PMDD: an extreme version of PMT

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Mellicia Watts has paid an unnaturally high price for being a woman. Every month, for the fortnight leading up to her period, Melissa has gone through personality changes she didn't understand and couldn't control.

For more than a decade, family life and relationships have been strained, as this young mum endured physical symptoms - migraines, sinus troubles, aches and pains, coupled with the monthly emotional turmoil.

"It's like a fury, I don't know how to put it into words, I just feel like I want to rip everything apart," Mellicia said.

Mellicia has been diagnosed with Premenstrual Dysphoric Disorder or PMDD - an extreme version of PMT. It could affect up to 700,000 Australian women, yet most don't know they've got it and suffer in silence.

"For two weeks of the month I'm a happy, chappy person and then for two weeks of the month, something happens - I turn into a she devil," Mellicia said.

Husband Brad has borne the brunt of the mood swings, admitting it's pushed their relationship to the edge. He says love made him stay.

"You think maybe tomorrow might be a better day," Brad said.

The slightest thing would set Melissa off and home life became hell. Mellicia had no idea what was happening and neither did her doctors. More than a dozen told her she suffered from depression but they were wrong.

Then a consult with GP Dr Shashi Patel for sinusitis, led to Melissa being diagnosed with PMDD.

"This was a woman that's looked very, very well, it just didn't add up," Dr Patel said.

Dr Patel put the puzzle together, after studying all of Melissa's symptoms. It was the combination of physical and emotional problems that gave him his best clue.

"Sinusitis and migraines, to earaches, to jaw pain, to chest pain, to back pain, to the classic pelvic pain you get with pre menstrual syndrome, and the key thing here is that it's accompanied by a raft of other things - emotional changes, changes in personality," Dr Patel added.

The diagnosis came as a huge relief for Melissa.

"It is a sense that you're actually losing control of yourself," said head of Psychological Medicine at Perth's King Edward Memorial Hospital, Dr John Rampono.

Dr Rampono says PMDD is serious and the impact on women can be debilitating. Internationally, there are cases where it's been used as a medical defense in criminal cases, where the rage rendered women insane.

"In the phase leading up to the menstrual period - be it 7 days, or for some women 14 days - they get a significant change in their mental state and also physiological state," he added.

So what exactly is PMDD? Hormones released from the pituitary gland, trigger ovulation. The change in hormones also triggers symptoms through the brain's neurotransmitters, affecting levels of serotonin - the chemical that helps moderate mood, sleep, aggression, even appetite. Doctors believe these changes trigger PMDD.

"If you look at the facts, this does not occur in women before puberty or after menopause, it does not occur in woman who've had ovarian removal so it is clearly linked to the hormonal cycle," Dr Rampono said.

Mellicia is not depressed, but it's a depression medication that's now Melissa's treatment. For two weeks a month she now takes a serotonin boosting anti-depressant, the drug licenced in Australia for PMDD.

"What it does is it changes the cascade of symptoms, but you've got to start before the cascade starts at ovulation and it's the increase of serotonin that reduces the impact of those hormonal changes," Dr Rampono explained.

Dr Rampono says women who think they have PMDD need to keep a diary for two months, rating their mood from 0-3 every day, noting also when their period falls. If there are significant mood changes in the week or fortnight before, see your doctor.

"It's a serious illness and it needs appropriate management," Dr Rampono said.

Mellicia Watts isn't out of the woods yet, but she now knows how to manage her condition. She's gone public hoping other daughters, wives and mums will also get help and avoid the years of misery she's endured.

Further information

PMDD - Premenstrual Dysphoric Disorder
Treatment options include:

• Adequate regular hours of sleep in the second half of the Menstrual Cycle
• Reduce caffeine, salt, alcohol and nicotine
• Regular exercise in the Aerobic range
• Relaxation strategies
• Vitamin B6 - up to 50 mg/day ONLY
• Medications that increase the efficacy of Serotonin in practical terms - the new generation Antidepressants - from day 14 to the commencement of Menstruation. These are generally known by the trade names of Lovan, Lexapro, Zoloft, Cipramil etc.
• Women who think they might have PMDD, should keep a diary for two months, rating their daily mood (on a 0-3 scale), and noting when their period occurs. In the case of PMDD, physical and emotional changes occur in the 7-14 days preceding their period. If you have these symptoms, see your doctor.

GPs who state "an interest in Women's Health" are more likely to be informed about PMDD

Source: Dr Jonathan Rampono, Head of Psychological Medicine, King Edward Memorial Hospital Perth.