Hello! It’s Not Just PMS. PMS and PMDD Are Not the Same Thing

Let's set the record straight once and for all, shall we? PMS and PMDD are not the same thing.

I remember PMS. I had it as a very young girl and woman. It was signified by the typical energy drop, irritability, cravings, weepiness, bloating and leaden legs that preceded my period. It was a pain in the...well, you know. It made it a challenge to go about life as usual, but I managed, because PMS is manageable. At least, it was for me. I have a huge pain tolerance!

At some point in my life, something switched on...or maybe off. Either way, PMS started to transform into something a lot less friendly. I was markedly becoming an entirely different person for several days before my period, changing back again as soon as the blood flowed. This wasn't about bloating and irritability. This was about marked personality changes characterized by extreme sensitivity to stimulus and anger. Simply put, I couldn't stand to be around people, and I couldn't handle the simplest of frustrations.

Enter peri-menopause. Now at age 48, PMDD has become an even bigger nightmare. With the shifting of my hormones comes a much more unpredictable barrage of cyclic symptoms including anxiety, rapid mood swings, rumination and self-sabotage the likes of which even years of extreme personal development can't help me tackle. Add to the mix suicidal fantasy, full-on rage, and an aversion to my partner with its characteristic withdrawal and silence that is completely destructive. Marked personality changes have become unrecognizable personality! Day-long crying jags have replaced weepiness. And bloating and cramping have morphed into days of constipation, muscle aches, headaches, and other inexplicable weirdness including strings of 12 hour naps! This ain't PMS, folks!

I wonder how many of my well-meaning associates who say they have or had PMDD really know what they are talking about. Did they have those simple cramps, bloating, and mood changes I recall from my youth? Do they think that is PMDD? Do they understand that PMDD is a life-altering, destructive, and altogether demonic monthly possession which leaves one feeling completely effed-up? I have to wonder. Because often, something in the way they say it or look at me or how they live their lives makes me think they don't. The dead give-away is of course, "It went away with exercise and dietary changes" or "You just have to think more positively".

These two female "things," PMS and PMDD, are often lumped together. There is no harm in that, necessarily. The problem arises when everything that is generally known about PMS is transferred to PMDD and an assumption is made that they are in fact the same thing or so closely associated as to be kissing cousins. In actuality, they are entirely different races. And speaking of races, it's a lot easier to run the PMS race, let me tell you. The PMDD race? Honey, it's a never-ending marathon of trials over which a woman has very little control, no matter the extent of her efforts.

Are you suffering from PMS or PMDD? Learning the difference can make a world of difference in understanding yourself and your symptoms. For more information, visit the National Association for PMDD/Gia Allemand Foundation website. 

Liana's note:  The above guest post was written by the blogger Cheekyminx. With her permission, several posts she has written about PMDD will be featured on this blog in the months to come. In the meantime, to find out more about her work as a PMDD Advocate, please visit her Facebook page, PMDD Life Support.

