“I thought my PMDD diagnosis explained everything — but could autism reveal the bigger picture?”
A PMDD diagnosis can be life-changing when years of confusing symptoms finally have a name. But for author Laura Elizabeth Woollett, a medical emergency raised new questions about hormones, neurodivergence and mental health.
Sally Saunders
Words: Laura Elizabeth Woollett. Images: Shutterstock. Headshot: Leah Jing
When I was diagnosed with premenstrual dysphoric disorder (PMDD), a cycle-based hormonal mood disorder, I felt an immediate relief. Finally, I had an explanation for why I felt like tearing off my skin in the days before my period each month. Finally, it made sense how I could be brimming with confidence and creativity one week, and the next be contemplating suicide.
This clarity didn’t last. After I was placed on an oral contraceptive to manage my symptoms, I had a month of extreme productivity, during which I hardly seemed to need food or sleep. Then I had a seizure and spent a week comatose due to severe hyponatremia, a condition in which blood sodium levels become dangerously low.
As well as bringing up questions about my medication, the incident led me to wonder whether PMDD was the only diagnosis relevant to me. Doctors attributed my hyponatremia to drinking too much water, a symptom of an underlying eating disorder.
My family agreed that I had always been ‘weird’ about food, and in other ways, such as my ability to disappear into writing and research for hours on end, while being absentminded, accident-prone, and socially awkward.
The relationship between PMDD and neurodivergence is widely discussed in PMDD communities, though not yet well understood. While PMDD was only added to the DSM-5 in 2013, a 2008 UK study found a statistically significant occurrence of what was then termed ‘late luteal phase dysphoric disorder’ among women with severe autism and learning difficulties.
This study, which had only twenty-six participants, is the source of an oft-cited, dubious statistic, ‘92% of autistic women have PMDD’.
Dr Tory Eisenlohr-Moul, an associate professor of psychiatry at the University of Illinois, acknowledges that PMDD shares some symptoms with autism, among them ‘sensory sensitivity, difficulty connecting with other people, a sense of being different and disliked’.
Yet she is reluctant to emphasise a connection between the conditions. ‘I worry that the autism label is being used when actually what we need to do is take sensory sensitivity and personal alienation more seriously in PMDD.’
Nonetheless, Eisenlohr-Moul advocates for better understanding of premenstrual exacerbation (PME). Though not an official diagnosis, PME is a recognised phenomenon wherein the symptoms of existing mental health conditions (from ADHD to trauma-related disorders) may be exacerbated by hormonal fluctuations.
PME patients are often excluded from PMDD diagnosis and treatment, despite the fact that their premenstrual symptoms may be equally severe and have a shared causality.
Professor John Eden, a gynaecologist and associate professor of reproductive endocrinology at the University of New South Wales, believes that education about PME is particularly overdue among emergency psychiatric services.
Relating the story of a patient with an existing mood disorder who was referred to him after making multiple premenstrual suicide attempts, he says, ‘That it would take three attempts for this woman just shows the lack of education amongst psych doctors and psych nurses about women’s health … We started [the patient] on some oestrogen and chemical menopause, and when I saw her three months later, she was markedly improved.’
Recent years have seen a rise in discussion about the unique ways in which autism and ADHD can manifest in girls and women. With this has come increased attention to the links between hormonal fluctuations, mood, and behavioural symptoms among neurodivergent people.
A 2021 study measuring symptoms in women with ADHD throughout the menstrual cycle and postpartum found that this group were unusually sensitive to hormonal fluctuations, with almost half of the 200 participants meeting the diagnostic criteria for PMDD. Further research points to puberty, pregnancy, postpartum, and the menopause transition as periods of heightened risk for the development and worsening of ADHD.
The relationship between PMDD and trauma is another area of research interest. Although PMDD is not categorised as a trauma-related disorder, a 2024 review found that trauma exposure was highly represented among PMDD patients.
Dr Eveline Mu, a HER Centre research fellow who participated in this review, tells me that early-life trauma can disrupt the hypothalamic-pituary-adrenal (HPA) axis, a series of hormonal pathways that mediate stress. According to Mu, such disruption ‘could lead to a lot of other disruptions in neurochemistry, neurobiology, neurodevelopment’, which in turn can lead to mood, behavioural, and physical symptoms.
Even if it doesn’t lead to hospitalisation, living with PMDD can be traumatic, wreaking havoc on one’s relationships, career, and self-image. Being neurodivergent in a society that is intolerant of difference can likewise be traumatic, especially if it leads to bullying and workplace discrimination.
Seven years on from my hospitalisation, I have not felt the need to be assessed for autism or ADHD. Yet I have come to recognise the role of sensory sensitivity in my PMDD, along with my history of disordered eating.
Conceptualising my mood symptoms as sensory meltdowns rather than manifestations of poor character has made me less inclined to hate myself. It’s also made it easier for me to identify triggers, and to decompress accordingly.
Laura Elizabeth Woollett is an author and critic based in Naarm/Melbourne. Her latest book, Hell Days: Into The Inferno of Hormonal Mood Disorder, is out September 10th (Scribe, £12.99)
