If I get pregnant, will my PMDD finally go away?

Will Pregnancy Be the End of PMDD?

For many women grappling with Premenstrual Dysphoric Disorder (PMDD), the monthly battle against severe mood swings, intense anxiety, irritability, and profound despair can feel relentless. Living with PMDD often involves navigating significant disruptions to daily life, relationships, and overall well-being. In this context, the thought of pregnancy can emerge not just as a life event, but also as a potential reprieve – a hope that the nine months of gestation might finally bring an end to the cyclical suffering. But is this hope truly a reality? Will PMDD symptoms simply disappear during pregnancy?

The relationship between PMDD and pregnancy is multifaceted, influenced by significant hormonal shifts that occur in a woman's body. While many women do experience a welcome remission of PMDD symptoms during pregnancy, it is equally important to understand the complexities, including the potential for mood challenges in the postpartum period. Understanding these patterns empowers women to approach pregnancy and postpartum with informed expectations and proactive strategies.

The Hormonal Shift: PMDD Remission During Pregnancy

The core of PMDD is believed to be an abnormal sensitivity in the brain to the normal fluctuations of ovarian hormones, particularly the sharp decline of estrogen and progesterone in the luteal phase of the menstrual cycle. Pregnancy dramatically alters this hormonal landscape, and this is why many women experience a significant improvement or even complete remission of PMDD symptoms.

During pregnancy, the body produces high and, crucially, stable levels of both estrogen and progesterone.

• High and Stable Estrogen: Estrogen levels rise significantly and remain consistently high throughout pregnancy. Unlike the sharp drops seen in the luteal phase of the menstrual cycle that trigger PMDD symptoms, this sustained high level of estrogen can have a stabilizing effect on mood-regulating neurotransmitters, such as serotonin, in the brain.

• High and Stable Progesterone: Similarly, progesterone levels are elevated and remain stable throughout pregnancy, primarily produced by the placenta. While the withdrawal of progesterone metabolites is often implicated in luteal phase sensitivity for PMDD, the sustained presence of progesterone and its calming metabolites during pregnancy can contribute to a more stable mood.

Because the cyclical fluctuations that trigger PMDD are largely absent during pregnancy, many individuals report feeling remarkably better, experiencing a reprieve from the debilitating emotional and physical symptoms they face monthly. This period of remission can be a welcome and much-needed break for those who have suffered for years.

The Postpartum Period: A New Hormonal Landscape and Potential Challenges

While pregnancy often brings relief, the postpartum period presents a new and significant hormonal challenge. Immediately after childbirth, there is a sudden and dramatic drop in both estrogen and progesterone levels as the placenta is expelled. These hormonal levels plummet back to pre-pregnancy levels within a matter of days.

This rapid hormonal withdrawal is a major physiological event and can be a vulnerable time for any new mother. For women with a history of PMDD, this sudden and steep decline in hormones can act as a significant trigger, increasing the risk of mood disturbances.

• Postpartum Depression (PPD): Women with a history of PMDD are at an elevated risk of developing Postpartum Depression (PPD). While PMDD and PPD are distinct conditions, they share a common thread: sensitivity to rapid hormonal shifts. The symptoms of PPD can include persistent sadness, anxiety, irritability, feelings of hopelessness, severe mood swings, fatigue, and difficulty bonding with the baby. These symptoms can be quite similar to PMDD, but they are not cyclical and can be more prolonged.

• Recurrence of PMDD Symptoms: Once menstrual cycles return after childbirth (which can vary widely depending on breastfeeding and individual factors), PMDD symptoms are very likely to recur. The return of regular ovulatory cycles means the return of the luteal phase and its associated hormonal fluctuations, to which the PMDD brain is highly sensitive. The intensity of symptoms may be similar to pre-pregnancy, or in some cases, women report them feeling even more severe due to the added stressors of new motherhood and sleep deprivation.

Planning and Prophylactic Measures: Empowering Your Journey

Understanding these potential postpartum challenges is not meant to cause alarm, but rather to empower women with knowledge. Knowing what to expect allows for proactive planning and the implementation of prophylactic measures, which can significantly impact your well-being during this vulnerable time.

1. Open Communication with Healthcare Providers:

   • During Pregnancy: Discuss your PMDD history with your obstetrician and a mental health professional specializing in perinatal mood disorders. Develop a postpartum plan before the baby arrives.

