Deprecated: Creation of dynamic property wpdb::$categories is deprecated in /home/1/s/speilvendt/www/wp-includes/wp-db.php on line 668

Deprecated: Creation of dynamic property wpdb::$post2cat is deprecated in /home/1/s/speilvendt/www/wp-includes/wp-db.php on line 668

Deprecated: Creation of dynamic property wpdb::$link2cat is deprecated in /home/1/s/speilvendt/www/wp-includes/wp-db.php on line 668

Deprecated: Return type of WP_Theme::offsetExists($offset) should either be compatible with ArrayAccess::offsetExists(mixed $offset): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-theme.php on line 554

Deprecated: Return type of WP_Theme::offsetGet($offset) should either be compatible with ArrayAccess::offsetGet(mixed $offset): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-theme.php on line 595

Deprecated: Return type of WP_Theme::offsetSet($offset, $value) should either be compatible with ArrayAccess::offsetSet(mixed $offset, mixed $value): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-theme.php on line 535

Deprecated: Return type of WP_Theme::offsetUnset($offset) should either be compatible with ArrayAccess::offsetUnset(mixed $offset): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-theme.php on line 544

Deprecated: Return type of WP_REST_Request::offsetExists($offset) should either be compatible with ArrayAccess::offsetExists(mixed $offset): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/rest-api/class-wp-rest-request.php on line 952

Deprecated: Return type of WP_REST_Request::offsetGet($offset) should either be compatible with ArrayAccess::offsetGet(mixed $offset): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/rest-api/class-wp-rest-request.php on line 972

Deprecated: Return type of WP_REST_Request::offsetSet($offset, $value) should either be compatible with ArrayAccess::offsetSet(mixed $offset, mixed $value): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/rest-api/class-wp-rest-request.php on line 984

Deprecated: Return type of WP_REST_Request::offsetUnset($offset) should either be compatible with ArrayAccess::offsetUnset(mixed $offset): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/rest-api/class-wp-rest-request.php on line 995

Deprecated: Return type of WP_Block_List::current() should either be compatible with Iterator::current(): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 151

Deprecated: Return type of WP_Block_List::next() should either be compatible with Iterator::next(): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 175

Deprecated: Return type of WP_Block_List::key() should either be compatible with Iterator::key(): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 164

Deprecated: Return type of WP_Block_List::valid() should either be compatible with Iterator::valid(): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 186

Deprecated: Return type of WP_Block_List::rewind() should either be compatible with Iterator::rewind(): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 138

Deprecated: Return type of WP_Block_List::offsetExists($index) should either be compatible with ArrayAccess::offsetExists(mixed $offset): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 75

Deprecated: Return type of WP_Block_List::offsetGet($index) should either be compatible with ArrayAccess::offsetGet(mixed $offset): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 89

Deprecated: Return type of WP_Block_List::offsetSet($index, $value) should either be compatible with ArrayAccess::offsetSet(mixed $offset, mixed $value): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 110

Deprecated: Return type of WP_Block_List::offsetUnset($index) should either be compatible with ArrayAccess::offsetUnset(mixed $offset): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 127

Deprecated: Return type of WP_Block_List::count() should either be compatible with Countable::count(): int, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-includes/class-wp-block-list.php on line 199

Deprecated: Creation of dynamic property ACF::$fields is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/fields.php on line 138

Deprecated: Creation of dynamic property acf_loop::$loops is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/loop.php on line 28

Deprecated: Creation of dynamic property ACF::$loop is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/loop.php on line 269

Deprecated: Creation of dynamic property ACF::$revisions is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/revisions.php on line 387

Deprecated: Creation of dynamic property acf_validation::$errors is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/validation.php on line 28

Deprecated: Creation of dynamic property ACF::$validation is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/validation.php on line 215

Deprecated: Creation of dynamic property acf_form_customizer::$preview_values is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/forms/form-customizer.php on line 28

Deprecated: Creation of dynamic property acf_form_customizer::$preview_fields is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/forms/form-customizer.php on line 29

