During the luteal phase of the menstrual cycle, many women experience what is known as Premenstrual Syndrome (PMS) — 75% of women experience at least one or two symptoms of PMS in their lifetime. Premenstrual Dysphoric Disorder (PMDD), the more severe form of PMS, is rarer, affecting less than 10% of women worldwide. However, studies have found that up to 46% of women with ADHD and 92% of autistic women experience symptoms of PMDD. But why does PMDD so disproportionately affect these individuals, and how does their experience differ from that of a neurotypical woman?
Why PMDD occurs
Hormonal sensitivity is the main culprit for the high prevalence of PMDD in these individuals. Dr Shruti Agnihotri, consultant psychiatrist at Asha Hospitals, says, “In neurodivergent individuals, there is a heightened sensitivity to any hormonal fluctuations. So, when hormonal changes occur, their minds and bodies have intense reactions to it.”
The interplay of hormones and neurotransmitters only aggravates this further. “During the luteal phase, oestrogen levels decrease, and less serotonin and dopamine are released,” she explains, adding, “The levels of these neurotransmitters are already altered in people with ADHD and autism, making them even more sensitive to these fluctuations.”
Exacerbated symptoms
While neurodivergence makes people more susceptible to PMDD, this disease also worsens existing symptoms of neurodivergence. “Individuals with neurodivergence absorb a lot of stimulus and their nervous system is constantly trying to stay regulated,” notes Dr Swetha Turlapati, psychotherapist and founder of The World Within, adding, “Their nervous system ends up working overtime in the luteal phase and these experiences intensify, leading to emotional dysregulation, heightened sensory sensitivities, executive dysfunction and overstimulation.”
When people with ADHD and autism are unable to regulate, it increases the risk of meltdown or shutdown. “In ADHD — where dopamine is further compromised — individuals become hyper-aroused and even daily stressors can result in emotional outbursts,” the psychologist explains. She further adds, “In autism, any sensory stimulus may feel overwhelming, and individuals become hypo-aroused, which results in shutdowns.” This decreased tolerance makes it difficult to cope and function effectively.
Challenges in treating PMDD
Gender plays a crucial role in how PMDD is treated alongside ADHD and autism. Pooja Gupta, a city-based counselling psychologist, states, “The symptoms of ADHD and autism show up differently in women compared to men. But since women are conditioned from a young age to behave in certain ways, they end up masking their neurodivergent traits and internalising their symptoms.”
Masking in women can negatively impact their self-image, hindering them from recognising their symptoms and getting the support they need — and when PMDD is added to the mix, it proves even more challenging to reach out for help. The first step to navigating PMDD, for both neurodivergent individuals and those around them, is to be curious.
Dr Swetha and Pooja suggest using the RAIN paradigm — ‘Recognise’ the symptom, ‘Analyse’ where it is coming from, ‘Investigate’ what is needed at a given time, and ‘Nurture’ the body. Tracking the cycle and anticipating the symptoms also helps better manage emotions during the luteal phase. Light exercise, adequate sleep, proper nutrition and necessary medication can also help alleviate stress.
It is important that people respect their limits, ask questions instead of assuming, and be kind to themselves and others.