What causes uncontrollable crying during a breakdown

"Are there any other women here with symptoms similar to those I experience?" Asks a woman in a forum. She reports anxiety, depression, emotional breakdowns, and even suicidal thoughts. The symptoms are cycle-dependent and are limited to the second half, starting with ovulation. The result: two weeks of exceptional circumstances, which alternate with two weeks of normalcy. The hormones determined everything in her life. That is why she puts important appointments and vacations in the first half of the cycle, she describes relationships as difficult to impossible because no partner can endure long with a person who is so torn. "It's like the hormones make me a different person every month."

Recently, complaints like these have had an official number, "GA34.41", in the World Health Organization (WHO) catalog of diseases. Behind this is the name premenstrual dysphoric syndrome (PMDS). While premenstrual syndrome (PMS) manifests itself primarily through physical complaints, "dysphoric" also refers to the emotional component. It is estimated that around three to eight percent of women of childbearing age suffer from this severe form of menstrual symptoms. Symptoms for women with mild PMS are mainly physical - tightness in the chest, bloated stomach, pain. PMDS patients also experience mental horror: instability, irritability, tension, stress.

But is it really a separate clinical picture? In addition to the WHO catalog, PMDS is also listed in the DSM-5 psychiatric classification system. But these classifications were not without controversy. In the run-up to the WHO classification, bioethicist Tamara Browne argued that PMDS is a "culturally bound phenomenon, not a universal one". Mental health symptoms are reported much more frequently in western countries than in developing countries, for example. The classification as a disease is an unnecessary pathologization of natural processes. However, even Browne does not deny that women affected by the symptoms described often have a high level of suffering.

The diagnosis is complex because the hormone-related symptoms are so diverse

This is how Spanish doctors determined in the specialist journal Plos One recently some of the "dysfunctional coping strategies" associated with PMDS: According to this, many sufferers deny a problem, withdraw emotionally, or resort to drugs. Relativization from the outside is also the order of the day. Mom had that too. Come on. It's part of a woman's life. "But that's just not true," says the Hamburg gynecologist Anneliese Schwenkhagen. Women felt their cycle that it was normal. Especially with the start of ovulation, where there is a transition from the follicle to the corpus luteum phase. Schwenkhagen writes in a study that estrogen has a positive influence on the serotonin balance, which contributes to an improvement in mood. Shortly before ovulation, the level of estrogen in the woman's body is highest, and the production of progesterone that begins with ovulation usually counteracts this high. How strongly a woman reacts to these mood-changing effects depends not only on her genes but also on her personality, the demands on herself or stress. Strict control mechanisms still help in the job. Affected people cry secretly in the toilet, hiding their anger behind a mask of happiness. "The tatters fly at home in the evening," says Schwenkhagen. The cat runs to the neighbors, the children no longer want to talk to the mother, the partner says: honey, I can no longer live with you.

As early as the 19th century, scientists were researching how cycle hormones influence physical and mental well-being. The English doctor Henry Maudsley first made a connection between menstrual cycle and symptoms and spoke of "menstrual madness". Today it is assumed that a disturbance in the central serotonin metabolism is the cause. PMDS patients are at increased risk of developing another psychiatric illness during their lifetime. Conversely, if a psychiatric illness is present, there is a greater risk of PMDS. It is therefore believed that these disorders share a common genetic component that makes the central nervous system (CNS) more susceptible to hormonal fluctuations. Those affected are risk candidates for postpartum depression, i.e. depression after childbirth. Even during menopause, women are likely to be exposed to a greater risk of hormonal fluctuations.

However, the breadth of the symptoms makes an accurate diagnosis difficult. There is no laboratory test because the concentration of hormones in the body does not automatically say anything about the response of the CNS. "The problem with PMS and PMDS is that it is difficult to define when it is an illness," says gynecologist and psychotherapist Maria Beckermann. Beckermann points out that the frequency of premenstrual complaints fluctuated between 85 and five percent. With the 85 percent figure, all complaints would be added, with the five percent "it is precisely defined which complaints must be present when and how strong". In order to differentiate between premenstrual and menstrual cycle-independent symptoms, women would have to write down their symptoms in a diary for at least three cycles every day. "Then it turns out in at least half of the women that the symptoms, such as headaches, are not strictly limited to the second half of the cycle," says Beckermann. This means that PMS is excluded. While physical symptoms suggest a hormonal imbalance, psychological and behavioral problems are "more likely to be understood as hormone-dependent depression," says Beckermann.

Symptoms can often be relieved with a healthy diet and plenty of exercise

The treatment then provides two options, which can also be combined: Either you inhibit ovulation by administering the pill without interruption. Or you try to influence the reaction of the nervous system to ovulation and hormonal fluctuations by giving serotonin reuptake inhibitors (SSRIs). In addition, regular exercise, especially endurance sport, and the administration of calcium and monk's pepper help. "Quit smoking, do sports, little alcohol, sugar and white flour, a lot can be achieved with that," says Eva Waldsch├╝tz, a gynecologist from Wuppertal. The composition of the pill, which should be agreed with the gynecologist, is also important. "At the moment the trend is - unfortunately - very much against hormonal contraception and many women are then amazed to notice the cycle," says Waldsch├╝tz.

It has only been possible to prescribe psychotropic drugs since it was classified as a mental disorder. "This is a great achievement because psychiatrists can now bill the health insurance company as well," says Valenka Dorsch, a specialist in psychiatry and psychotherapy. The doctor advocates greater visibility of the disease and a more natural way of dealing with this women's ailment. Especially perfectionist women found it difficult to cope with the strong mental changes. They felt it was a loss of control, they were ashamed. Society must absorb that better.