Disclaimer and Trigger Warning: This article, or pages it links to, contains information about suicide that may be triggering. The information contained within this article does not constitute and should not be used as a substitute for medical advice. Consult your doctor or healthcare provider for advice regarding any medical condition. Do not attempt to self-diagnose or treat medical conditions based on this information.

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Hormonal. Hysterical. Mad. Women’s bodies and moods have a complicated history in the field of mental health.  Early male philosophers and thinkers, like Hippocrates and Celsus, considered the uterus and its movements to be the source of ‘hysteria’ in women.  They would recommend remedies ranging from plant medicine to exorcism. However, were they trying to comprehend a literal type of ‘madness’ induced by hormonal shifts that has nothing to do with spiritual possession or sexual frustration and everything to do with biology and hormone disruption? Were they trying to understand a condition we now know to be Premenstrual Dysphoric Disorder or PMDD?

What is PMDD?

Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS). It causes a range of emotional and physical symptoms every month during the week or two before your menstrual cycle. It is sometimes referred to as ‘severe PMS’.

The female body is a beautifully complex ecosystem with its own cycles, seasons, and predators. Being entrusted with the gift of receiving, nourishing and birthing life is no small task and as such, it drives our biological reality on a day-to-day basis. Our ability to ovulate directs our monthly period, but also the biochemical shifts that impact everything from our skin and hair quality to our moods and metabolism.

Ideally, this monthly practice of procreation ebbs and flows like changing tides and the orbiting moon. But for many women in the modern world, the hormonal shifts we experience can range from physical symptoms, like bloating and breast tenderness, to emotional changes like moodiness and irritability.

When the emotional transitions manifest more drastically as anxiety, depression, and suicidal ideation, you likely have PMDD, a severe mood disorder that arises in the one to two weeks prior to menstruation.

Women’s Health Crisis

PMDD affects an estimated 1 in 20 women in the United Kingdom and takes an average of 12 years to diagnose.  Female bodies are consistently seen as mysterious and elusive, complex and crazy.  It is for these reasons that women’s reproductive health research is pathetically underfunded and sorely misunderstood even today. Many chide women as having PMS (Premenstrual Syndrome) when they express any kind of unexpected mood changes such as sadness or rage.

Navigating these stereotypes are challenging because there are legitimate biological shifts that happen on a daily and weekly basis due to our reproductive hormones. However, when women assert that there is something abnormal with either their period pain or the mental states they experience before their period, doctors regularly dismiss them as normal or may undermine the severity of the symptoms reported.

PMS itself indicates an abundance of unchallenged estrogen or what some call ‘estrogen dominance’. Our modern lifestyles regularly expose us to hormone-disrupting chemicals in skin and hair care products, pesticides and herbicides in our food supply, plastic containers, and processed foods. We can help to relieve PMS through our food choices, elimination habits, and efforts to detoxify our body care products, diet, and home. However, with PMDD, an individual is so highly sensitive to hormonal fluctuations that the brain’s biochemistry and nerve system is impacted which causes mood instability. Recent research by the National Institute of Health (NIH) suggests that a particular gene complex that helps women process hormones and stress responses is altered in women with PMDD.  

Telling a woman with PMDD that ‘it’s all in her head’ or that she’s ‘bipolar’ discredits the predictable pattern of mental health challenges that only arise one to two weeks before her period is due and is almost instantly relieved by the start of her period.

This is the experience that Hafsa endured every month “The symptoms began just after ovulation, two weeks before my period began. It would be difficult to pray, keep up
because some days it was difficult to get out of bed. My other PMDD symptoms included knee pain and anxiety and even depression – too many thoughts racing in my head – it debilitated two weeks of my life each month. Simple things like chores became difficult to do, praying became so heavy and it felt so exhausting.”

At first, Hafsa didn’t realise that the symptoms she was experiencing were due to PMDD “I was praying but I did feel I wish I had more faith in Allah and would feel guilty for feeling life was rubbish during this time. I felt a lot of rage and sadness.”

Other women we spoke to for this piece began to notice the same patterns as Hafsa and tried to adjust their routines around their cycle. Juggling this rocky rhythm is what lead Suad for example, a Nigerian-British freelancer, to load her work schedule heavily during the first half of the month knowing that her available energy will steeply decline in the latter half of the month.

“I taught myself to accept my struggles with PMDD and not be super hard on myself when it hinders my ability to be on top of my acts of worship. I’m very conscious of time, and sometimes to a fault. Ihsaan is a top value for me, so I always strive to show up and make the most of my time, which also made it difficult to accept that there will be long stretches of time (a few days to about two weeks, sometimes longer) where I can’t get up early to pray Tahajjud or even pray the two raka’ ah sunnahs or do anything productive really.”

Sarah, a British doctor, also didn’t notice the cyclical nature of her mood changes until her father pointed it out. At some points of the month, thoughts of suicide would plague her. As a woman of faith she knows that ending her life would not relieve her suffering, so instead, she would plead with Allah to end life for her.

A few sympathetic medical practitioners understood her experience to be more than just PMS and directed her to supplement with Vitex or Chaste Berry, a herbal remedy for reproductive support that she affirms has been a ‘game-changer’ for her PMDD management.