Differences Between PMDD and Bipolar Disorder

The following is a guest post inspired by fellow PMDD advocate Danielle Lasher Bosley, who answers countless questions in Facebook groups regarding what she's learned about PMDD.  Today's topic is about the differences between bipolar disorder and PMDD, which are commonly confused in the medical arena.  Welcome, Danielle!
I've had a few women message me lately about the tangled web of bipolar disorder and PMDD and how to tell the difference between them. This is a question that pops up more and more. And the answer is tricky, but I'm going to try to address it since it keeps coming up.
One thing I've noticed is most women who ask me about this do so privately. So many seem ashamed over the idea they could have bipolar disorder (which affects up to 3% of the population). I get it. Having PMDD - an autoimmune hormonal issue - seems a lot less stigmatized than saying you have a well-known mental health disorder people make fun of and mock all the time. So yes, I get it.
Buuuut... The longer you go treating one disorder (like PMDD) when you may not even have it and ignore the other (like bipolar), the worse it gets.  Liana adds: The reverse is also true—you could be taking medications for bipolar disorder when you actually have PMDD. Either way, The treatment plans and medications are not the same. Something to think about.
So... The diagnostic criteria for PMDD and bipolar disorder are different. There are different types of bipolar, too. I'm not gonna get into all of that right now. What I will say is - in the majority of cases with bipolar, there is some level of mania. Yes, there is one type that doesn't have mania. There is also hypomania which is milder. These cases are not the majority of bipolar cases. Most will have mania. Bipolar disorder also brings with it certain typical behaviors: reckless behaviors like frequent sexual partners and impulsive spending. These are not typical of PMDD. Do they exist with PMDD? Sure, they can because we are all different and have differing personalities, but as a whole, it's not a commonly recognized symptom like it is with bipolar.  Liana adds: PMDD impulse control issues generally have to do with mood swings and saying things we don't mean. That doesn't mean we don't indulge in a little retail therapy now and then, but not to the scale of shopping sprees during manic episodes of bipolar.
Most importantly: PMDD doesn't happen outside the luteal phase (the last two weeks of your menstrual cycle). Yes, stress and surprises and emotional upset are still hard for a woman with PMDD to handle. But the depressive lows or extreme highs will not suddenly hit you on Day 8 of your cycle. That's not PMDD.
Now, there is also PME, which throws many with bipolar disorder off track and onto PMDD. Women with PME experience prominent symptoms in their luteal phase because the fluctuating hormones worsen the underlying bipolar disorder. But the difference is that bipolar symptoms are still present outside of the luteal phase. Bipolar disorder is not predictable like PMDD symptoms are and with bipolar disorder it's not happening during the same timeframe month to month.

With bipolar disorder... your depressive state may lead to suicidal thoughts that change over to feelings of euphoria  and endless energy. These extreme mood swings can occur more frequently – such as every week – or show up more sporadically – maybe just twice a year. There is also no defined pattern to the mood swings. One does not always occur before the other – and the length of time you are in one state or the other varies as well... 

Also, and this is the most important part: if you don't have physical symptoms, it's very likely not PMDD. The diagnostic criteria for PMDD is used to emphasize this better. Since it was tweaked in 2013, we are seeing more women with bipolar disorder being misdiagnosed or self-diagnosing with PMDD. Traditionally, the most common physical symptoms of PMDD are extreme bloating, an all over heaviness, joint and muscle aching, acne, lethargy and fatigue, weight gain, and food cravings... And most with PMDD have more than one or two of these physical symptoms. If you're dealing mostly with mild mood changes and the physical stuff is more along the lines of PMS, the issue may actually be bipolar with PMS, not PMDD.
Substance abuse (whether it's pills and needles or you're the woman who "needs" wine every day) is also far more common in women with bipolar disorder than PMDD.
Danielle sums up: This is how I differentiate between bipolar and PMDD. You don't have to agree, but I think the differences need to be mentioned and that women who suffer with either PMDD or bipolar disorder need to recognize what exactly they have, own it, and get the help they need. As we well know, doctors haven't been the most helpful in this regard over the years. So we need to be our own best advocate. We need to be  honest with ourselves about what's going on.  Liana chimes in: I agree.  We need to do our own research.  With just a little effort, you *can* figure out the difference for yourself.  The tools are available and the information is out there.  And we deserve better than to spend years taking the wrong medication for something we don't have.
As always, get your hormones and thyroid tested annually (if only to find out what you don't have). Chart your cycles.  It's the best way to determine whether you have PMDD or not.
But most of all: Don't give up. ❤ The answer that is right for you is out there somewhere.

PMDD - When Women Who Don't Have it Do Harm to Those Who Do

April is PMDD Awareness Month.  Last week, I presented a Quote of the Week from a psychiatrist in South Africa who does indeed understand what PMDD is about and the need to treat it.  This week we present the flip side of the coin--the side most of us are unfortunately all too familiar with--in the form of a guest post by fellow blogger Twilah, written in response to a TED Talk in which a woman psychologist proceeds to negate the validity of PMDD by, among other things, dismissing PMDD and its sister disorder PMS as a cultural myth.

Twilah: This TED talk came to my attention because it was posted on a PMDD forum online. Other women complained that the talk seemed invalidating and dismissive of the illness they live with. I tend to agree with the feedback of the women affected by PMDD. This is my analysis.