Deprecated: Creation of dynamic property acf_form_customizer::$preview_errors is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/forms/form-customizer.php on line 30

Deprecated: Creation of dynamic property ACF::$form_front is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/forms/form-front.php on line 600

Deprecated: Creation of dynamic property acf_form_widget::$preview_values is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/forms/form-widget.php on line 34

Deprecated: Creation of dynamic property acf_form_widget::$preview_reference is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/forms/form-widget.php on line 35

Deprecated: Creation of dynamic property acf_form_widget::$preview_errors is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/forms/form-widget.php on line 36

Deprecated: Return type of WPCF7_FormTag::offsetExists($offset) should either be compatible with ArrayAccess::offsetExists(mixed $offset): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-content/plugins/contact-form-7/includes/form-tag.php on line 395

Deprecated: Return type of WPCF7_FormTag::offsetGet($offset) should either be compatible with ArrayAccess::offsetGet(mixed $offset): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-content/plugins/contact-form-7/includes/form-tag.php on line 387

Deprecated: Return type of WPCF7_FormTag::offsetSet($offset, $value) should either be compatible with ArrayAccess::offsetSet(mixed $offset, mixed $value): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-content/plugins/contact-form-7/includes/form-tag.php on line 381

Deprecated: Return type of WPCF7_FormTag::offsetUnset($offset) should either be compatible with ArrayAccess::offsetUnset(mixed $offset): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-content/plugins/contact-form-7/includes/form-tag.php on line 399

Deprecated: Return type of WPCF7_Validation::offsetExists($offset) should either be compatible with ArrayAccess::offsetExists(mixed $offset): bool, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-content/plugins/contact-form-7/includes/validation.php on line 78

Deprecated: Return type of WPCF7_Validation::offsetGet($offset) should either be compatible with ArrayAccess::offsetGet(mixed $offset): mixed, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-content/plugins/contact-form-7/includes/validation.php on line 72

Deprecated: Return type of WPCF7_Validation::offsetSet($offset, $value) should either be compatible with ArrayAccess::offsetSet(mixed $offset, mixed $value): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-content/plugins/contact-form-7/includes/validation.php on line 59

Deprecated: Return type of WPCF7_Validation::offsetUnset($offset) should either be compatible with ArrayAccess::offsetUnset(mixed $offset): void, or the #[\ReturnTypeWillChange] attribute should be used to temporarily suppress the notice in /home/1/s/speilvendt/www/wp-content/plugins/contact-form-7/includes/validation.php on line 82

Deprecated: Creation of dynamic property Shortcodes_Ultimate::$about_menu is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/shortcodes-ultimate/includes/class-shortcodes-ultimate.php on line 207

Deprecated: Creation of dynamic property Shortcodes_Ultimate::$unsafe_features_notice is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/shortcodes-ultimate/includes/class-shortcodes-ultimate.php on line 229

Deprecated: Creation of dynamic property Shortcodes_Ultimate::$widget is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/shortcodes-ultimate/includes/class-shortcodes-ultimate.php on line 256

Deprecated: Creation of dynamic property Automattic\Jetpack\Connection\Manager::$error_handler is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/vendor/automattic/jetpack-connection/src/class-manager.php on line 91

Deprecated: Creation of dynamic property WPCOM_REST_API_V2_Endpoint_Instagram_Gallery::$is_wpcom is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/core-api/wpcom-endpoints/class-wpcom-rest-api-v2-endpoint-instagram-gallery.php on line 23

Deprecated: Creation of dynamic property WPCOM_REST_API_V2_Endpoint_Mailchimp::$wpcom_is_wpcom_only_endpoint is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/core-api/wpcom-endpoints/class-wpcom-rest-api-v2-endpoint-mailchimp.php on line 17

