Today’s Post is Not About Mindfulness
Today’s post is about something I’ve struggled with for over 10 years, ever since getting my first period—Pre-Menstrual Dysphoric Disorder, AKA PMDD—and today I wanted to share a bit about what PMDD is, as well as the emotional, psychological, and physical impacts it has.
I found out what PMDD is over 4 years ago, when I went into my therapist’s office. Suddenly, I was constantly fighting with my boyfriend, I hated my body, I “hated everyone”. Negative emotions of aggression, anger, loss of control, and hopelessness abounded. I did not want help, and I felt inconsolable.
My mood swings felt like nails scratching against a chalkboard in my skull. I told my therapist all this, sobbing and angry, a mounting pile of tissues next to me, my face covered in snot—what the heck was happening?
The previous week, I’d been doing well. The previous week, I was on my way to recovery, feeling positive and excited about life, feeling great, really, better than I had in a while.
In one short week, it seemed everything had devastatingly changed, and I had absolutely no idea why. I looked at my therapist, mentioning that it was probably the PMS coming on, knowing that I was due to get my period in the next couple days.
She threw her hands up in the air, as though she was a Jeopardy contestant figuring out the answer before her competitors had time to wrack their brains for even 10 seconds, and said,
Oh, you know, you have PMDD, I do too.
“PMDD? What is that,” I asked.
Pre-Menstrual Dysphoric Disorder, I went through it beginning around the age of 18, and it sounds like exactly what you are going through.”
I looked at her, a bit confused, but also relieved—there it was, it had a name, this was real, this was a diagnosable disorder—I wasn’t simply a demon-were-wolf-monster 1 out of every 4 weeks.
My First Experience with PMDD
Ever since I was little, I was sensitive. Sensitive to people, to certain smells and sounds. I am highly empathic and quick to cry. Little did I know, when I got my first period, that intense sensitivity would translate into a high level of sensitivity to hormonal fluctuations induced by puberty.
I still remember by first period. It was Halloween, and I’d dressed up as the color “Blue” for my costume. I had blue spray-painted hair, wore all blue clothes, and my mom painted my face blue, with little blue tear drops on my face. This was way before the movie Inside Out was released, but I basically looked like the little blue character who represents sadness.
Now, I can see the irony of my being dressed as Blue the day I experienced my first-ever bout of PMDD, but back then it was anything but funny. I walked home from school, sobbing uncontrollably and unclear what the exact source of my sorrow was, only knowing it felt heavier than any weight I’d ever carried.
It was a pit in my stomach and a racing of my heart; it was hopelessness, a feeling I hadn’t experienced to that degree before that day. It was a level of internal chaos I am now familiar with, but at the time had absolutely no clue as to the source or cause of.
What Causes PMDD?
The cause of PMDD is unclear, but researchers believe it is partially due to already low levels of serotonin, such as in patients with depression, anxiety, and obsessive compulsive disorder, AKA OCD, all three diagnoses which I also possess.
PMDD is the result of an already sensitive neurochemical system like mine being exacerbated by the changing levels of estrogen, progesterone, and other hormones that arrive 1-2 weeks before beginning your period.
These hormone increases are correlated with our ovulation cycles as well. Some women’s symptoms begin during peak fertility, continue throughout the interval between ovulation, and continue several days into beginning their periods. I am one of those women.
There are a variety of treatments for PMDD symptoms, including anti-depressants, therapy, vitamins, exercise, and hormone therapy, like birth control.
For those of us with a high sensitivity to hormone changes, even our balance can be significantly affected during different times of the month. One of my yoga teachers, about 2 years ago, told me to pay attention to where I was in my cycle in relation to my ability to do balancing poses.
Increased fluid retention and hormones can even make you more dizzy and unbalanced, leading to frustration with activities like surfing, hiking, and yoga. So, unfortunately, some of the activities which help to combat PMDD are also made more challenging by the symptoms.
Surfing the Emotional Roller Coaster
For me, surfing is my litmus test for PMDD. I’ll start noticing I’m falling more, getting more frustrated, and having increased invasive thoughts before, during, and after a session. Surfing is the “canary in the coal mine” for my PMDD, letting me know to gear up for the massive swell of intense emotions about to arrive.
