PMDD & Being In Education
Our Young Advisory Board highlighted how much PMDD/PME had impacted their studies and their lives at school/college/university and how they felt it was essential that resources be available - both for the students themselves and teachers/lecturers/staff to demonstrate how they could best support their students to help them thrive.
Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-based mood disorder with symptoms arising during the luteal phase of the menstrual cycle each month and subsiding within a few days of menstruation. It affects about 5.5% of women and AFAB individuals of reproductive age. PMDD is a spectrum disorder, so will affect people to differing degrees and in different timescales (though symptoms will only be present in the luteal phase and taper off after menstruation). PMDD is a chronic health condition by definition.
Premenstrual Exacerbation (PME) refers to the premenstrual exacerbation/worsening of the symptoms of another disorder, such as major depressive disorder or generalized anxiety disorder.
Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME) are difficult to distinguish from each other. Take the self-screen here for a better understanding. Both can affect your health and studies - while this page focuses on PMDD in Education, much of the information will also apply to those living with PME.
This information is guidance only - please use it according to your personal circumstances and severity of symptoms.
How PMDD may affect your studies
At a time where you are perhaps moving away from friends and family, living with new people, juggling finances, and starting a new place of study - it can certainly be a very difficult (and exciting!) time. Throw in trying to manage difficult cyclical symptoms into the mix and it’s no wonder some people struggle!
PMDD causes symptoms such as having a very low mood, being withdrawn or being overwhelmed, and/or irritability. They may mean you feel you are unable to attend your place of education, find it difficult to manage your workload, struggle to be around other people, and even want to quit your studies at times!
Here we are going to talk about the symptoms of PMDD, and how they may impact your studies, and our Young Advisory Board members share some examples of their experiences:
Mood/emotional changes (e.g., mood swings, feeling suddenly sad or tearful, or increased sensitivity to rejection) - “I used to get overwhelmed about doing even simple things - suddenly, instead of enjoying being away from home, I used to get chronically homesick and just go to bed and sob”
Irritability, anger, or increased interpersonal conflict - “I found it difficult to navigate living with others when I was so quick to get angry and blame others for my bad mood”
Depressed mood, feelings of hopelessness, feeling worthless or guilty - “I definitely had ‘Imposter Syndrome.’ For me, the rejection aspect was the most damaging to my studies, and I think that's what led to me feeling so alone. I always felt like I wasn't meant to be there and wasn't good enough”.
Anxiety, tension, or feelings of being keyed up or on edge - “I had to leave important lectures on numerous occasions due to overwhelming anxiety and sometimes full-blown panic attacks. This not only increased my workload, but I felt embarrassed that I couldn’t ‘cope’ like everyone else ”
Decreased interest in usual activities (e.g., work, school, friends, hobbies) - “When you are feeling apathetic or disengaged, it’s going to be hard to get passionate about an essay, right? I used to go to bed for days and couldn’t face seeing anyone or doing anything”
Difficulty concentrating, focusing, or thinking; brain fog - “I found my concentration lacking in lectures and practicals after 20-30 minutes. The brain fog was horrendous, and I couldn't keep up with what everyone else was doing. The one thing that I struggled with most was forgetfulness. I found it so hard to learn lines, which heavily affected my marks”.
Tiredness or low-energy - “When I started treatment for PMDD, I gained 60lbs and could only stay awake for a few hours at a time. I couldn’t attend college full-time because of this. I think it is important to note that the PMDD symptoms are debilitating at times, but that treatments can often yield their own issues”.
Changes in appetite, food cravings, overeating, or binge eating - “I ate a lot of junk food anyway at university but would binge eat on chips and fast food a lot in the days leading up to my period. This meant I felt sluggish and even more tired - but I would not feel full up and would be so hungry in lectures that all I could think about was eating”
Hypersomnia (excessive sleepiness) or insomnia (trouble falling or staying asleep) - “Sleep disturbances were disruptive when I had to go to lectures or do group assignments. I would arrive late to the meetings or could not stay awake for long hours in the library. I always felt guilty because I felt like I was bringing my team down. I would want to do the assignments as soon as it was assigned in my good weeks, but everyone else would wait until the last minute, and I would be stretched thin”.
Feeling overwhelmed or out of control - “I used to catastrophize and become overwhelmed by my workload - and I would spiral as I felt like I could never get it finished in time (when in reality - I could if I was well)
Physical symptoms such as breast tenderness or swelling, joint or muscle pain, bloating, or weight gain. “Physical Symptoms affected my concentration so much. Apart from that, it made it difficult to put on regular clothes and sit in the classroom; the chair felt uncomfortable, and the temperature in the room was uncomfortable. I stopped going to classes because of this. Luckily, all my lectures were live-streamed, and professors would take my questions by email”.
Rachel - IAPMD Youth Advisory Board Chair
“Talk to different lecturers until you find one sympathetic to your PMDD, and allow them to help you navigate senior members and other staff if you need extensions. Don’t be afraid to ask for as much help as possible - there is no shame in taking longer than other people if needed. I found that graduating a year late was better than not graduating at all, and better than damaging your mental health by trying to do more than you are capable of at that time”
Download a “PMDD in Education” overview for teachers/educators
One thing our Young Advisory Members said they really struggled with was finding the right words to explain PMDD. Top of their list was a handout that they could print/email to teachers/school staff to educate them about PMDD and show them that it is a legitimate condition. With their help, we have created the following resource - so download it and use it to help advocate for help, assistance, and support:
Planning Your Schedule
Being aware of your menstrual cycle is so important (even for those who don’t have a PMD!). Tracking your moods and energy alongside your cycle can help you regain a sense of control. You can know when you have the most energy, when you focus best on tasks, when you need to rest, and which days you may need to practice extra kindness and self-care. With this knowledge, you can plan your time better - making sure you spread your workload out and keep it as manageable as possible.