Deprecated: Creation of dynamic property WPCOM_REST_API_V2_Endpoint_Tweetstorm_Gather::$wpcom_is_wpcom_only_endpoint is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/core-api/wpcom-endpoints/class-wpcom-rest-api-v2-endpoint-tweetstorm-gather.php on line 21

Deprecated: Creation of dynamic property WPCOM_REST_API_V2_Endpoint_Tweetstorm_Gather::$is_wpcom is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/core-api/wpcom-endpoints/class-wpcom-rest-api-v2-endpoint-tweetstorm-gather.php on line 22

Deprecated: Creation of dynamic property WPCOM_REST_API_V2_Endpoint_Gutenberg_Available_Extensions::$wpcom_is_site_specific_endpoint is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/core-api/wpcom-endpoints/gutenberg-available-extensions.php on line 20

Deprecated: Creation of dynamic property WPCOM_REST_API_V2_Endpoint_Memberships::$wpcom_is_wpcom_only_endpoint is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/core-api/wpcom-endpoints/memberships.php on line 23

Deprecated: Creation of dynamic property WPCOM_REST_API_V2_Endpoint_Memberships::$wpcom_is_site_specific_endpoint is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/core-api/wpcom-endpoints/memberships.php on line 24

Deprecated: Creation of dynamic property WPCOM_REST_API_V2_Endpoint_Subscribers::$wpcom_is_wpcom_only_endpoint is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/core-api/wpcom-endpoints/subscribers.php on line 15

Deprecated: Creation of dynamic property POMO_FileReader::$is_overloaded is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 21

Deprecated: Creation of dynamic property POMO_FileReader::$_pos is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 22

Deprecated: Creation of dynamic property POMO_FileReader::$_f is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 153

Deprecated: Creation of dynamic property MO::$_gettext_select_plural_form is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/translations.php on line 293

Deprecated: Creation of dynamic property Automattic\Jetpack\Sync\Queue::$random_int is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/vendor/automattic/jetpack-sync/src/class-queue.php on line 38

Deprecated: Creation of dynamic property Publicize_UI::$in_jetpack is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/modules/publicize.php on line 53

Deprecated: Creation of dynamic property POMO_FileReader::$is_overloaded is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 21

Deprecated: Creation of dynamic property POMO_FileReader::$_pos is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 22

Deprecated: Creation of dynamic property POMO_FileReader::$_f is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 153

Deprecated: Creation of dynamic property MO::$_gettext_select_plural_form is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/translations.php on line 293

Deprecated: Creation of dynamic property POMO_FileReader::$is_overloaded is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 21

Deprecated: Creation of dynamic property POMO_FileReader::$_pos is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 22

Deprecated: Creation of dynamic property POMO_FileReader::$_f is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 153

Deprecated: Creation of dynamic property MO::$_gettext_select_plural_form is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/translations.php on line 293

Deprecated: Creation of dynamic property CZR_resources_scripts::$_resouces_version is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/class-fire-resources_scripts.php on line 20

Deprecated: Creation of dynamic property POMO_FileReader::$is_overloaded is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 21

Deprecated: Creation of dynamic property POMO_FileReader::$_pos is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 22

Deprecated: Creation of dynamic property POMO_FileReader::$_f is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 153

Deprecated: Creation of dynamic property MO::$_gettext_select_plural_form is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/translations.php on line 293

Deprecated: Creation of dynamic property CZR_resources_styles::$_resouces_version is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/class-fire-resources_styles.php on line 35

Deprecated: Creation of dynamic property WPCOM_Widget_Goodreads::$shelves is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/modules/widgets/goodreads.php on line 33

Deprecated: DateTime::__construct(): Passing null to parameter #1 ($datetime) of type string is deprecated in /home/1/s/speilvendt/www/wp-includes/script-loader.php on line 331

Deprecated: Creation of dynamic property POMO_FileReader::$is_overloaded is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 21

Deprecated: Creation of dynamic property POMO_FileReader::$_pos is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 22

Deprecated: Creation of dynamic property POMO_FileReader::$_f is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 153