For me, the swell includes:
1. bouts of increasingly intense depression
2. extreme feelings of frustration, anxiety, and anger
3. starting fights with others
4. a debilitating level of difficulty concentrating
5. apathy and lack of interest or desire
6. difficulty surfing and exercising
7. inexplicable waves of anger
8. extreme emotional reactivity
9. desires to self-harm
10. increased urges to drink alcohol
Misplacing my keys, something laughable most of the month, becomes devastating, dissolving me into a puddle of tears for my inadequacy as a human who cannot keep track of her keys. A passing comment from my boyfriend is an invitation to fight about literally anything.
Road rage, something I don’t believe in 75% of the time, suddenly seems like the best solution . I feel unexcited about life, apathetic about my future, hopeless, insecure, and mega-hostile, Dr. Jekyll and Mr. Hyde style. Every tool I’ve ever learned in therapy, from CBT to breathing techniques, gets tossed out the window and written off as “stupid,” or “useless.”
In the last 6 years, I’ve noticed some months are harder, and some are easier, which makes it even more confusing when the symptoms rear their ugly heads. The worst is how surfing, because it’s something I love so much, becomes unenjoyable, triggering, and upsetting during some of these weeks.
In a word, it Sucks, with a capital S and a 15 exclamation points. It’s even more disorienting because it happens in a matter of days or even hours. The creeping unease I felt yesterday becomes a monster living in my body and mind.
If you are going through this too, I feel for you girl, because it is a rough road to walk every month.
What PMDD is Like Now
As I’m writing this right, I’m going through it myself, real bad. About 4 weeks ago, I was feeling very good, super positive. My depression had abated, and I was surfing, exercising, and drinking much less alcohol and caffeine , so I stopped taking my Prozac.
I’d been doing so well, up until 6 days ago. Between 10am on Thursday to 2pm that afternoon, everything had radically shifted. I’ve been crying randomly the last 3 days, angry and unmotivated, even to write this.
Two nights ago, I couldn’t write, I couldn’t do anything except crawl into bed by 7pm and read, just to make myself stop feeling so awful. Whereas 6 days ago when I felt excited about my life, these last few days I’ve felt afraid, upset, angry with everyone, and almost pathologically incapable of doing anything.
It. Is. So. Freaking. Hard. But, while there are so many aspects of this that completely suck, there are ways to help ourselves when going through this.
What I Do to Combat Symptoms
One important step is talking to your doctor to get a confirmed diagnosis, and then talk to a psychiatrist about medications, which I will be doing this upcoming week. Anti-depressants stabilize our levels of serotonin, significantly lessening the impact of PMDD symptoms.
You can even try an online self-assessment to see whether you meet the criteria, before consulting your doctor (but please don’t let these results deter you from getting help if you believe you have PMDD, because computers aren’t in your head, and quizzes are only quizzes).
I’ve been on and off medications for about 7 or so years now, and it’s always been difficult for me to stay on them. I don’t feel like myself completely, but it does significantly alleviate the symptoms. Another option, for those of us who don’t want to use medication consistently, is to cycle SSRI medications only during the weeks when we need it.
Studies show that the most effective dietary strategy is to increase protein and complex carbohydrate intake, as both aid in boosting our tryptophan levels and combatting the effects of PMDD.
I’ve also generally, but especially during this time, limited or eliminated caffeine and alcohol, as they both worsen my symptoms. I try to stay away from sugar as much as possible, but still enjoy my evening desert because I like something sweet after a long day of battling my PMDD.
Modified Exercise Routine
During this time, I try gentler exercise routines, like walking or swimming, which require less coordination yet provide us with endorphins to counter-balance the hormone swings. We can also modify the exercises we are doing to be less strenuous, while still incorporating the mood-boosting benefits. Aerobic exercise, specifically provides much-needed serotonin and endorphins for our systems.
I do my best to keep up with my exercise, even when it sounds most unappealing but I maintain a “try and quit” mentality. Basically, I try an exercise, and if it’s too difficult for my body that day, I quit and try something else. At the gym today, I didn’t feel up to running, so I tried the bike instead. Lunges were out of the question (thank you, dizzy spells), so I used the leg press machine, allowing me to strengthen my legs without feeling unstable.
