While most people know that April is Autism Acceptance Month, I haven’t seen any acknowledgement on Tumblr that it is also PMD Awareness Month. This is especially surprising considering that premenstrual disorders seem to be significantly more common in the autistic community (as well as in people with ADHD), although more research is sorely needed.
I have premenstrual dysphoric disorder (PMDD), which is a cyclical, hormone-based mood disorder where symptoms occur during the premenstrual, or luteal, phase and disappear shortly after menstration begins. For me, it’s like a switch flips in my brain after ovulation and I turn into a whole different person. I know that I’m going to start bleeding because I wake up, the switch has flipped back, and I feel totally normal. Symptoms include irritability, mood swings, depression, anxiety, overwhelm, fatigue, sleep difficulties, and physical symptoms. While these may seem like “typical PMS that most people experience,” trust me, it absolutely is not. People with PMDD are a high risk group for suicidality and many of us make serious decisions during the luteal phase that we later regret, including quitting jobs and leaving partners. Symptoms like lashing out at others, verbally and/or physically and homicidal ideation can cause serious relationship and problems, shame, and difficulty with work and school.
PMDD is not a hormone imbalance — it is a severe negative reaction to the typical changes in hormone levels. The exact mechanism is not known (there seems to be several subtypes that respond to treatment differently but once again research is scarce), but it seems to cause an increased sensitivity to stress. It makes sense, then, that autistic people would be more likely to experience PMDD as our brains and bodies already experience and react more to stress than allistic people do.
Treatment for PMDD includes therapy, SSRIs, hormonal birth control, and, as last resorts, chemical menopause and removal of the uterus and both ovaries. Hysterectomy alone does not treat PMDD. Hopefully, some day, treatments specifically for PMDD will be developed.
Premenstrual exacerbation (PME) can occur in a wide range of of other disorders, including depression, anxiety, bipolar disorder, migraines, epilepsy, IBS, and PTSD, with symptoms becoming much worse during the luteal phase and is typically even less researched than PMDD. Sometimes increasing regular treatments during the luteal phase can help reduce PME.
