MAFS shone a light on PMDD and relationships. Bridie knows the struggle well

Bridie describes herself as happy, bubbly and positive. Except for two days of the month.

"In those two days, I feel unbearable, and wouldn't wish it on anyone," the 39-year-old from Queensland says.

Bridie, who asked we don't use her surname, has premenstrual dysphoric disorder (PMDD) — a condition that causes severe emotional and psychological distress in the lead-up to menstruation.

Warning: this story talks about suicide ideation.

She was diagnosed eight years ago after speaking to her doctor about feeling "incredibly depressed" during certain periods in her cycle, and it impacting her relationships.

"I found this cycle of breaking up with my partners every month.

"Granted I was not in the right relationships, but for about two days a month I felt heightened — I have no self-worth, which is the complete opposite of how I am for the rest of the month."

PMDD can have a negative impact on romantic relationships, says Melanie Hemsley, Women's Health GP with Jean Hailes for Women's Health.

It's something we saw play out on the recent Married at First Sight (MAFS) UK season.

Participant Kristina Goodsell openly shared her struggle with PMDD on the reality program, which was central to relationship hurdles between her and "husband" Kieran Chapman.

PMDD and its symptoms

PMDD results from an increased sensitivity to hormonal fluctuations in the lead-up to menstruation, explains Jayashri Kulkarni, director of Monash University's Health Education Research Centre.

Unlike PMS, which refers to a broad range of physical and emotional symptoms in the days leading up to a person's period, PMDD is a significant and severe depression that comes on suddenly, Professor Kulkarni explains.

As well as depression and low mood, she says symptoms can include tearfulness, rage, brain fog, and extreme fatigue.

Dr Hemsley says anxiety, feelings of helplessness and sensitivity to rejection may also arise.

"Which has knock-on effects for interpersonal relationships."

While the exact causes of the hormonal sensitivity aren't known, Dr Hemsley says it could be genetic, and rates are higher in those who have a history of depression or have experienced early childhood trauma.

"We also see an emergence of [the symptoms] worsening during perimenopause."

The statistics on the prevalence of PMDD vary widely, says Professor Kulkarni, ranging anywhere from 5 to 15 per cent for women of reproductive age.

And given many people assigned female at birth don't become aware they have PMDD, even those figures are likely underestimated, she says.

There are no tests for PMDD, so diagnosis is determined by the pattern of symptoms.

A key difference between PMDD and depression is that PMDD symptoms improve once menstruation begins.

Management of the condition depends on an individual's symptoms and can include hormonal treatments including certain types of oral birth control, therapy, and anti-depressants, but Professor Kulkarni warns the latter may not be as effective as some women hope.

"It is what most general doctors and psychiatrists will offer [but] it doesn't necessarily to achieve the best outcomes."

How it plays out in relationships

Bridie says having PMDD is like being "suffocated by your hormones".

"My friends would describe me as a true Gemini; bubbly, social, funny. The person who can light up a room.

"I feel worthless, like a burden, I feel suicidal at times."

Bridie, who is currently single, says her PMDD symptoms are more intense when she's in a romantic relationship. And she's never been with anyone who made her feel supported during that time.

"I actually got to know my body so, so well. As soon as the teariness started, I would go 'OK, it's about to start, so can you please be gentle with me. I know this is hard for you, but it's hard for me too. For two days can you have it together for me?'

"And they couldn't."

Bridie's experiences have caused her to question entering relationships.

"I don't want to put that burden on somebody else.

"You question … are all the other days of being amazing and great, is that enough for somebody to stay when you are at your worst for two days?"

Bridie has three sons and says she's able to protect them from her PMDD symptoms, although they are aware she experiences them because she's openly shared.

"They are the kindest people I've ever met. My oldest will cook dinner when I'm feeling that way.

"My middle one mowed the lawn the other day. My youngest gave me massages."

Professor Jayashri says the rage women can experience may be particularly hard on partners.

"Of course there might be justification and a real reason she feels that, but it's as if perspective goes out the window.

"Women will also describe a sense of falling out of love, or just not having the capacity to feel positive emotion."

Managing PMDD as a couple

Bridie says she has gotten better at knowing what she needs from a partner when experiencing symptoms.

"For me personally, I need to have no big conversations. No major conversations that will escalate.

Dr Hemsley says women should have compassion for themselves during that time, and communicate what they need from loved ones.

"I have some patients that lightly schedule that week prior to their period coming.

"That's not when they say yes to that extra task at work … or they might need to schedule extra relaxation or gym sessions — so upping coping strategies."

Professor Kulkarni says it's understandable partners may feel hurt of like they are "taking quite a battering" when their partner is experiencing PMDD symptoms.

She says educating themselves about PMDD can help them be more understanding and seek their own support too.

"It's difficult to navigate between the couple if there are issues that get magnified around this time.

"Or it may be there are no issues, and it's all just really out of proportion anger because of her mental health."

Individual therapy and couples' counselling can be helpful, says Dr Hemsley.

Bridie says seeing Kristina share her story on MAFS has helped her feel less alone, and she hopes sharing her story can do the same for others.

"It's such an awful thing to go through."