I call my friends, my family, talk to my boyfriend, and keep up with therapy therapists. I do my best to ask for help and support. I’ve found that just having someone who says, “that sounds really hard,” can dramatically help with getting out of the spiral.
Acknowledging My Improvements
This is the first experience of PMDD I’ve had without turning to alcohol, restriction, or being on medications, and it’s been quite difficult, but I also know that there are many strides I’ve made—yay me!
Communication with PMDD
In terms of relationships, PMDD turns me into quite the fighter. In the past, I would lash out, quick to anger and ready to fight with my boyfriend, my friends, my mom, basically anyone. Now, when I feel the fight response kicking in, I ask questions.
What pushes me to fighting is the negative self-talk: “he said X, but he really meant that you are the worst girlfriend ever,” is an example of something my imbalanced head tells me. So, I’ll ask,
“did you really mean that?”
to clarify. Or, I’ll politely shut conversations down, saying something like,
“I know you want to help, but that advice is not helpful for me right now, can we change the subject?”
These are communication techniques I use all the time, but I rely on especially heavily during my PMDD spells.
Avoiding the Binge T.V.-Feel Bad-Repeat Cycle
Working and motivation can also be severely impacted by PMDD. Writing posts for my blog, starting my business, and daily chores like laundry, cleaning, and grocery shopping become harder during this time.
As with depression, sometimes all I want to do is stare at the T.V. all day and night. I don’t want to interact, go outside, or do anything except let myself be a zombie, almost like hiding in the basement until a hurricane passes. You know it’s out there, but you try to ignore it. The problem with this tactic is we can’t just shut out the world for 3, 4, 5, or 7 days.
Lives must be lived, errands must be run, and the world continues to turn, whether the storm inside us a Category 1 or not. The trick, for me, has been to make those tasks into even smaller, bite-size assignments, and figure out what tasks can be put off until next week, when I’m more stable.
“Does the house have to get cleaned today, or can I put it off till next week?
Can I skip the grocery store for 3 more days?
Will it be the end of the world if I don’t write another blog post today?”
These are the kinds of questions I’ve started asking to help me lighten my to-do list, without putting off everything so that next week will be even more stressful. As with depression, too, sometimes T.V. and bingeing shows is the exact opposite of what will help me, so I try to be conscious of what is self-helping versus self-defeating.
Netflix and check-out may sound appealing, but then 6 hours later I’m even more upset with myself than when I started. Now, as with my sugar intake, I try to balance both in a way that is more supportive of my system’s needs, rather than what will best check me out of reality, such as with Mindful Time Limits.
More Mental Health Mondays Ahead
Mental Health Mondays are going to be about how we can accept our mental illnesses as part of our stories, instead of as the authors of our lives.
Mental Health Mondays are my way of letting you know that you are not alone, regardless of what you are going through, because I understand the pain and suffering your own mind inflicts on you.
Mental Health Mondays are also about how we can acknowledge our improvements, how we can create our solutions, and how we can become more accepting of ourselves in the process.
Coming to Terms
I have made incredible strides with improving my life with PMDD, but it’s still difficult to accept that I even have to go through this. It feels like having to word that much harder to deal with my depression, anxiety, OCD, and now this?! Sometimes I want to scream,
“Are you kidding me?”
at my body and brain. Sometimes I wish I was different. Sometimes I wish I was someone else entirely.
In those moments, I have to stop and remember that each of us has our own mental health path to walk. Each of us has struggles to overcome, and challenges we can either meet head-on or hide from.
My depression, anxiety, OCD, and PMDD are not who I am.
They do not define me.
I am not my illness, and neither are you.
Until Next Time
I am right here with you, reader, in spirit, wherever you are or whatever you are going through, because I know what it is like. We all have our own stories, but I am here to listen. As always, please comment your thoughts and questions, or head over to my Contact page and feel free to email or DM me.
I know we won’t just survive this.
I know we will thrive,
Sources and References
goodhousekeeping.com; webmd.com; womenshealth.gov; health.harvard.edu; iapmd.org
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[…] giddy hormones that fitness gives me are especially important in helping me to deal with stress and hormonal imbalances when PMDD hits extra […]