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Period Dignity: In Discussion with Dr. Arianna Di Florio

Your VP Welfare, Georgie East and Women's Officer Polly Denny talk to psychiatrist and clinical senior lecturer, Dr. Arianna Di Florio about Premenstrual Dysphoric Disorder (PMDD)

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Period Dignity - For everyone who menstruates at Cardiff Uni. In partnership with TOTM.

Who are you and what do you do at Cardiff?

I am a psychiatrist and a clinical senior lecturer at Cardiff University. Here I lead the Reproductive Mental Health Research Programme.

What is PMDD and who can experience it?

PMDD (Premenstrual Dysphoric Disorder) is an umbrella term used to describe different symptoms profiles, all characterised by cyclical mood symptoms, arising during the week or two before menstruation and subsiding within a few days after the period starts. 

The current technical definition of the American Psychiatric Association requires at least five symptoms, including one affective symptom, such as mood swings, irritability, and/or depression, in the final week of the majority of menstrual cycles. Symptoms  must become minimal or absent in the week after the onset of menses. Symptoms need to be severe enough to cause distress and interfere with daily life. PMDD is the only psychiatric disorder requiring patients to keep a daily record of their symptoms for a few months. 

One size however does not fit all. Some women may experience symptoms that don’t fit such structure. The current definition excludes women who may experience cyclical symptoms at other points during the menstrual cycle, for example around ovulation.

How many people experience PMDD?

Although it is common to have one or a few premenstrual symptoms, PMDD affects about 2-5% of women and AFAB (assigned female at birth) individuals of reproductive age. 

How might my hormonal contraception impact PMDD?

Not all hormonal contraceptives are equal. Some combined oral contraceptive pills have been shown to improve symptoms of PMDD. Others, such as progestin-only methods, might potentially have a negative effect on mood in women with or without pre-existing mood disorders, including PMDD.

Does transitioning impact PMDD? 

Anyone who has ovaries can suffer from PMDD, regardless their gender identity. There is little evidence on the impact of transitioning on PMDD. For some individuals, PMDD is triggered by a negative response of the brain to typical hormone fluctuations which occur in the menstrual cycle. It is therefore possible that other fluctuations, such as those associated with starting/stopping/changing hormone therapy, can trigger mood symptoms.  

According to the Centre of Excellence for Transgender Health at the University of California San Francisco, there is no clear evidence of association between testosterone therapy and mental disorders. Indeed, it can improve mood symptoms associated with gender dysphoria.

How would I know if I have PMDD and what should I do next?

The best place to start is by visiting your doctor.

PMDD is the only psychiatric disorder requiring patients to keep a daily record of their symptoms for a few months (at least two). You can use a printable symptom tracker or download an app such as Me v PMDD app to track your symptoms. You can then bring the records to your doctor’s appointment. 

What support or resources are available?

What part of your research are you most excited about?

We are currently conducting the first molecular genetic study of the psychiatric sensitivity to sex hormone changes, including PMDD.  The project, funded by the European Research Council, "Genetic Architecture Of Sex Steroid-related Psychiatric Disorders" (GASSP) will study whether genetic and environmental markers can help identify women at risk of psychiatric disorders in relation to the menstrual cycle, childbirth and transition to menopause. The findings will improve the current approach to diagnosis, prevention and treatment. We hope that by providing evidence-based, easy-to-understand information, GASSP will contribute to the destigmatisation of mental disorders related to women’s reproduction. 

Georgie East, VP Welfare and Campaigns and Polly Denny, Women's Officer

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