Deprecated: Creation of dynamic property acf_field_oembed::$width is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/fields/class-acf-field-oembed.php on line 31

Deprecated: Creation of dynamic property acf_field_oembed::$height is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/fields/class-acf-field-oembed.php on line 32

Deprecated: Creation of dynamic property acf_field_google_map::$default_values is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/fields/class-acf-field-google-map.php on line 33

Deprecated: Creation of dynamic property acf_field__group::$have_rows is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/advanced-custom-fields/includes/fields/class-acf-field-group.php on line 31

Deprecated: Creation of dynamic property POMO_FileReader::$is_overloaded is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 21

Deprecated: Creation of dynamic property POMO_FileReader::$_pos is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 22

Deprecated: Creation of dynamic property POMO_FileReader::$_f is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/streams.php on line 153

Deprecated: Creation of dynamic property MO::$_gettext_select_plural_form is deprecated in /home/1/s/speilvendt/www/wp-includes/pomo/translations.php on line 293

Deprecated: Creation of dynamic property WP_Block_Type::$plan_check is deprecated in /home/1/s/speilvendt/www/wp-includes/class-wp-block-type.php on line 284

Deprecated: Creation of dynamic property Jetpack_Shortcode_Unavailable::$shortcodes is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/modules/shortcodes/unavailable.php on line 19

Deprecated: trim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/1/s/speilvendt/www/wp-includes/class-wp.php on line 173

Deprecated: Creation of dynamic property WP_Term::$object_id is deprecated in /home/1/s/speilvendt/www/wp-includes/class-wp-term.php on line 198

Deprecated: Creation of dynamic property CZR_header_model_class::$mobile_nbwrapper_class is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_header_model_class::$primary_nbwrapper_container_class is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_header_model_class::$topbar_nbwrapper_container_class is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_logo_model_class::$src is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_related_posts_model_class::$excerpt_length is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_related_posts_model_class::$media_cols is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_related_posts_model_class::$content_cols is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_related_posts_model_class::$element_width is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_Model::$inner_container_class is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283
Diagnose (Avtrykk): PMDD – Premenstruell Dysphoric Disorder – Speilvendt
Deprecated: Implicit conversion from float 35.400000000000006 to int loses precision in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/functions-ccat.php on line 1638

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Deprecated: Implicit conversion from float 117.00000000000003 to int loses precision in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/functions-ccat.php on line 1640

Deprecated: ltrim(): Passing null to parameter #1 ($string) of type string is deprecated in /home/1/s/speilvendt/www/wp-includes/wp-db.php on line 3031

Deprecated: preg_split(): Passing null to parameter #3 ($limit) of type int is deprecated in /home/1/s/speilvendt/www/wp-content/plugins/jetpack/_inc/lib/class.media-summary.php on line 420

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Deprecated: Creation of dynamic property CZR_Model::$element_inner_class is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

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Deprecated: Creation of dynamic property CZR_Model::$args is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_Model::$inner_elements_class is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_Model::$search_form_container_class is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_Model::$inner_elements_class is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_Model::$args is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Diagnose (Avtrykk): PMDD – Premenstruell Dysphoric Disorder


Deprecated: Creation of dynamic property CZR_thumbnail_model_class::$lighbox_url is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Deprecated: Creation of dynamic property CZR_thumbnail_model_class::$has_lightbox is deprecated in /home/1/s/speilvendt/www/wp-content/themes/customizr/core/fmk-ccat.php on line 283

Premenstruell dysforisk forstyrrelse

Det antas at majoriteten av mennesker med en menstruasjonssyklus opplever fysiske, psykiske eller atferdsmessige plager som oppstår mellom eggløsning og begynnelsen av menstruasjonen  (Yonkers et al., 2008). Den humørsyke kvinnen som spiser sjokolade i store kvanta, gråter i dusjen og glefser mot kjæresten har blitt humoristisk portrettert flere ganger opp gjennom populærkulturens historie. 

