Slaying the Beast: #PMDD

This is a PMDD post. I write these from time to time, mainly to help other sufferers, and to raise awareness of the condition. Also out of sheer exhaustion and exasperation at trying to find some kind of treatment that works.

What is PMDD?

PMDD is Premenstrual Dysphoric Disorder. It is often described as ‘a more severe form of PMS,’ but I don’t think that description really does it justice. Most sufferers (the condition affects up to 10% of women of reproductive age) experience symptoms which render their normal lives impossible during the week or so leading up to their period. Most fellow sufferers I’ve connected with call this ‘hell week.’ Symptoms vary from person to person, but some of the more common symptoms include extreme bouts of anger and irritability; sensitivity to light and sound; hypersomnia; extreme anxiety and panic attacks; feelings of hopelessness and suicidal thoughts. Welcome to hell!

Why does PMDD happen?

The condition is still not fully understood. It was only recognised as a condition by the APA in 2013. As for other countries, knowledge of the condition and treatment options can vary dramatically.

PMDD is not caused by a hormonal imbalance, but rather the brain being overly sensitive to changes in reproductive hormones which occur naturally during the reproductive cycle. It can get worse over time, and following life events such as the birth of a child, or a traumatic event. It is more common in women with a history of depression, and it is thought to be hereditary.

How PMDD affects me

Unfortunately, when I went to the doctor in Spain looking for help with my condition, I got told ‘there, there, all women get a bit moody before their period.’ Yes, the doctor was a man. Not a criticism of male doctors, but perhaps female doctors who are familiar with the effects of hormone fluctuations are more likely to take the condition seriously. So I’ve been tracking my symptoms over several months, and trying to control the condition with vitamin supplements (haven’t noticed much improvement I’m afraid). Here’s my typical symptom pattern:

• Day 17-18: Hypersomnia sets in. Feel ridiculously tired and drained. Don’t want to get out of bed. Once out of bed, spend the whole day wanting to return there.
• Day 19-20: Usually not too bad (progesterone levels rise, then dip, then rise sharply again at this phase of the cycle, so I suspect these days fall within that dip).
• Day 21-23: This is when the real fun starts. It normally begins with me losing my temper with an inanimate object, such as the tumble drier. Then I realise I can’t tolerate any loud sounds, such as the kids screaming. It becomes impossible to focus on more than one conversation at once, so if someone is trying to talk to me and the radio is playing, for example, I can’t concentrate. I get waves of feeling like I’m about to die: like a severe hangover, and I haven’t drank for over a year. Probably there is some element of panic attack in this as well.
• Day 24-26: At this point, I can hardly bear to be around people, have to avoid crowded places, often fight with my partner to the point we talk about separating, and then depression and hopelessness set in. I don’t feel suicidal in the sense that I want to kill myself right then and there, but I have the thought ‘if this is how my life is then I don’t want it to go on’ quite often.

As you may gather from the above list, PMDD is no joke. After ‘hell week,’ it takes another week for life to normalise, as I try to fix all the hurt I’ve caused when I wasn’t myself. It feels as though I’ve been body snatched. And once things finally calm down, I get maybe 10 days respite before it all begins again. I can’t go on like this any longer.

Trying a new treatment

The main chemical treatment options for PMDD are SSRIs, hormonal birth control, or a combination of the two. I’ve had a bad experience with SSRIs which I don’t ever want to repeat, so I know these aren’t for me. So I’m trying the hormonal birth control route. The recommended pill for PMDD symptoms contains drospirenone and ethinyl estradiol. I believe this is marketed as Yaz in the US, and I’m not sure in other countries. I bought mine over the counter in Spain, but I’ve been afraid to try it up to now.

My main worry with the pill is that I will have psychological symptoms: I’ve taken some pills before which have triggered depression. So far (only one day in) I’ve only noticed a bit of nausea for a few hours after taking it. I can cope with that. I’m hoping it will help level out the problems associated with ‘hell week.’ Hell, if it works, I might ask my doctor if it’s ok to take it continually. Or on a 24+4 regime instead of a 21+7. I read recently that the only reason women were ever advised to take a 7 day pill break was in an attempt to make the pill more palatable for the Catholic Church. This PR stunt didn’t work, and I don’t appreciate my body being messed with for quasi-religious reasons.

I realise I am self-medicating, but at least this way if I meet another ‘there, there’ doctor I can tell him (most likely a him) that I need it for contraception. And if it works, I will continue to take it, at least until I find a longer-term solution. I can’t help but be reminded of playing ‘Zelda: Skyward Sword’ on the Nintendo Wii: there is one boss called ‘The Imprisoned.’ Every time you defeat it, it gets pegged down underground, but it keeps coming back. I am afraid that if the pill works I will unleash the beast anew once I stop taking it. But I have to try something.

I will aim to update you a few weeks into my cycle, when I would normally be entering ‘hell week.’ If you think you may have PMDD, or know someone whose life has been affected by it, please do get in touch. Unfortunately, having this often misunderstood condition means we have to be willing to advocate for our own reproductive health and mental wellbeing. The best way to do this is by sticking together. Fellow sufferers, you are not alone!

Previous Posts about PMDD

9 Months Sober
The Wall
Like This
Le Horla, Mental Health and PMDD

Please share these posts freely with anyone you feel might find them helpful.