Basics #101 — What is PCOS & PMDD and how can we support someone living with it?
By Sonal Jain
PCOS (Poly-cystic Ovarian Syndrome) is a hormonal disorder that could be caused by multiple reasons, most common being insulin resistance, inflammation caused by gluten, excessive androgens or (Oral Contraceptive) pill induced PCOS. Some of the common symptoms of PCOS obesity, difficulty in losing weight, hair loss/ thinning of hair, hirsutism, irregular periods, oily skin etc. PCOS has no cure as such but it can be managed by change in lifestyle and taking supplements. There is now research showing that going dairy-free and gluten-free helps increase insulin sensitivity and supplements such as Vit D, Inositol and Metformin help in managing the food cravings. Low intensity workouts and leading a stress- free life helps in managing hormonal balance better as well. Varying research shows that 1 or 2 in every 5 menstruators are likely to have PCOS to some extent and should take necessary steps to manage it.
In cases where period is late by several months, extremely painful (dysmenorrhea) and low blood pressure has been reported, requiring hospitalization. In some rare cases of extreme blood loss, blood transfusion might also be required. If you are someone who experiences menstrual cramps that disrupt your everyday activity, please consider discussing it with your healthcare provider and do not hesitate to request a strong painkiller such as Ketorolac injections when necessary. Dismissal of women’s pain (and that of trans men, non binary folx) is a reality we must challenge and overcome.
PMDD (Pre-Menstrual Dysphoric Disorder) is a mood (mental health) disorder characterised by extreme mood disturbances and physical symptoms before the onset of one’s menstrual period. It causes significant mental distress and interferes with work/ school and relationships. It is distinguishable by the dysphoria that is experienced. Feelings of being completely overwhelmed, spiralling thoughts, mood swings, depression, outrage, anger, frustration, anxiety and suicidal ideation coupled with the physical symptoms, which can include, bloating, tender breasts, cramps, lower back pain, lethargy, and sleep and appetite changes. One can document their PMS (Pre-Menstrual Syndrome) symptoms for 3–4 months and discuss it with a psychiatrist to be diagnosed. PMDD is usually treated after ruling out other mental health disorders such as depression, borderline personality disorders etc to eliminate cases of PME (Pre-Menstrual Exacerbations). It is treated with a combination of antidepressants (SSRI or SNRI) along with psychotherapy and lifestyle changes. IAPMD.org is a resource I’d recommend to learn more. About 2–5% of the menstruating population is likely to live with PMDD.
PMDD is essentially a cellular disorder where our body is extremely sensitive to changes in hormones. In my experience, the mood swings and depressions were debilitating. To experience six intense emotions in an hour’s time, have unwarranted crying spells and suicide ideation have been prominent indicators for the need to seek help. People with PMDD often meet with gaslighting by gynecologists and family who are unaware for the severity of conditions. If you or someone you know is experiencing ‘severe PMS’ I’d urge you to seek professional psychiatric help. Please note that this disorder was recognized by the mental health fraternity as recently as 2014 and some psychiatrists may require a reminder.
How can we support?
In both these cases, it is important to ask the person living with these conditions about what their needs are and how they would like to be supported. You could share research and available helplines if they are open to working together on it. Do not share ‘articles’ or information unsolicited by the patient. Do not try to explain their emotions to them.
Incase of PCOS, support your person’s choice of diet (dairy-free, gluten-free), exercise and other coping mechanisms. Become an accountability buddy and help with reminders and planning necessary (stress-busting, low intensity workout) activities as dates/ hang out sessions. Accompany them to medical check-ups if they are comfortable. Affirmations about body image and gender can be helpful.
Incase of PMDD, it is important to understand that the person with PMDD could be under immense mental distress and might need to prioritize themselves in those moments/ phases. It is best to have a conversation with them before their PMDD or luteal phase (i.e. during their follicular phase) about how you can support them — with physical comfort, food, gentle reminders etc. It is important to track the person’s period and be supportive at the onset of the luteal phase and offer help in everyday tasks to free their time (to focus on mental state/ well being) if the person is comfortable with it. Affirmations about self-worth, grounding practices and compassion are helpful.
Author’s experience, engagement with and understanding of menstrual health disorders and conditions has been broken down into cases of medical, social, cultural and personal realizations in the TEDx talk above.