Hello and Welcome!!

~Seek first to understand, then be understood~
If you're looking for information on a particular topic, type that word in the search box below. If I have written about that subject, a list of posts will appear. If no posts come up, I haven't written about it...yet. Emails, and questions in the comments section for possible posts, are welcome.
I have a "friend" who shows up once a month. She turns my world upside down, over and over again.
I am a good person, caring and sweet, but when she comes to visit, I could rip off your head.
She takes no prisoners, foul words she does spout, I try to keep the words in, she lets them come out.
People don't understand me, or what this is about, to have this creature inside my head.
I despise who I am, half of the time, I feel sorry for my daughter, family and friends.
There's no way to describe it, for those who don't know, it's a living nightmare, she really needs to go.
~Neysia Manor, Rest in Peace

Friday, November 9, 2012

Is it PMDD or Pre Menstrual Exacerbation?

I was wrong.  In my last post, I thought I was experiencing an episode of PMDD.  I felt like I had an iron band around my head and it pounded all day long.  It had been going on for four days with no relief.  Turned out, though, it was my allergies acting up. 
About 15 years ago, I started having sinus and breathing problems during the changing of the seasons.  For a few years I had a prescription I would dutifully take for 30 days each spring and fall.  Gradually, I switched to homeopathic remedies.  Then, as I specifically began to concentrate on my diet and nutritional needs, the need for even that went away.  But the allergy medication (bought on sale, as it was by now available over the counter) remained in the medicine cabinet, unused except for when nothing else would work.
So the other day, with my head pounding as it had been for days, I opened the medicine cabinet for something else, and all of a sudden the allergy medication was front and center in my vision.  It's always been in the same spot, I just haven't paid attention to it in a while.
But that day it practically jumped out at me.  Since I practice awareness, I thought, hmmm....you know, it *is* allergy season...maybe that's my problem. 
I took one and my headache cleared right up.  I took one for the next five days, until I ran out, and haven't had a problem again until...this month.
Imagine that.  Is it a coincidence or what?
It's *or what*. What's happening is called pre-menstrual exacerbation (PME) of an underlying condition.  That's when your body might be able to handle (insert condition here) during the rest of the month --  but during the week prior to your menses, it can't, and you have breakthrough symptoms of whatever your underlying condition is. 
When this happens, many of us seek treatment for the underlying condition, not realizing its connection to our menstrual cycle.  When the symptoms ease off, we feel the medication we are now (quite often unnecessarily) taking daily has solved the problem—until the next time around.  At this bewildering and frustrating point, dosages are increased, medications are changed, or we simply give up looking for help and try to cope on our own because our doctors don’t know what else to do for us.

So here's a primer on (just some!) Conditions That Can Be Exacerbated During Episodes of PMDD:
Bipolar Disorder
Blood Sugar Problems
Chronic Fatigue Syndrome
Dysthmic Disorder
Eating Disorders
Insulin Resistance
Irritable Bowel Syndrome
Joint Pain
Panic Disorder
Personality Disorders
Seizure Disorders
Somatoform Disorders
Thyroid Disorders

A Special Word About Bipolar Disorder
            The depression in PMDD is similar to that experienced in Bipolar Disorder, but PMDD does not include the manic phases of Bipolar Disorder.  Many, many, women have been misdiagnosed as bipolar, and have been put on a wide array of bipolar medications, one after the other, to no effect, when the real culprit was PMDD.
            Manic Episodes
            This can not be stated enough.  There are no manic episodes with PMDD.  That’s one thing that distinguishes it from Bipolar Disorder.  With PMDD you have time periods when you feel good, and time periods when you feel miserable, overwhelmed, out of control, snappish, sluggish, and/or depressed.  With PMDD, you may spend a lot of time in what may look or *feel* like a manic frenzy, trying to catch up on all the things you weren’t able to do during a PMDD episode, but this is more a function of your personality than genuine mania.  Genuine mania can include any of the following:
Extreme optimism
Inflated self-esteem
Poor judgment
Rapid speech
Racing thoughts
Aggressive behavior
Increased physical activity
Risky behavior
Spending sprees
Increased drive to perform or achieve goals
Increased sexual drive
Decreased need for sleep
Tendency to be easily distracted
Inability to concentrate
Drug abuse
An Additional Word About Major Depressive Disorder
            The only difference between PMDD and clinical depression is that the PMDD woman’s episode of depression will end with the onset of her period.  This, and the fact that a PMDD episode can last up to two weeks, the essential feature of a Major Depressive Episode, is why so many women with PMDD are misdiagnosed with Major Depressive Disorder.  Also, depression is most prevalent in women, period, which further confuses the issue.

