For most of her life, Cori Lint was content. She balanced her days working as a software engineer with nights playing the cello part-time, and filled her free hours with inline skating, gardening, and long conversations with friends. However, every month, Lint’s mood would plummet for a few days. She experienced sudden panic attacks and suicidal thoughts.
Lint, 34, who splits her time between St. Petersburg, Florida, and Tulsa, Oklahoma, had been diagnosed with anxiety and depression. Yet, she struggled to comprehend the severe mood swings that made her feel like two different people.
“When I felt better, it was like I was looking back at the experience of someone else, and that was incredibly confusing,” Lint explained.
In 2022, she gained clarity. Lint noticed her symptoms were cyclical, coinciding with her menstrual period—an aspect her doctors hadn’t considered.
The Overlooked Aspect of Women’s Health
A longstanding lack of investment in women’s health has left significant gaps in medical knowledge. This issue is so prevalent that President Joe Biden signed an executive order this year to advance women’s health research and innovation.
Research indicates that women are less likely than men to receive early diagnoses for conditions like heart disease and cancer. Their medical concerns are often dismissed or misdiagnosed. Disorders specifically affecting women remain understudied, leaving many unknowns about their causes and treatments. This is particularly true for the impact of menstruation on mental health.
Seeking answers, Lint turned to the internet and discovered a debilitating condition linking mental and reproductive health.
“Sounds like me,” she thought.
What is PMDD?
Premenstrual dysphoric disorder (PMDD) is a severe reaction in the brain to natural hormonal changes occurring one to two weeks before menstruation. Symptoms include irritability, anxiety, depression, sudden mood swings, fatigue, joint and muscle pain, and changes in appetite and sleep patterns. These symptoms typically improve once menstruation begins.
Unlike the mild discomfort of premenstrual syndrome (PMS), PMDD’s effects are life-altering. Those affected may endure nearly four years of cumulative disability throughout their lives.
Researchers estimate that PMDD affects about 5% of menstruating individuals, similar to the prevalence of diabetes among women. Yet, it remains relatively unknown, even among healthcare providers. A 2022 survey of PMDD patients published in the Journal of Women’s Health revealed that over a third of participants felt their family doctors were unfamiliar with PMDD and its treatments. About 40% said the same about their mental health therapists.
The Challenge of Recognizing PMDD
Reproductive mental health has been sidelined as a specialty, says Jaclyn Ross, a clinical psychologist and associate director of the CLEAR Lab at the University of Illinois-Chicago. Few healthcare providers receive training or become aware of such disorders.
“If you’re not considering the menstrual cycle, you’re at risk of misdiagnosing and missing what’s actually going on,” Ross emphasized.
This was the case for Jenna Tingum, 25, from Tampa, Florida, who experienced panic attacks and suicidal thoughts as a premed student. It wasn’t until her college girlfriend read about PMDD online and noticed Tingum’s symptoms flared before her period that Tingum consulted her gynecologist.
“I don’t think I would have ever put the pieces together,” Tingum admitted.
The Suicide Risk and Treatment Options
Due to limited research, the cause of PMDD remains somewhat of an enigma, and treatments are still evolving. PMDD was only added to the Diagnostic and Statistical Manual of Mental Disorders in 2013 and recognized by the World Health Organization in 2019, although medical literature references date back to the 1960s.
Early efforts to define PMDD as a medical condition faced pushback from some feminist groups wary of reinforcing stereotypes about PMS and periods. However, Ross insists that patients must be taken seriously.
A study revealed that 72% of PMDD patients had suicidal thoughts during their lifetime, and 34% had attempted suicide, compared to 3% of the general population.
Marybeth Bohn, who lost her daughter Christina to suicide in 2021, now works to raise awareness about PMDD. Christina connected her extreme distress to her menstrual cycle only months before her death. Bohn advocates for medical and nursing schools to incorporate questions about premenstrual symptoms into mental health evaluations.
“We need more research to understand how and why these reactions to hormones occur,” Ross stressed. “There’s so much work to be done.”
Available Treatments
While no universal approach exists, three main treatments have emerged, according to Rachel Carpenter, medical director of reproductive psychiatry at the University of Florida-Jacksonville College of Medicine.
Selective Serotonin Reuptake Inhibitors (SSRIs): These common antidepressants are often the first line of treatment. Some patients take them regularly, while others use them only during the symptomatic week or two.
Hormonal Birth Control: This can alleviate symptoms by controlling or preventing hormone release.
Talk Therapy and Cycle Awareness: These methods help patients build mental resilience for difficult weeks.
Sandi MacDonald, co-founder of the International Association for Premenstrual Disorders, highlighted the need for funding research and education. She hopes the new White House initiative will foster advancements in women’s health research.
The Importance of Conversations
Both Lint and Tingum, diagnosed after independently learning about PMDD, believe a lack of discussion about periods delayed their care. Lint recalls periods being the butt of jokes rather than serious conversations.
“For the longest time, I thought, ‘Well, this happens to everyone, right?’” Lint said of her symptoms. “Has a doctor ever asked me what my symptoms are like? No, absolutely not. But we’re talking about a quarter or more of my life.”
Brett Buchert, a former University of Florida athlete who struggled with severe symptoms, noted that doctors often treat questions about periods as a formality. “The conversation ends there,” she said.
Buchert, now in Boulder, Colorado, says understanding her cycle has helped her manage her condition.
Finding Support
Tracking her cycle allows Lint to plan around her symptoms, making fewer commitments and carving out more self-care time before her period. Reading others’ stories has provided solace.
“It’s helped me process the extremes,” Lint said. “There’s not something wrong with me as an individual. I’m not crazy; this is something that’s legitimately happening to me. It helps to know I’m not alone.”
This article was produced through a partnership between KFF Health News and the Tampa Bay Times.