Dette velkjente fenomenet, også kalt premenstruelt syndrom (PMS), kan knyttes til de hormonelle svingningene som holder menstruasjonssyklusen i gang. PMS i seg selv er ingen sykdom, men for 3-8 % av de som menstruerer bærer denne perioden av syklusen med seg såpass mye fysisk og psykisk lidelse at det går ut over sosiale, familiære og jobbrelaterte forhold (Halbreich et al., 2003). Vi kaller dette for premenstruell dysforisk forstyrrelse (PMDD); en alvorlig og veldig plagsom form for PMS. 

PMDD er klassifisert både som en somatisk (endokrin/hormonforstyrrelse) og psykisk sykdom (i DSM). Symptomene på PMDD følger menstruasjonssyklus og oppstår ofte uken før menstruasjon og avtar noen dager etter. Symptomene inkluderer vanlige PMS-symptomer som oppblåsthet, brystsmerter, kramper, akne, økt appetitt og emosjonell labilitet, samt mer alvorlige og påfallende stemningsforandringer. Blant disse er det ofte observert en markant økning i irritabilitet og sinne, noe som fører til konflikt, en forhøyet avvisningssensitivitet, dårlig selvbilde og søvnforstyrrelser. Mange kan også oppleve sterke angst- og depresjonssymptomer, samt panikkanfall, selv om symptomer som tilsvarer en diagnose ikke er tilstede under andre deler av syklusen (Feingold et al., 2000). Mennesker med PMDD har en markant forhøyet selvmordsrisiko sammenlignet med den øvrige befolkningen, og det er estimert at om lag 70 % av denne pasientgruppen sliter med selvmordstanker, både som en direkte konsekvens av hormonelle forandringer og som resultat av lidelsestrykket denne sykdommen medbringer (Pilver et al., 2013).  

Diagnostisering og sykdomsforløp
For at en PMDD-diagnose kan settes, må symptomene være tilstede i majoriteten av pasientens menstruasjonssykluser, og kun være tilstede under pasientens lutealfase (perioden mellom eggløsning og menstruasjon). Dersom symptomene strekker seg utover denne fasen, skal andre diagnoser vurderes. Dette er fordi PMDD er knyttet til de hormonelle forandringene i forkant av menstruasjon (Yonkers et al., 2008). 

Mot slutten av lutealfasen, omtrent 10-14 dager etter eggløsning, går progesteronnivået i kroppen kraftig ned. Dette fører til at slimhinnen i livmorveggen støtes ut. Det er dette som kalles for menstruasjon. Fra menstruasjonens begynnelse øker progesteronnivåene igjen, og progesteronets metabolitter påvirker GABA-reseptorene i hjernen. Disse er knyttet til nedregulering av angstresponser. En hypotese er at personer med PMDD responderer dårlig på den raske nedgangen i progesteron i uken før menstruasjon, altså mot slutten av lutealfasen, noe som fører til de kraftige premenstruelle symptomene (Hantsoo et al., 2020). 

PMDD feildiagnostiseres ofte som bipolar type 2. En mulig forklaring på dette kan være at mange klinikere har dårlig kjennskap til PMDD-diagnosen, og at de to lidelsene har mange fellestrekk. Den sentrale forskjellen ligger i at de depressive periodene hos de med PMDD kun forekommer i perioden mellom eggløsning og menstruasjon, og at de dermed også er lettere å forutse. Konsekvensen av feildiagnostiseringen er at personer med PMDD ikke får den behandlingen og hjelpen de egentlig har krav på riktig hjelp. For eksempel vet man at medisinene som brukes i behandlingen av bipolar lidelse har svært liten effekt på PMDD-symptomer. (Studd, 2012). 