   • Postpartum Monitoring: Ensure your healthcare team is aware of your PMDD history so they can monitor you closely for signs of PPD or PMDD recurrence.

2. Building a Support System:

   • Delegate and Accept Help: The postpartum period is demanding. Line up support from family, friends, or a doula for household tasks, childcare, and emotional support.

   • Connect with Others: Join new parent groups or support groups for women with PMDD or PPD. Sharing experiences can reduce feelings of isolation.

3. Prioritizing Self-Care (even when it feels impossible):

   • Sleep: Prioritize sleep whenever possible, even if it means "sleeping when the baby sleeps" or asking for help with night feeds. Sleep deprivation is a major trigger for mood disturbances.

   • Nutrition: Maintain a balanced, nutrient-dense diet to support your physical and mental recovery.

   • Gentle Movement: Once cleared by your doctor, incorporate gentle physical activity. Walking can be incredibly beneficial for mood.

   • Stress Management: Practice mindfulness, deep breathing, or short meditations. Even a few minutes can make a difference. Recognize that the postpartum period is inherently stressful, and managing that stress is crucial.

4. Considering Treatment Options:

   • Medication: For women with a history of severe PMDD, a healthcare provider might recommend starting prophylactic medication (like SSRIs) in the immediate postpartum period, or once menstrual cycles resume, to prevent or mitigate symptoms.

   • Hormonal Strategies: Discuss with your doctor if certain hormonal strategies, once cleared for breastfeeding, might be appropriate when cycles return.

The journey through pregnancy and postpartum is unique for every woman. For those with PMDD, pregnancy often offers a much-needed period of symptomatic relief due to stable high hormone levels. However, the dramatic hormonal drop after childbirth can increase vulnerability to postpartum mood disorders and the eventual return of cyclical PMDD symptoms. By being informed, proactive, and building a strong support system, women can navigate these transitions with greater resilience and ensure their mental well-being is prioritized throughout this profound life stage.

Disclaimer

The information provided in this blog post is for educational purposes only and should not be considered medical advice. It is essential to consult with a qualified healthcare professional, such as a doctor, gynecologist, or psychiatrist specializing in perinatal mental health, before making any decisions about pregnancy, PMDD management, or postpartum care. Individual experiences with PMDD and pregnancy can vary significantly.

Related Articles

• What Role Does the Luteal Phase Play in PMDD?: This article provides a foundational understanding of the hormonal shifts in the menstrual cycle's luteal phase and how they trigger PMDD symptoms, which is crucial for understanding why pregnancy brings relief and why symptoms recur postpartum.

• Why am I so tired and can't focus before my period? Is it PMS?: While focused on PMS, this blog explains the connection between hormonal fluctuations and symptoms like fatigue and brain fog. Understanding these mechanisms helps contextualize similar mood and energy challenges that might arise postpartum for women with PMDD.

Conclusion

For women with PMDD, the prospect of pregnancy often carries the hopeful promise of relief from relentless symptoms. It is true that for many, the stable, high hormonal environment of pregnancy offers a significant reprieve from PMDD's debilitating emotional and physical challenges. However, it's vital to acknowledge that the dramatic hormonal shifts in the postpartum period can usher in new vulnerabilities, including an increased risk of postpartum depression and the inevitable return of PMDD symptoms once menstrual cycles resume. By being well-informed, actively collaborating with healthcare professionals, and building robust support systems, women can navigate these life transitions with greater awareness and proactive care, ensuring their mental health remains a priority at every stage.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.

Cleveland Clinic. (n.d.). Premenstrual Dysphoric Disorder (PMDD): Causes & Treatment. Retrieved from Cleveland Clinic website.

Halbreich, U., & Kahn, L. S. (2007). Hormonal aspects of postpartum depression. Psychoneuroendocrinology, 32(Suppl 1), S89-S94.

NIMH. (n.d.). Premenstrual Dysphoric Disorder (PMDD). National Institute of Mental Health. Retrieved from NIMH website.

Payne, J. L., & Warner, V. L. (2018). The Role of Reproductive Hormones in Premenstrual Dysphoric Disorder. Dialogues in Clinical Neuroscience, 20(4), 263–272.

Sharma, V., & Sharma, S. (2012). Postpartum psychiatric disorders: an overview. Indian Journal of Psychiatry, 54(3), 209–216.