How MDD predisposes women toward PMDD and vice versa
            Just as the physiological origin of Major Depressive Disorder resides in an imbalance in the neurotransmitters in a woman’s brain, our reproductive hormones (estrogen, progesterone, testosterone) influence those same neurotransmitters, including dopamine, serotonin, and norepinephrene.  This can therefore increase the risk of depression in women during any time of life related to reproductive hormonal fluctuations, such as the menstrual cycle, (PMS and PMDD), the peri- and post-partum period, peri-menopause, and menopause.  Also, women who suffer from Seasonal Affective Disorder (SAD) are more likely to suffer from PMDD and vice versa.  There may be a genetic link between SAD, PMDD, and PMS.

PMDD and Dysthmic Disorder
            It is not clear that Dysthmic Disorder (previously known as Dysthmia) is really separate from Major Depressive Disorder. It may only differ in terms of severity and the course of the illness.  Therefore, Dysthmic Disorder, too, can be confused with PMDD.  But only if you ignore the fact that Dysthmic Disorder can only be diagnosed when you have had depressive symptoms for two straight years without a break.  Unfortunately, many doctors do.

Peri-menopause and Menopause  --  Confusion City
            When a woman enters peri-menopause, her reproductive hormones begin to fluctuate wildly from month to month as their levels start to decline as part of her natural aging process.  Still, to a woman experiencing these wild fluctuations, it’s as if the body doesn’t know which way to go, and a fierce battle to maintain the status quo is being waged inside her hormonally, while at the same time she's trying to hold on to (what's left of) her shape and mental abilities.  If she’s been able to manage her PMDD episodes up to this point, the added instability in her hormones can bring on a double whammy of symptoms, leading to increased episodes of :
Tension, Anxiety
Irritability, Anger
Foggy Thinking
Lethargy, Fatigue
Overeating and Food Cravings
Hypersomnia or Insomnia
Physical Aches and Pains
Bloating and Weight Gain
            Considering that during peri-menopause a woman is still having some periods, the sheer unpredictability of when her period will come—or won’t—combined with the increased hormonal activity in her body, and the effects of these wildly fluctuating hormones on her brain, can lead her to think she’s truly going insane. 
The Bottom Line  --  PMDD Makes Everything Worse
            The bottom line is if you have PMDD, whatever you're feeling will get worse pre-menstrually, including any underlying depressive or anxiety disorders, and/or the naturally occurring fluctuations in your perimenopausal hormones.  Even reactions to food and drink and drugs will intensify during an episode of PMDD.  This includes cravings and allergic reactions.
So the next time you feel an upsurge of symptoms, no matter what they are, take the time to stop and ask yourself...is it PMDD or PME?
The answer can make all the difference in which path you take to treatment. 


  1. I love reading your blogs! Its nice to know I'm not alone. I just recently started adding Chia seeds to my diet. Have you tried it? I looked it up and found it to be beneficial for the brain and neurotransmitters. Whats even better is theres no taste so its not hard to eat. :) Thanks for all the information you post!

  2. Hi, Bianca, Thank you so much! No, I have not looked into Chia seeds. I'll check them out, though, and maybe do a special "brain foods" post. I know I have a folder on that in my files!

  3. I'm on a desperate search for relief, as everyone who suffers from PMDD is. Diagnosed bipolar, medicated accordingly, and have most of the symptoms 'required' to be diagnosed with PMDD... I heard about a dissertation by Dr Erika Timby in Sweden, she found that a hormone called allopregnanolone could be a remedy in the future. I have searched the web for the results of her studies and implications, even emailed her directly but I can't find any further information about it, or whether it is something that could be used in the near future. Have you heard of allopregnanolone and the supposed effects on PMDD?

  4. Hi, Tina, Yes, yes, yes! I have a copy of that dissertation. You can get one too. Google Allopregnanolone effects in women and a PDF of the dissertation will come up. Thanks for asking and good luck!

  5. My daughter is 22. She has suffered with what we think is PMDD for a long time. She was on medication for 5 years, and they kept upping. finally she had had it and went off all medication, and tries to handle the difficult 7-14 days with exercise, nutrition, vitamins. But she is getting weary. The last depression lasted 2 weeks, and then she had a very manic episode following. Even had a hard time sleeping. She is very concerned, but also is worried to go see someone because they automatically turn to meds. Low serotonin runs in ALL females in our family. Most are on Lexipro or Prozac. She does need help though:( Should she go see someone and get a proper diagnosis? Now that she is 22 it may be easier to sort out what she is dealing with.

    1. I understand your daughter's weariness. Please email me privately at info (at) livingwithpmdd (dot) com. I will answer you there, but it may take me a week to do so. Thanks!