leg pain or like heaviness, changes in sleeping habits. Some people get insomnia. I used to get hypersomnia, which meant however much I slept, it never stopped for fatigue. I slept for 19 hours a day and couldn't keep my eyes open.

All of these PMDD symptoms are contained within that luteal period, which is the time between ovulation and around the time of your menstruation. For some people, it goes the whole two weeks through, assuming a 28-day cycle. For other people, they may feel worse around the time of ovulation, and then it picks up a bit and then they know they go downhill.

Georgie Kovacs: What is your PMDD story?

Laura Murphy: My symptoms started at about the age of 16. I had a long depressive episode, and I was asked to leave school. Times were very different back then. There was no support. I was just asked to leave because I wasn't turning up, I wasn't getting involved. I wasn't committing to it. To be honest, that didn't help.

At 17, I took the contraceptive pill for heavy periods and on the day 21 when I skipped the sugar pills, I crashed and burned, and my life changed forever. On that day, I was on the floor hyperventilating. My first or full-on panic attacks, and then I went into a six months long depression.

For the next few years, I had longer periods of depression. I also knew I had very bad PMS, where it was a bit of a running joke with my female housemates at university that I could be a bit scary when I had PMS, but it was a long standing joke rather than a concern. My partner at the time even said it's like living with a different person for a week a month.

I was eventually given the Mirena IUD, and it did help for a little while. I had no periods, I went and backpacked. However, I think the progestins built up in my system, and I just had a crash where I had what was basically PMDD symptoms for 18 months straight. I was suicidal every day, and I had to give up work. It was probably one of the worst times of my life.

Georgie Kovacs: Did the Mirena IUD potentially trigger or exacerbate these PMDD-like symptoms?

Laura Murphy: I started Googling “Mirena depression” and finding some things coming up on forums. I went to my doctor and suggested that the Mirena and my mood might be linked. She'd been really good leading me through the devastation. However, I was told, "No, the hormones in the brain can't do that. It doesn't travel outside your uterus. It's all very contained. Don't believe everything you read on the internet."

Georgie Kovacs: How did you finally get diagnosed with and treated for PMDD?

Laura Murphy: I paid privately to have therapy weekly, and she was amazing. She said, “You know, this isn't a PMS like your doctor is saying, but this isn't it.” That was 17 years into my journey.

I found out about an amazing doctor in London, Dr. Panay, who's now on IAPMD Clinical Advisory Board. It turns out I'd already gone through some of the first line treatments, so we decided to remove my ovaries. So I had a total hysterectomy with bilateral oophorectomy. And so I was in surgical menopause at the age of 37.

Georgie Kovacs: You seem to have taken this rough journey, which I am sorry about, and transitioned into helping other women with PMDD. Tell us about that.

Laura Murphy: I started a patient awareness campaign, Vicious Cycle, because everyone was saying the same thing - "I'm going to my doctor, they don't know what it is. I've been undiagnosed for, you know, 10 years, 15 years. 20 years." People were going to their doctors, they're being gaslit, they've been turned away. We started this patient education campaign, Vicious Cycle, and through that I just connected with so many amazing people around the world.

Around the same time, I was working with Vicious Cycle, and I ended up joining the Board of Directors, and I have been working with them since.

Georgie Kovacs: What a story, and I am really sorry for everything that you have had to go through. I appreciate the courage that you have to continue to help other women. As someone is seeking treatment, how, in the meantime, do you recommend they work through the emotional roller coaster that comes with PMDD?

Laura Murphy: It's completely okay to take responsibility for how you're feeling. There's so many of us that are on that kind of difficult path, kind of weaving through and trying to get a diagnosis and trying to find the treatment and trying to find the answers.

Self-care is important for PMDD patients - yoga, meditation.

Georgie Kovacs: How does someone with PMDD get diagnosed? Some of the symptoms overlap with so many other conditions like endometriosis and Hashimoto’s.

Laura Murphy: PMDD tends to be like a light switch for people or a fade. During your follicular phase, you feel great, and then when ovulation hits, it's a tipping point where things tend to get very dark for people. They get very anxious and rage-y. When the bleeding starts, people describe it often as like a black cloud lifting and that's exactly how I used to be. I remember sitting on the toilet and seeing blood and wit