Understanding PMDD, Postpartum, and Perimenopause with Dr. Stacy Cohen | SHE MD Podcast

Differentiating PMS and PMDD

• 🎯 PMDD (Premenstrual Dysphoric Disorder) is a severe form of PMS affecting 3-8% of women, characterized by significant mood disruption cyclically before and during menstruation.
• 💡 A key factor in PMDD is how the brain reacts to hormonal fluctuations during the luteal phase, rather than a simple hormone imbalance.
• ⚠️ Many women with PMDD are misdiagnosed or dismissed by doctors, leading to a lack of proper treatment and validation.
• 🧠 High stress and trauma can make individuals more prone to PMDD, exacerbated by societal pressures around appearance and performance.

Managing PMDD Symptoms

• 🗓️ Calendar homework can help identify patterns, even for those on hormonal contraceptives or with IUDs, by tracking mood fluctuations over the cycle.
• 🧘‍♀️ Setting new expectations for the luteal phase, such as scheduling rest or self-care, can reduce self-shaming and improve coping mechanisms.
• 💊 Pulse dosing of antidepressants (like Zoloft or Prozac) during the luteal phase (days 14-28) can be effective because the brain's receptivity to these medications changes during this time.
• 💊 Yaz is the only FDA-approved birth control pill for PMDD, working by tempering hormonal surges and preventing ovulation.

Postpartum Mental Health

• 📉 The postpartum period can be an exaggerated form of PMS/PMDD due to a significant crash in hormones after delivery.
• 😥 While the