Premenstrual dysphoric disorder (PMDD) is a mood disorder that is triggered by the hormonal changes of a woman’s menstrual cycle. It differs from typical premenstrual syndrome (PMS) in severity and how it affects a woman’s life. While PMS often makes women feel irritable and physically and mentally uncomfortable, these changes are only a minor nuisance for most.

In contrast, PMDD can trigger panic attacks and depression so severe that it makes some women suicidal. Even if it doesn’t lead to severe psychiatric crisis, PMDD may impact a woman’s ability to function, causing problems at work, at home and in close relationships.

These stressors may drive women with PMDD to abuse substances. Unfortunately, the effort to manage their symptoms can extend throughout the month and ultimately lead to addiction.

Effects of Substance Abuse on PMDD Symptoms

Premenstrual dysphoric disorder is unique among psychiatric disorders in that it only affects women and is directly linked to fluctuations in reproductive hormones, especially progesterone.. Substance abuse can disrupt a woman’s menstrual cycle by doing any of the following:

  • Causing her to have a lighter or heavier period
  • Increasing or decreasing the average length of her period
  • Inducing amenorrhea, or causing her to stop having a period

Misusing substances may be riskier for women with PMDD, because  it worsens symptoms in two different ways:

  • Directly triggering changes in mood and inducing other psychiatric symptoms
  • Indirectly intensifying mental health symptoms through changes to the menstrual cycle

For women with PMDD, severe psychiatric symptoms like panic attacks, severely depressed mood and suicidal thoughts are triggered by changes to their reproductive hormones and brain chemistry the week before menstruation begins.

It is not yet clear whether PMDD causes differences in hormone levels or differences in sensitivity to hormones. Regardless, substance-induced intensification of hormonal changes worsens the symptoms of PMDD. Given that PMDD links with an increased risk of suicidal thoughts, this puts women with these co-occurring disorders at higher risk of self-harm.

Statistics on PMDD and Drug Abuse

About 90 percent of women experience symptoms of PMS, and about 3 to 8 percent of women experience PMDD. Almost 15 percent of women with PMDD will attempt suicide at least once in their lifetimes. People who use substances also have a significantly elevated suicide risk relative to the general population. This fact means that women with PMDD who also use substances are at a substantially increased risk of suicide. As many as 10 percent of cases of PMS link to the effects of comorbid alcohol use, which either causes or intensifies associated symptoms.

PMDD and Alcohol

Premenstrual dysphoric disorder has strong links with alcohol use disorders. Women with PMDD are more likely to abuse alcohol, and women who abuse alcohol are more likely to have severe premenstrual syndrome (PMS) or PMDD. Unfortunately, PMDD and alcohol use is a dangerous mixture, because both increase the risk of intentional or accidental self-injury.

Several studies show that PMS symptoms link with increased use of alcohol. Research shows that women with PMS may drink harder alcohol, while other research found that women with family histories of alcohol use disorders drink heavier in the week before their periods.

Other research shows that alcohol can cause or worsen PMS or PMDD symptoms. A study shows that women who abuse alcohol are likely to experience PMS symptoms and that the risk is even higher for women who drink heavily. Research shows that women with PMDD are hypersensitive to the effects of alcohol.

PMDD and Marijuana

Marijuana is becoming increasingly socially acceptable for both recreational and medical uses. Unfortunately, while marijuana can help some people with pain management, it also comes with side effects and risks, especially for people with mental health conditions. Marijuana use, especially heavy use, has been linked with episodes of dissociation, anxiety, paranoia and panic.

In addition to triggering anxiety symptoms, marijuana use can affect PMDD by changing the menstrual cycle. Research shows that it has measurable, but inconsistent effects on hormone production and ovulation. This finding means that PMDD and marijuana can be a risky combination for women with severe symptoms. In addition to triggering panic attacks, it can cause hormonal fluctuations that affect mood and cognition.