The speaker, Robyn Stein DeLuca, opens by gauging the audience’s familiarity with the concept of PMS. She establishes that PMS is a familiar concept with easily recognizable symptoms. She goes on to point out that mainstream American media accepts and propagates ideas and assumptions about PMS.

DeLuca then drops her bombshell that after five decades of research the jury is still out on PMS. It’s poorly defined, treatment protocols vary… it may not even be real! She explains how historically the symptoms of the disorder described by psychologists varied so greatly that the very definition of PMS became meaningless! 

She goes on to outline the shabby research techniques and protocols that characterized the presumably five decades of research she referred to earlier. She claims that the DSM “…in 1994…redefined PMS as PMDD, Premenstrual Dysphoric Disorder.”

Actually the DSM didn’t distinctly include PMDD until DSM 5, which was released in 2013. Prior to that, the DSM 4 included PMDD not as a distinct mental illness, but as a “depressive disorder not otherwise specified.” The speaker heralds the clarity established by the diagnostic guidelines offered in DSM 5. She then points out that under the new criteria in DSM 5 the number of women affected by PMDD turns out to be only 3-8%, which she considers “not even a lot of women.”

So DeLuca opens with a claim that five decades of research hasn’t supported the premise that PMS exists. Then she points out how poorly conducted much of that research was. 

Okay…you are using five decades of research that by your own reports doesn’t count for anything to support your premise that PMS is a dangerous and erroneous cultural creation? It’s generally a bad idea to use volumes of poorly conducted research as support for anything. And a mere 3-8% of presumably the world’s female population is affected? If women are slightly less than 50% of the estimated 7 billion humans on this planet, and about 2 billion of these women are menstruating, then 3% of menstruating women translates to roughly 60 million women with PMS/PMDD…whichever she is calling it right now…because she wants to undermine a PMDD diagnosis by conflating it with a cultural concept of PMS!  (Liana speaks up:  I want to say here that PMS and PMDD should never, ever be used interchangeably, as they are two separate conditions, and while PMDD affects 3-8% of menstruating women, PMS is said to affect approximately 80% of menstruating women. That means this woman, aside and apart from the huge disservice she is doing to women who do have PMDD, is also dismissing the monthly experiences of possibly another 1.6 billion women and calling it "good news".) 

Head spins…

She goes on to posit that, “the PMS myth” persists because of cultural limitations on the role of women.

Now I won’t argue for a minute that many cultures, especially the American one to which she is primarily referring, frequently limit the roles of women. Popular conceptions of PMS have been used by sexist people to minimize women’s speech and self-advocacy. That is undeniable. But the irrational interpretations of a sexist culture have zero bearing on whether a medical condition is real. Many well established medical conditions are stigmatized and used to oppress individuals affected by the conditions. Think of any disease that might cause a person to wear a colostomy bag, think leprosy, think any one of legions of mental illnesses. Simply because a culture uses a diagnosis to oppress a person with the diagnosis does not mean there is no validity to the diagnosis. The cultural interpretation of the illness needs to be addressed, the disease doesn’t need to be denied. 

DeLuca’s assertion that PMS is a largely Western concept is irrelevant also (Liana: as well as totally untrue). Lots of women’s health issues are more marginalized in non-Western societies. That has no bearing on their realness or validity. If society at large and physicians in particular choose not to discuss the high infant mortality rate in any country that doesn’t hold women in high regard, that doesn’t mean high infant mortality doesn’t exist in that country. That means it isn’t talked about or researched in that country.

To say that diagnosis and treatment of PMS or PMDD is anti-feminist is more hurtful to 60 million women than much run of the mill sexism. To have other women, who we would hope are our allies, take a stand to deny us diagnosis and treatment for a life threatening condition is morally reprehensible. 

