Trigger Warning: This article contains reference to suicide.
A look into the terrifying disorder that leads women to suicide
Imagine you are living your regular life; Uni and your job are going well, and so are your friendships and your relationships – you are doing okay. Then one day, you wake up, you feel terrible, and for the next two weeks, you just want to die. Then you feel okay again, and the vicious cycle starts again. It seems unbelievable, doesn’t it? Yet it’s reality for many women.
It is common knowledge that the hormonal changes caused by menstrual cycles affect women not only physically but also mentally and psychologically. However, the fact that it is common knowledge does not mean that the issue is understood or treated with the required seriousness. We have all heard at least a version of the never-funny, misogyny-stained “someone’s on her period” joke. The truth is, there’s always been a stronger focus on how period symptoms affect the people around them rather than the women who experience them.
That is until recent years. More light is being shed on diseases that affect the female population and on the grave underfunding of research and studies in women’s health and “women’s diseases” compared to the overfunding of those in “men’s diseases”. Academic and scientific interest, as well as mass interest in mental health and mental illness is also on the rise – mirroring the global, pandemic-induced increase in mental health conditions (25% for anxiety and depression). This has led to new research being conducted on women-specific diseases that link physical and mental health.
One of them being Premenstrual Dysphoric Disorder – also known as PMDD. In short, PMDD is an extremely severe form of premenstrual syndrome (PMS). The two conditions share some of the symptoms which occur during the luteal phase – such as the more common cramps, back, head, and muscle aches, low mood or heightened irritability and agitation, diminished sex drive, and food cravings – albeit at different levels of intensity. However, the psychological symptoms of PMDD are far more dangerous, and they can be exacerbated by pre-existing mental health conditions.
A study published by BMC Psychiatry in 2022 observed that – of the 599 women with PMDD that took part in the study – 87 and 72% reported respectively experiencing lifetime passive and active suicidal ideation, 49% suicidal intent, 42% preparing for and 34% suicide attempt, and 51% non-suicidal self-injury. Furthermore, 70% of the sample also reported one or more comorbid psychiatric diagnoses, meaning 70% of the women were simultaneously suffering from mental health conditions that interact with the symptoms of PMDD. For that 70%, the percentages of passive and active suicidal ideation go up to 90 and 74%. A second article published by the Journal of Women’s Health – which systematically reviewed and meta-analysed 13 studies relating to PMDD and suicidal risk in women – found that women with PMDD are almost 7 times more at risk of suicide attempt and 4 times more likely to exhibit suicidal ideation.
However, the cause of PMDD is still partially unknown. Studies suggest a link to neurobiological differences – like abnormal dorsolateral prefrontal cortex functioning and executive control network connectivity – but mainly to an abnormal sensitivity and a pathological response to the shift in reproductive hormones caused by the menstrual cycle (BMC, JoWH). A family history of PMS or PMDD, or depression, anxiety, and mood disorders can also increase the risk of PMDD – although the cause-effect relationship between PMDD, mental health conditions, and SBT (Suicidal Behaviours and Thoughts) is not yet clear.
More studies and research are clearly still needed to fully understand and especially to accurately treat a disorder with such devastating symptoms and consequences that affects between 5 and 8% of menstruating women. Considering the grave symptoms of PMDD and its still causes and unclear course of treatment, mental health support should be a vital and central component of women’s health. In fact, the referenced PMDD studies all agree in concluding that the clinical implications should be to conduct frequent screenings for STB risk (BMC, JoWH) and consider women with PMDD as at high-risk for suicidality.
But first, before even thinking about treatment, women need to be able to quickly get a diagnosis. With women taking years longer than men to get diagnosed with the same diseases (2.5% for cancer and 4.5 for diseases like diabetes) and waiting an extremely long time for period-related diagnosis (an average of 7.5 years for endometriosis), a systematic change is also clearly needed. It’s time to take women’s pain seriously.
Mental Health Helplines (UK):
Samaritans: 116 123
SANEline: 0300 304 7000
National Suicide Prevention Helpline UK: 0800 689 5652