Emotional Support Sisters

I, Missy, was recently diagnosed with PMDD. I’m going to share a little of what I’ve learned, and my experience experiencing PMDD.

Premenstrual dysphoric disorder (PMDD) is the severe, more debilitating version of premenstrual syndrome (PMS). Both are experienced in the 1-2 weeks leading up to the start of menstruation or in less medically formal terms when the 1-2 weeks before your period starts.

PMS includes symptoms like mood swings, breast tenderness, some stomach issues like bloating, cramps, constipation, cravings (chocolate for me), increased fatigue and irritability, and possibly depression. PMDD also includes those symptoms, and then some. On the Johns Hopkins website, they list an extensive list of symptoms. They include but are not limited to: irritability, nervousness, lack of control, agitation, anger, insomnia, difficulty concentrating, depression, severe fatigue, anxiety, confusion, forgetfulness, poor self-image, paranoia, emotional sensitivity, crying spells, moodiness, trouble sleeping, fluid retention, respiratory problems, eye problems, abdominal cramps, bloating, constipation, nausea, vomiting, pelvic heaviness or pressure, backaches, skin problems, earache, dizziness, fainting, numbness, prickling, tingling, easy brusing, heart palpitations, muscle spasms, decreased coordination, painful menstruation, diminished sex drive, appetite changes, food cravings, and hot flashes.

The big difference (as I understand it, I could be wrong) between PMS and PMDD is the severity of the symptoms, the consistency of symptoms, and the ability to function with the symptoms. PMDD is considered a disability and qualifies for accommodations under the Family and Medical Leave Act (FMLA). Funny sidenote (that I can not cite my source for because I read it in the middle of the night during a bought of insomnia) one FMLA accommodation that was recommended was to provide an  isolated office space for the person with PMDD so they could concentrate better and avoid things (people) who could cause anger. All I could think about is how do I implement a 2 week isolation period as a homemaker. I couldn’t think of a way, so my house is not FMLA compliant. 
To get a PMDD diagnosis the symptoms need to be severe enough to interfere with the ability to function in life. They need to have happened consistently for some time, websites vary on how long that period is (anywhere from 2-5 months). The symptoms improve, or in my case end, within a couple of days of starting your period.

The cause of PMDD is not 100% understood, but some prevailing theories make sense to me. One thought is that after ovulation estrogen and progesterone levels decrease and the decrease of the hormones may cause symptoms. The other thought is serotonin levels changing through the menstrual cycle could cause the symptoms. Or a combination of both is a possibility too.

Now that the info dump is out of the way it is story time.

I have experienced PMS throughout my life. I’ll get a little extra tired or irritable,  have a weird craving, or take an extra long nap and wonder “Where did that come from?”. I’d often tell my husband “I’m just feeling blah and can not figure out why.” He would say you’re starting your period in a couple of days and whatever I was experiencing made sense. If I get a migraine it is traditionally the week before I start my period.

Last summer, as I have mentioned before, I came off of Prozac because I was experiencing serotonin syndrome, and then crap hit the fan. In cleaning up the crap I was diagnosed with ADHD and started medicine to help treat it. The medicine would work, and then as I approached my period it would work less and less until it stopped working and I was in a foggy haze of irritability, confusion, indecision, distress, anxiety, crying, anger ( I had to apologize a lot to my family), frustration, and forgetfulness (I’m sure I forgot an emotion in there, but you get the picture). I would also wake up with night sweats. I would get random rashes. The last 3 days before my period started I would have insomnia. I would take all the sleeping medicine that was safe to take and still stare at the ceiling all night. The amount of chocolate and baked goods I ate was definitely not healthy. I researched monthly getting a hysterectomy so I wouldn’t have to experience the hell the week before my period was. I was certain I would never be able to teach in schools like I want to when my kids are older because I could not process information fast enough to teach. I also was much too angry to be in a classroom of teenagers. I was also unsure if I could ever work anywhere because interacting with people or making any decisions was impossible. My husband became my emotional support blanket. I would go into his office and he would give me a giant squeezy hug. It didn’t make the symptoms go away, but it did make me feel loved, which was good because I felt unlovable when I was so angry, grumpy, and irrational towards everyone and couldn’t imagine anyone wanting to put up with me. I didn’t even want to put up with me. The day my period started all the symptoms went away. It was like a light switch. One day I was a crazy lady and the next day I was a fully functioning adult. If I were not so in tune with my cycle, I would have thought I had bipolar disorder because the first couple of days after I started my period I had a manic energy and drive to make up for the last week of nothingness. That manic energy also drove my kids nuts because I went from blah mom to get all your stuff done now mom.

The first few months I brushed the experience off (gaslighting myself?) because my husband was out of town, or it was a stressful month or it was the holidays, or whatever other excuse I came up with. The month that this all happened and there was nothing different or stressful going on in life was the month I made an appointment with my Nurse Practitioner to figure life out.

By the time I had my appointment, I had, of course, already researched PMDD and knew what the common treatments for it were. They are SSRIs (like Prozac), or certain types of hormonal birth control (like Yaz). I couldn’t go back on to Prozac, because of serotonin syndrome. I had concerns about hormonal birth control because I have several risk factors for stroke. We talked through the concerns and came up with ways to mitigate my concerns and she prescribed me birth control.

I just finished my first month of treatment. It was night and day. I still had several of the symptoms, but nowhere near as bad. I was able to communicate my needs, express my frustrations, and alleviate other symptoms with additional medicine. It was nice to still feel like me, even if it was a slightly grumpier more anxiouse me.

If you are experiencing something like this, please seek help. There are treatments, and you are not crazy.

Missy

Good resources that helped me
https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd

https://my.clevelandclinic.org/health/diseases/9132-premenstrual-dysphoric-disorder-pmdd

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759213/#:~:text=The%20oral%20contraceptive%20with%20the,with%203%20mg%20of%20drospirenone.

And the rabbit hole google provides by suggesting other questions to ask that are similar to the questions I have already asked.