Behandling

PMDD kan lindres med hormonell prevensjon som flater ut kroppens naturlige syklus. Antidepressiva i form av selektive serotoninreopptakshemmere (SSRI) har også vist å være effektfullt for en betydelig andel pasienter. Medisinering med SSRI har rask effekt på PMDD (i motsetning til ordinær depresjon) og man trenger bare behandling i dagene rundt menstruasjon (FHI, 2021). Psykoterapi har vist å ha liten effekt, og anbefales ikke som behandlingsform alene, da symptomene er så nært knyttet opp mot somatiske forhold. For noen kan likevel kognitiv terapi bidra med verktøy til å håndtere angst- og depresjonssymptomer. Hva som fungerer og ikke, vil variere fra individ til individ, og en betydelig andel vil oppleve at ingen av disse behandlingsmetodene bidrar til god nok lindring. Da vil en hysterektomi, eventuelt hormoner som induserer overgangsalder, kunne fungere som et siste behandlingsalternativ. Dette er fordi PMDD kun oppstår hos individer med aktiv menstruasjonssyklus. 

Premenstruell dysforisk forstyrrelse innebærer ofte stor grad av lidelse. Sterke følelser av depresjon, angst, og emosjonell usikkerhet rundt menstruasjon kan føles umulig å stå i. Noen beskriver at tiden før menstruasjon er preget av en følelse av å miste seg selv helt. Andre sammenligner det med en lysbryter som skrur seg av og gjør alt mørkt (Ro, 2019). Personer med PMDD har økt risiko for å falle ut av arbeidslivet og sine sosiale nettverk (Rapkin, 2013). Derfor er det viktig med tidlig og riktig diagnostisering. Bevisstgjøring rundt egen syklus og symptomer er viktig fordi det gjør en i stand til å tilrettelegge hverdagen rundt gode og dårlige perioder. Det kan også være hjelpsomt å vite at det man gjennomgår har en klar medisinsk årsak. 

Kilder:
Halbreich, U., Borenstein, J., Pearlstein, T., & Kahn, L. S. (2003). The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology, 28 Suppl 3, 1–23. https://doi.org/10.1016/s0306-4530(03)00098-2 

Yonkers, K. A., O’Brien, P. M., & Eriksson, E. (2008). Premenstrual syndrome. Lancet (London, England), 371(9619), 1200–1210. https://doi.org/10.1016/S0140-6736(08)60527-9 

Feingold KR., Anawalt, B., Boyce, A. et al., Premenstrual Dysphoric Disorder (Formerly Premenstrual Syndrome) [Updated 2017 Jan 23]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Table 1, Diagnostic Criteria for Premenstrual Dysphoric Disorder (PMDD) Available from: https://www.ncbi.nlm.nih.gov/books/NBK279045/table/premenstrual-syndrom.table1diag/ 

Pilver, C. E., Libby, D. J., & Hoff, R. A. (2013). Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample. Social psychiatry and psychiatric epidemiology, 48(3), 437–446. https://doi.org/10.1007/s00127-012-0548-z 

Hantsoo, L., & Epperson, C. N. (2020). Allopregnanolone in premenstrual dysphoric disorder (PMDD): Evidence for dysregulated sensitivity to GABA-A receptor modulating neuroactive steroids across the menstrual cycle. Neurobiology of stress, 12, 100213. https://doi.org/10.1016/j.ynstr.2020.100213 

Rapkin, A. J., & Lewis, E. I. (2013). Treatment of Premenstrual Dysphoric Disorder. Women’s Health, 537–556. https://doi.org/10.2217/WHE.13.62 

Studd, J. (2012). Severe premenstrual syndrome and bipolar disorder: a tragic confusion. Menopause international, 18(2), 82–86. https://doi.org/10.1258/mi.2012.012018

Ro, Christine (16.12.2019). The overlooked condition that can trigger extreme behavior. BBC, BBC future. https://www.bbc.com/future/article/20191213-pmdd-a-little-understood-and-often-misdiagnosed-condition 

Norsk Helseinformatikk (FHI) (2021), Premenstruelt syndrom (PMS og PMDD)
https://nhi.no/kroppen-var/kropp/premenstruelt-syndrom/?page=4


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