Is there a cure?

Conventionally, PMDD is treated with anti-depressants, hormonal birth control, chemically-induced menopause and ovary or uterus removal. Addressing PMDD as a traditional case of depression, anxiety, or bipolar disorder disregards the timely hormonal onset and relief. All other options seek to abruptly halt ovulation and prevent the subsequent progesterone production that tends to drive PMDD. Removing ovaries and inducing menopause not only ceases menstruation but also the possibility of conception which for some is a small price to pay compared to the monthly torment they experience.

Women seeking alternative approaches to managing PMDD find support in addressing deeper hormonal imbalances. Simply knowing how to support the female endocrine system becomes challenging because conventional information around health and fitness is oriented to male biology.

The benefits of various diets and exercise regimens are most clearly researched and articulated for men’s physiology because male hormonal cycles repeat a predictable 24-hour cycle. However, the nuance of women’s month-long infradian hormonal rhythm makes the female body more intricate to study. Our brains and bodies are literally not the same on a daily basis, so the same nutritional and fitness inputs don’t produce common results during the various phases of our monthly menstrual cycle.  

Female hormonal expert and author of In The Flo, Alisa Vitti, affirms that women regularly experience hormonal imbalances because we lack awareness and understanding about the unique needs that each menstrual phase presents to us. By cross-training diet, movement, and self-care along the monthly hormonal shifts, we can better support reproductive and hormonal function throughout the entire menstrual cycle. While none of these suggestions can help a woman in the pit of a mental health crisis, they can help soften the hormonal peaks and valleys that are experienced over the course of the month.  

Nicole Jardim, author of Fix Your Period, asserts that the range of both PMS and PMDD are “highly influenced by nutrient deficiencies, excess psychological stress, genetic factors, gut health issues, and blood sugar abnormalities that drive estrogen to become dominant over progesterone.” In either case, our endocrine system functions best with stabilized blood sugar, clear detoxification pathways to ensure that excess hormones are balanced, well-supported gut health for estrogen metabolism and limiting histamines and inflammatory foods in the diet. 

Dietary and lifestyle modifications are long-term commitments that may not offer a quick fix solution, but they may give women a greater sense of agency by knowing how their daily choices can work in alliance with their hormonal needs instead of being against it. This fact doesn’t fault women for their experience of PMDD but rather offers a way to responsibly approach and potentially influence how PMDD is managed.  

Practising self-awareness and strengthening her connection with Allah is what helped Suad manage her work tasks, social expectations, and self-care.

“At the start of this year, I made the conscious effort to put myself and my health first, to fully internalise what it means to have an All-Loving, Merciful and Kind God who sees all I’m going through, who knows my struggles and loves me regardless. With this in mind, when the first round of being unable to get out of bed to do anything came around, I lifted my hands in surrender and said: God, you know what l’d rather do, but this is my test and I accept it. This acceptance and acknowledgement has been a game-changer in how I’m dealing with my PMDD. I berate myself a lot less about my unending or untouched to-do list, and I take each day as it comes.”

“My faith is actually what gets me through the dark moments. I don’t know how I would cope or get through life if I didn’t have to stand up to pray five times a day. There are days where that’s all I do, and having that reason to get up is enough. Sure, it’s not always with khushoo and I do it because it’s an obligation, but the benefit remains and it’s a constant reminder to myself that Allah is with me through this difficult time.”

For Hafsa, Rapid Transformational Therapy (RTT) session played a pivotal role in helping her to give a name to the nightmare she was reliving every month “Once I realised my symptomps were down to PMDD, there was a huge sigh of relief that this wasn’t actually me, but the chemicals in my brain.”

Through her RTT session, Hafsa also came to an important realisation that would eventually help her to bring her PMDD symptoms under control:

“PMDD is more than just hormones, it’s linked to the small childhood traumas – the feeling of not being good enough or not belonging. I discovered that I had unhealed trauma which I wasn’t actually aware of but it manifested again in my adulthood through PMDD. The feelings which I’d never reallv addressed kept resurfacing even though I most likely ignored them without addressing them hence the physical pain. It’s important for you to be aware of those triggers and watch how you feel and monitor your moods to see what’s actually going on.”

For other women suffering with PMDD, Hafsa has a message of hope:

“There are many different ways to healing – it is possible. There is light at the end of the tunnel. We have to take action even if it’s joining a support group online. Realising so many other women understand is just a huge weight off your shoulders. For me RTT worked and The Red Tent Programme created especially for women suffering PMDD. It isn’t just your hormones – it’s your body saying no!”

If you suspect that you might be experiencing PMDD, you can complete an online screening and begin tracking your daily mood and physical changes to identify a monthly pattern of onset and relief.  Seek out support groups for women with PMDD, as many people can’t relate to how terrorizing the condition can be. Lastly, consult with your medical provider about the following lifestyle changes before exploring pharmaceutical or surgical options:

• Avoid skipping meals and eat adequate amounts of protein and healthy carbohydrates
• Limit inflammatory foods like sugar, caffeine and histamines in your diet
• Supplement with Vitamin B6, Vitamin C, magnesium and quercetin
• Support your gut health and liver detoxification
• Prioritize rest and stress management