“Creating a calendar where you overlap your school/college important dates (like exams and deadlines) with where those dates fall in your cycle. This can help you to prepare in advance and ask for extra help from professors or classmates if something important falls on your luteal phase”. - Gabrielle
Track your cycle for a few months using an app like mevpmdd, taking real notice of the peaks and troughs of your mood/energy/concentration levels. Then make a calendar (either digital or print a free one - there are lots of designs to choose from online!) and add/highlight important dates, deadlines, and events from your University schedule. Then add details you have collected from tracking your cycle and try to notice any areas where you may need to be more mindful of where you are using your time/energy. Make it work for you! Personally, we prefer a printout on the wall with a bit of color-coding - any excuse to buy new highlighters!
If you can't accurately track your cycle try and give yourself as much compassion as you can if you are unable to do things others can - separate your symptoms from your actual ability to do your work.
Nichole - IAPMD Young Advisory Board Member
“I love the idea of planning the month like this, however, from my experience, I know that it might not work for everyone. One reason is because of how unpredictable student life can be whether lectures are canceled or a deadline has been moved forward or other things like you can’t plan for. The number of times my lessons changed or they got canceled. I couldn’t get my head around that - let alone planning how that fit into my menstrual cycle! My menstrual cycle was pretty all over the place. I knew I had a long cycle (average of 42 days) however I could never predict when my symptoms would be starting. Looking back I would have struggled to plan”
10 tips from fellow students on how to advocate for yourself and manage your studies
Listen to your body. It can be hard, but if you need to rest and self-care, you have to make time for it. Having an early night, if you need it, can make all the difference.
Time management is essential - the last thing you need in the PMDD zone is deadlines looming and being behind on work! If you know you are not going to be able to finish/submit a project/assignment due to your PMDD - do not leave it until the last minute to ask for help - reach out for additional help or ask for an extension - and do not feel guilty or ashamed about it.
Do not be afraid to seek counseling if you are able to - it can be so helpful to have someone neutral to talk to. This is sometimes available through your education facility.
Avoid alcohol (a depressant) and caffeine (a stimulant) in your luteal phase - these can heighten the symptoms of PMDD.
Talk to other students about the workload to see how they are coping - but don’t compare yourself to others. Everyone has different commitments and abilities - some may be able to go out a lot and party, and some can’t - that’s OK.
Build a community around you where you have people to talk to - connect with PMDD folk from around the world to share lived experiences - you are not alone. Join the Young IAPMD support group or the IAPMD INSPIRE community and use the #pmddpeeps hashtag on social media to find others to connect with!
If you tend to feel anxious - pack a small bag to carry with you with items that may help - lavender oil, any medication, a phone charger cable (for emergencies!), a note from a loved one, and anything else that helps and makes you feel less anxious.
Studying can be intense - make sure you make time to do fun things, too - hobbies and activities you enjoy are essential for a balanced lifestyle!
Visit/talk to supportive friends - people who make you feel good about yourself. Plan some visits in advance, so you have things to look forward to (and get advance deals on travel costs!)
If you feel comfortable, talk to your housemates and explain what you are going through, and ask for space, compassion, and patience (as needed!). Show them the iapmd.org website to help explain.
One message that came very strongly from members of the Young Advisory Board was: Do not compare yourself to others. Of course, life isn’t always so simple and curveballs come our way. Give yourself a break and know that if you mess up - you are not the first and you certainly won’t be the last! Take a deep breath and start again tomorrow.
Talk to someone you trust if you are feeling anxious/in need of help. If you feel that you are at risk please call your emergency services and/or a local crisis support center. You can find details of crisis services worldwide here.
Speaking up if you need additional help/support
PMDD is very real, and you deserve to be supported to ensure you can thrive in your studies. You know (more than anyone else) what you are going through and if you need extra help and support. Do not be afraid to ask for it…and advocate for yourself until you get it. It can be daunting, but from their experiences, our Young Advisory Members make the following recommendations:
Speak to the University’s Disability services and set up a student support plan as soon as possible.
If your University doesn't immediately recognize PMDD as Disability, take information from a credible source (such as IAPMD!) and approach your Department Head - it’s more likely they have the discretion to offer reasonable adjustments and should help advocate for you.
If you are an international student or belong to an ethnic minority, speak to a BIPOC (or equivalent) student representative if you feel you need extra guidance or support within the system.
Speak up about any discrimination you may face in school due to your disorder, tell your university, and show them evidence based resources on PMDD.
Speak to the Student Welfare Office (or equivalent).
Having a supportive member of staff when you are battling with a serious chronic condition like PMDD/PME can make all the difference. Print out this guide [link] for staff/mentors to help them understand PMDD and how it may affect your studies. Talk to a few different lecturers until you find one who is sympathetic, and allow them to help you navigate senior members of staff if you need extensions, etc.
If you need support, consider taking a friend when you have any meetings. They can maybe help take notes too!
Check out school/college/university policies (beforehand if possible) regarding what support they offer for students with a chronic health condition, and research in advance to see if you can access any financial aid.
Don’t leave it until the last minute to reach out for help if you are struggling. It can put extra stress on yourself if you put off requesting deadline extensions etc
Struggling to find the right words to explain PMDD to school/college staff? Here is a downloadable handout you can print/email to teachers/school staff to educate them about PMDD and show them that it is a legitimate condition: