PMDD Quote of the Week - A Doctor's View

April is PMDD Awareness month.  I can't begin to imagine how much further we would be along the path to health and healing if we only had more doctors like this.  This woman "gets" it.

What is PMDD?

"A reproductive disorder whereby women experience transient physical and emotional changes around the time of their period, PMDD is associated with a level of impairment that is similar to major depressive disorder and poorer quality of life compared with community norms, therefore it should be considered a serious health condition. PMDD can have adverse consequences on a woman's social functioning, relationships, work productivity and healthcare use..."

and

"Treatment generally continues for duration of a woman's reproductive life.  If one considers that a female typically menstruates 300 - 500 times during her lifetime, timely identification and initiation of appropriate treatment may prevent impairment.  This, together with support and TLC from loved ones or spouses, can go a long way in improving the quality of life of PMDD sufferers."

~Dr. Eileen Thomas, a specialist psychiatrist at Akeso Clinic, Milnerton (Cape Town, South Africa)

To read the full article, go here.

As Dr. Thomas so rightfully points out, a female can experience up to 500 menstrual cycles during her lifetime. I also mention this in my books, PMDD and Relationships, and PMDD:  A Handbook for Partners.  Below are a couple of sample excerpts:

Let’s do the math. The average age of female puberty is 12; the average age of menopause is 51. Round that off to 40 years of menstruation. Multiply that by 12; that gives you 480 months of periods if you never have children, less if you do. Let’s go with 450 periods for now. That gives you 900 weeks of pre-menstrual issues. Divide that by 52 weeks per year, and you get 17+ years that a woman can spend in the living hell that is PMDD.

Seventeen years, people!

and 

Seventeen years is a long time to feel and/or be out of control. Seventeen years is also a long time to be on medication, especially medication that studies now show doesn’t work more than half the time.

Listen, nobody knows for sure what causes PMDD. All scientists know is it is a biological event that manifests as emotional symptoms. What does that mean? It means PMDD is caused by something that happens in your body and shows/expresses itself in your moods. The closest science has come to defining what happens is that whatever happens, happens in concert with your menstrual cycle, and involves your hormones. The hormones they have looked at the most are estrogen, progesterone, and now a metabolite of progesterone, called allopregnanolone.

Some schools of thought are convinced it has something to do with the levels of these hormones in your body, and whether they are in the right balance or not. But you can’t detect PMDD with a blood test, and every estrogen/progesterone blood test I have taken has shown my levels to be perfectly normal, even when I was in the middle of a PMDD episode.

I think the best science has come up with so far is that yes, PMDD does have to do with your hormonal fluctuations, but it’s more that something goes awry in your brain when processing these normal and natural hormonal fluctuations in your body.

That’s right. Something goes wrong in your brain.

No news to us, right? We’ve known all along something wasn’t right with our brains, with our thinking processes, during an episode of PMDD. Why else would we say and do the things we say and do during an episode, but not during the rest of the month?

As part of PMDD Awareness month, I invite you to share in the comments section below any adverse consequences YOU have experienced in your social functioning, relationships, work productivity and/or healthcare use due to your PMDD.  Share to help make aware!

Top 20 Tips for Partners Dealing With PMDD

What follows is my most widely-read blog post, completely updated in December 2015 and included in my book, PMDD: A Handbook for Partners. That said, here is the post that inspired the book.

Unfortunately, my research has uncovered a complete lack
of serious information for men on the subject of PMDD, so here
it is, short and sweet, a list of the top 20 things you can do for
your partner with PMDD.
1. Believe her. When she tells you what she’s
experiencing, believe her. Even if it doesn’t make sense.
Because PMDD doesn’t make sense. The symptoms are as
unique and individual as the woman having them.
2. Do not tease her. Do not make fun of her, as this is a
serious and often debilitating condition. Would you tease a
combat veteran for having PTSD? During an episode, a PET
scan of a woman with PMDDʼs brain shows the exact same
configuration as that of a vet with PTSD. This womanʼs brain
truly believes she is under attack, and will respond accordingly.
(This will cause her to do and say things she would never even
consider during her non-PMDD days.)
3. Chart her symptoms daily, either together or on
your own. If she refuses to admit there’s a problem, then do it
on your own so that you can be prepared for when the storm
hits.
4. Consult your chart or app when considering social
events, activities, or vacations and such. Surprises and big
decisions come under this heading, too.
5. Learn as much information as you can about
PMDD from reliable resources. If they have a product to sell
you, any type of product, proceed with caution.
6. Understand that if it is not treated, her PMDD can
only get worse. It could end up as Major Depressive Disorder.
7. Help her to find a doctor who will listen to her and
help her. This may take several tries, as most doctors are not
trained in the treatment of PMDD. Traditionally trained
medical doctors will only offer you birth control or
antidepressants, since they are the only drugs medically approved
for treatment of PMDD by the FDA. Your best bet is to find a
naturopathic doctor or nurse practitioner.
8. Don’t let her negative thoughts and feelings get the
better of her—or you. If she shares them with you, gently
remind her it’s the PMDD talking, not her, and postpone any
major changes or discussions/decision making for a few days.
9. Be supportive and encouraging as she tries different
things to feel better. Make a note of what works and what
doesn’t. Share this with her doctor. Do not blame her if any
medication she is prescribed does not work. It does not work for
most women. Science does not yet understand the brain well
enough to know what is biologically going on during an episode
of PMDD, despite what the television ads tell you.
10. Help her to get enough rest. Sleep is when our
bodies re-regulate themselves. If we don’t have enough (sleep)
time to do the work needed, we start the day at a disadvantage.
11. Join her for moderate exercise. Exercise is always
more fun with a friend. I have found a walk of 45 minutes can
buy me up to two hours of PMDD-free time.
12. Encourage her to eat healthy. (Avoid alcohol,
caffeine, sugar, sugar substitutes, energy drinks, anything made
with high fructose corn syrup, and white rice and flour, for
starters.)
13. Buy her some high quality dark chocolate. Keep it
on hand for the bad days.
14. Do what you can to keep stressful situations to a
minimum. PMDD feeds on stress.
15. Do not accept any behavior that is abusive. Ever.
16. Do not return such behavior if it happens. Calmly
walk away and resume your conversation when she is more in
control of herself. Be firm about refusing to engage when she is
out of control or abusive. When she gets this way, the PMDD
bully in her brain is in full control, and determined to destroy
whatever it can.
17. Remember that she literally is not herself during
an episode of PMDD. Try not to hold the things she says and
does against her. It’s not personal, and it’s not about you. It’s the
bully that has taken over her brain egging her on.
18. Be as comforting as she will allow you to. If she
won’t let you near her, let her know you will be nearby if she
needs you. To her brain during this time, allowing comfort
equals weakness. Weakness equals vulnerability. Vulnerability is
dangerous to the PMDD brain.
19. Don’t expect her to be full of sunshine and
laughter when she’s not having a PMDD episode. A
healthy, balanced, and emotionally well-rounded woman feels
every emotion—not just the good ones.
20. Last, but not least: Do not blame every time she
becomes irritated, annoyed, angry, afraid, or upset on her
PMDD. Nothing is more irritating than having a genuine
concern or grievance, and being told, “It’s your PMDD again,
isn’t it?”
Maybe it is, and maybe it isn’t. Take the time to check her
chart to see if she’s supposed to be having an episode, and then
carefully sort through (usually by talking it out) and separate
what is her PMDD and what is a genuine fear or concern on her
part. Encourage her to feel and express the full range of
emotions, just like people without PMDD do.
More than anything, a woman with PMDD just wants to
feel normal. These 20 tips will go a long way toward helping
your partner do just that.

Note:  PMDD: A Handbook for Partners, and its sister book, PMDD and Relationships, are available in both ebook and print.  If you participate in the Amazon Smile program, please consider designating the National Association for Premenstrual Dysphoric Disorder (NAPMDD) as your chosen charity.  You can also buy these (print) books on the NAPMDD website, where $1 from each purchase goes to support the NAPMDD Awareness Fund.

Snapping Out with PMDD

Here’s but one small example of how PMDD can affect your life and or relationships. A few weeks ago, my teenage son mentioned a wildly popular movie he’d seen over the weekend, and asked if I wanted to watch it with him. I love watching movies, and love spending time with my son, and was thrilled that he’d thought enough of the movie (and me) to ask so even though I had already seen the movie years before and didn’t particularly care for it, I said, “Sure, honey, we can watch it this weekend.”

For the past twelve years, we’ve enjoyed Movie Night every Sunday evening, as a way to settle in and prepare for the week to come. So he got the movie, and brought it home. A few days later, movie in hand, he asks, “Do you want to watch the movie now?”

And I snapped out on him and told him in no uncertain terms that I did not.

I don’t recall doing it. This is not me. I mean, I’ve watched Winnie the Pooh and Thomas the Tank Engine and Theodore the Tugboat videos over and over and over again. I’ve seen most Disney animated videos at least twice, some several times. For a couple of years, I stopped what I was doing every afternoon to watch the Power Rangers.

I have watched a LOT of shows and movies I might not have felt like watching, but did so because they were age appropriate at the time.

But apparently I changed my mind this time, and I don’t even remember doing so.

A few weeks later, I innocently mentioned to my son in passing that we hadn’t watched the movie yet, and he looked at me and said, “That’s because you said, `I don’t see why I should have to sit through a movie I don’t even like just because you want me to watch it.'"

“I did?” I asked, feeling totally embarrassed. “When did I do that?” “A few days after I first asked you about it and you said it would be okay.” “I’m sorry,” I said. “I don’t remember doing that. What did you say or do when I did that?” He shrugged and said, “I just figured it was one of your PMDD days and left it alone.”

I’m glad he knew it wasn’t him that caused my snappishness, but still…

“Where’s the movie now?” I asked.

“In my room,” he says.

“You want to watch it?”

He did. We did. It was better than I remembered, but I also remembered why I didn’t like it, as it contained some subject matter I find unpleasant. In addition to that, it had a sad ending.

“You asked me to watch a movie that would make me cry?” I teasingly accused him afterwards, still sniffling.

But he was sniffling, too. It was a good movie, a good moment, and sparked a good conversation about life and death.

And I would have missed that chance to have that conversation with him because of my PMDD.

I try not to look back, but I wonder how many other opportunities like that were missed because of something sharp I said when I didn’t mean to. Worse yet, I wonder how many times I hurt someone’s feelings by snapping out and don’t even remember it.

Because that’s part of PMDD. You get irritable, you snap at people, and don’t even realize you’re doing it. You think you’re behaving normally, until something ugly happens, or someone who feels close enough to you or comfortable enough with you gently points out you may be having an episode. (Which nine times out of ten you will vehemently deny until you realize they are right.)

Or, before either you or they are aware that you have PMDD, they may be less gentle or understanding, and may simply shout, “What the hell is wrong with you?”

You don’t know, they don’t know, and the relationship starts to strain at the seams. If you don’t get help, unless your friend or partner is a total saint or a doormat, the relationship falls apart.

Sound familiar?

Well, take heart in knowing it takes two to make a relationship work and it takes two to bring one to an end. It isn’t and wasn’t completely your fault. When you’re having an episode of PMDD, certain factors are out of your control.

That’s an explanation, not an excuse. (You’ll hear me say this over and over and over again, so get used to it.) You still need to go back and make amends if you’ve hurt someone you care about while your brain was not firing properly. You don’t need to beat yourself up over it. Your rage and irritability and emotional outbursts during an episode of PMDD are as uncontrollable as an allergic reaction. That doesn’t make them or the consequences from them any less painful, but neither does it mean you have to drown yourself in guilt afterward. You simply apologize and do what you can to make up for it.

If your loved ones really love you, they will understand and accept that there are times when you just aren’t yourself.

If you really love them, you’ll do everything in your power to see that those episodes are few and far between.

Tips and hints on how to do that can be found in this blog*, and in my books, PMDD and Relationships, and PMDD: A Handbook for Partners.  Also, if you use Amazon Smile, you can choose the Gia Allemand Foundation and they will receive a donation from Amazon.  Win-Win!

*Use the search box at the top of the page to locate topics you are interested in reading more about.  Type in the subject, and if I have written anything about it, a list of posts will appear.  This will save you a lot of time spent scrolling past stuff you're not interested in.