Perimenstrual Syndrome (PMS), on the other hand, can manifest at any age but is more prevalent during your 30s and 40s. Diagnosing and treating PMS has been a challenge due to the lack of a consistent definition for the condition. The American Psychiatric Association introduced Premenstrual Dysphoric Disorder (PDD), which shouldn't be confused with their earlier creation, the Late Luteal Phase Disorder (LLPD). Historically, healthcare professionals have perceived women as more susceptible to Mental Health issues than men, often attributing it to the unpredictability of their reproductive systems. Premenstrual Dysphoric Disorder (PDD) includes a well-defined set of symptoms, but only 3-5% of women, out of the estimated 30-60% who experience PMS symptoms, meet the criteria for PDD. But what if you don't meet the criteria? Physicians often face these questions because there isn't a straightforward, reliable test. Nevertheless, it's crucial to identify the root cause as treatments can vary. So, where do you begin?
You can start with your past. The age at which your mother or older sisters experienced menopause can influence your own menopausal journey. If your mother went through menopause in her late 40s and you're 34, it's more likely PMS. If your mother grappled with PMS, you are also at a higher risk. However, your mother may not remember when she experienced menopause, and your older sister may not disclose it. The only other substantial factor is if you smoke. If you smoke, you can expect menopause to start 1-2 years earlier than if you don't. Factors like pregnancies, birth control pills, your age at the onset of menstruation, or breastfeeding do not significantly impact the onset of menopause. However, if you are on oral contraceptives or other hormones like Depo-Provera or estrogen, these can affect mood, irritability, hot flashes, depression, and your menstrual cycle. Women who can't tolerate birth control pills are more likely to develop PMS and experience a challenging perimenopause. Adjusting the dose, brand, or timing of these medications can sometimes alleviate unwanted side effects.
Some symptoms of depression are shared between PMS and perimenopause. Menopause does not directly cause depression, but it can have a genetic component. If you're struggling with feelings of depression, loss of appetite, insomnia, and a general loss of interest or pleasure in life, you might be dealing with clinical depression. These feelings should be discussed with your healthcare provider. Depression and PMS can coexist, and it's not unusual for anxiety or depressive disorders to worsen during the week before your period and during menopause. It might seem perplexing, but every individual's experience is unique.
After reviewing your family history regarding the age of menopause and the presence of PMS and depression, it's advisable to maintain a symptom diary or calendar. This will serve as a unique record of your daily emotions. Over three months, monitor your menstrual cycle alongside your symptoms. Ideally, you should review your calendar with a healthcare provider, but there's much you can discover independently. Look for patterns. In PMS, emotional symptoms typically intensify around the mid-cycle (around day 14). In the week before your period, emotional symptoms peak, and physical symptoms may emerge. In the last few days, emotional symptoms reach their peak and then rapidly diminish after the onset of your period. Variations of this pattern exist, but the key is symptoms that intensify before and alleviate after your period.
Now that you have your symptom calendar in front of you, search for persistent depression that lasts most of the month. This could indicate that you are dealing with depression and need professional evaluation.