PMDD and the Coronavirus: How is COVID-19 Affecting Women?

The Coronavirus has reached pandemic proportions and is affecting virtually everyone worldwide in many ways. For those suffering from PMDD, while there is currently no known direct effect of the virus on PMDD, Coronavirus may have multiple indirect effects.

If a woman previously experienced a flu infection during the time that she was suffering from PMDD, then she may find that her PMDD is similarly affected by a Coronavirus infection.  However, the severity of the Coronavirus infection may be more severe resulting in either an accentuation or a minimization of her typical PMDD symptoms.  This would be a reflection of the effect of the Coronavirus infection on her ovulation that month and the subsequent quantity of progesterone produced with that ovulation.  Her symptomatic response will be mediated by this and can be either more severe, less severe or the same.

If one has not yet ovulated, an acute Coronavirus infection may prevent your ovulation.  If this happens, then you will not produce any progesterone and PMDD patients will not experience PMDD symptoms that cycle. 

However, if one’s ovulatory process proceeds to the point where significant progesterone is released into her blood stream, then women prone to PMDD will most likely be subjected to symptoms.  The severity of her PMDD that cycle will be unpredictable and will depend upon the quantity of progesterone produced.

Similarly, women who may have an underlying predisposition to PMDD but have never experienced it due to adequate levels of progesterone production with spontaneous ovulations may experience a disruption of their progesterone production with a Coronavirus infection.  This may cause her to experience the full spectrum of PMDD symptoms in both nature (anger and anxiety, depression, crying, suicidal thoughts, etc.) and severity (from mild to disabling).  This, most likely, will be an isolated incident and symptomatic therapies can be used as needed to help this woman through this episode.  One can expect this PMDD experience to be non-repetitive if there is a resumption of normal ovulatory function the next menstrual cycle.  This may be a “one and done” experience.

If you have a history of successfully treated and well controlled PMDD and are infected by the Coronavirus, recognize that you may experience a significant change in your symptom severity.  You may even experience new PMDD symptoms.  While you were previously responding well to a particular therapeutic regimen, you may need to make significant adjustments  in your medications to control these symptoms.  Always consult your health care professional before you make significant changes in your treatment plan.

If you never previously experienced PMDD, or previously experienced only very mild symptoms, you may find yourself suffering from severe to disabling anger, anxiety and/or depression concomitant with the high fevers, chills, cough, generalized achiness and other symptoms of the Coronavirus infection.  If treatment is needed for the PMDD symptoms, then short term use of anxiolytic agents for these illness incited symptoms may be indicated.  Since this will probably be a “one and done” phenomenon for these women, addressing the underlying cause of these symptoms is probably not warranted.

However, for a woman who had previously been experiencing ongoing, monthly PMDD, and successfully managing her symptoms, particularly if severe or disabling, she may require alteration in her medications and dosages.  In particular, if the PMDD is suddenly not responding to her previously successful medical regimen, then adjusting the timing or dosage of her medicines may be needed.  However, this should only be done under the guidance of her treating physician as there may be unexpected side effects and drug interactions when her PMDD medications are combined with medications to address the Coronavirus.  ALWAYS consult your doctor.

Even those not infected with the Coronavirus are suffering dramatically increased levels of stress and anxiety from the presence of the virus in our communities and our homes.  This new stress may also significantly worsen PMDD.  Again, one must be aware that changes in medication may be needed to enable the PMDD patient to function smoothly in this uniquely stressful environment.

May everyone stay safe during this Coronavirus pandemic and realize that resources are available to you through your treating health care provider to address your PMDD, even during this time of crisis.

Gerald V. Burke, M.D.