PMDD and Stimulants

Like marijuana, stimulants are known to trigger symptoms of anxiety including panic attacks. They activate the sympathetic nervous system, which links to fight-or-flight responses that heighten in people with trauma-related disorders. Since many women with PMDD have histories of trauma, stimulant use can trigger complex reactions for them.

Research shows that women respond differently to stimulants depending on which stage of the menstrual cycle they are experiencing. This response can cause a sudden spike in cravings for stimulants that can be especially challenging for women in the early phases of recovery.

Cocaine use links to increased levels of prolactin, especially during the withdrawal phase. Increased prolactin can have many different effects on the menstrual cycle, such as:

  • Preventing ovulation
  • Delaying menstruation
  • Causing irregular periods

Stimulants also cause people to experience episodic dysphoria, or mild depression, during periods between use. This response means they have the potential to trigger depressive symptoms for women with PMDD even during the two weeks between menstruation and ovulation The six most commonly abused classes of stimulants include:

Drug Abuse as a Cause of PMDD

Because most recreational drugs cause changes to hormone levels, they can directly cause PMDD, especially in women with the following risk factors:

  • Co-occurring mood disorders
  • A family history of mood disorders
  • A family history of severe PMS or PMDD
  • A personal history of childhood abuse or trauma

Women with these risk factors may be vulnerable to the changes in levels of reproductive hormones and serotonin that can be triggered by many commonly abused substances.

Women have a higher risk of developing PMDD as a consequence of substance abuse if they have already experienced severe PMS symptoms. By using substances that prolong the menstrual cycle and trigger increases in hormones linked with PMDD, women can further intensify PMS symptoms and ultimately develop PMDD.

Drug Abuse as a Hindrance to PMDD Treatment

Some people may use substances to change the way they think or feel, often to numb emotional pain. While this provides temporary relief, it blocks deeper healing. Substance use may hinder people’s ability to observe, understand and process their internal responses, it can interfere with the treatment of any mental health disorder.

Like any mood disorder, PMDD affects women’s thought processes as well as their moods. The symptoms of PMDD are similar to those of major depressive disorder (MDD) and can include:

  • Depressed mood
  • Severe anxiety and panic
  • Negative self-directed thoughts
  • Loss of pleasure in usual activities

These symptoms are only alleviated when a person makes behavioral changes and stops believing in the negative thoughts driving their depressed mood or anxiety. For example, panic attacks may decrease when a person learns to recognize the feelings that trigger them as irrational and to respond to them with targeted relaxation techniques.

When women use substances to try to improve PMDD symptoms with therapy or medication, they might block the potential beneficial outcomes of both. Substances may dampen the effects of many psychiatric medications and slow progress in treatment by distorting a person’s thoughts and feelings.

Treatment for PMDD with Co-Occurring Substance Use Disorder

Premenstrual dysphoric disorder has a strong biological link, which means women with the disorder respond well to medication-based treatment and may even require it to experience an improvement in their symptoms. Fortunately, both oral contraceptives and selective serotonin reuptake inhibitors (SSRIs), the two types of medications most commonly used to treat PMDD, can be safely taken by women receiving treatment for substance use disorders.

Therapy and lifestyle modifications used to treat PMDD can also be helpful for women seeking recovery from addiction. Cognitive therapy can help counteract negative thinking that worsens mood symptoms as well as the thought processes that lead to recurrence of use. Exercise, a healthy diet and relaxation techniques like meditation can not only help women recover from PMDD, but also may help them overcome co-occurring anxiety, mood and substance use disorders.

Integrated treatment is an effective method for co-occurring disorders. When clinicians provide services in careful coordination with one another, they can address developments in addiction treatment groups with the right interventions in individual and complementary therapies for co-occurring conditions.

If you or someone you know is struggling with a substance use and co-occurring disorder like PMDD, contact a representative at The Recovery Village today to learn which integrated treatment option is right for you.

Premenstrual Dysphoric Disorder (PMDD) and Substance Abuse
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