Because that’s what PMDD is. It is a life threatening condition. The 3-8% of women who are affected by this disease experience job loss, relationship difficulties, relationship loss, depression, and potentially suicide. And this woman thinks it is helpful to stand up in a forum like a TED talk and tell people that it’s really no big deal that over 60 million human beings deal with this disease every month? To suggest it is a cultural problem and not a medical problem? She criticizes what she calls “the medicalization of women’s reproductive health.” I criticize the politicization of a medical disorder. I criticize speech that discourages further well conducted research into a life threatening illness.  (Liana:  Up to 30% of women with PMDD regularly experience suicidal ideation or attempt suicide.  15%  those succeed.) 

The root of the problem is not a cultural misperception about PMS. The root of the problem is that an endocrinological disorder is being treated as a mental illness. The problem is that the hormonal health of women is being handed to psychologists and psychiatrists for treatment. Imagine going to a psychiatrist for your diabetes or your hypothyroidism. What do you think the outcome would be? What do you think the data would show? Imagine a man being told to go to therapy instead of being given testosterone supplementation for age related testosterone production changes.  (Liana:  I half agree, but also disagree.  If psychiatrists and psychologists are the only medical professionals attempting to take PMDD on, then I would gladly go to them over accepting no medical help at all.  But I do believe PMDD is more an endocrinological disorder than a mental one.)

DeLuca says that, “…the success of medication in treating PMS symptoms vary from woman to woman.” She uses that as evidence to support the invalidity of a PMS diagnosis. Of course the success rate of using psychiatric drugs to treat a hormonal disorder would have varying rates of success! Considering the efficacy of antidepressants to treat depression is disputed, with estimates ranging all over the place, it’s not surprise the efficacy is unpredictable when you prescribe a psychiatric drug for an endocrine condition. I’m sure you’d find the same kind of inconsistency if you prescribed Prozac for erectile dysfunction. A man just might get an erection because increased serotonin made him happier overall. (Liana:  If the medication doesn't work, that does not mean the condition is not real.  It means the medical options provided are not addressing the medical issue.)

But wait, we’re talking about women.

This presentation is so off base. The problem isn’t that a make believe, culturally based illness is being given credence. The problem is that a hormonally based illness is being investigated by mental health professionals, simply because one aspect of its presentation is similar to recognized mental illnesses. The problem that American society uses the term PMS to dismiss or demean women’s emotional states is a completely separate issue from research and treatment of a disease that may affect more than 60 million women. The problem is that an educated women would stand up in front of an audience of thousands and undermine the health concerns of millions of fellow women.

Let’s not back away from helping women because existing research is incomplete or inconclusive. Let’s fund more and better studies. Let’s take seriously the complaints of millions of women that their health is being affected by their hormones. Let’s listen to women’s voices instead of dismissing them. 

Twilah's blog can be found here.  

Scientific Awareness of PMDD is not the Problem

Almost daily I hear someone mention how we need to raise awareness of PMDD, so that more studies of this debilitating disorder will be done, and someone can finally unlock the secret of what causes PMDD and how to successfully treat it.

So one day last August, a week before my most recent brain surgery, I was apparently looking for some challenging reading material when I got out of the hospital, (thinking positive, I imagine) so I spent an hour and a half clicking on links and printing out various scientific abstracts and studies I could find on PMDD.

In just that small segment of time, I found nearly 50 studies on PMDD, which broke down as follows:

2013 - 19

2009-2012 - 18

2006 - 2008 -  I already have most of these in my files, so did not print them out again

2001-2005 - 10

I am sure there have been countless more studies done in the past 14 years, but this was a random sampling of those I might not already have read, and I also chose not to print out many that were over 7 years old, as so much information about PMDD has changed since 2007. 

Of the 2001-2005 studies, I printed only those that might be of use in my research.  A list of titles appears below.  And yes, I do intend to read each study listed, and share with you in plain language anything that seems relevant.  But first I want to point out that in the scientific community, the problem is not awareness.  Scientists are well aware of PMDD and for what looks like mixed reasons.   An analysis of what those reasons might be will be the subject of a future post. 

For now I just want to repeat that awareness on a scientific level is not the problem.  Awareness in the medical community—short of misleading advertisements by drug companies—and awareness in our friends and families is.  Hopefully blogs like mine will help to rectify that situation for you and your loved ones. 

In the meantime, here is a list of the studies on PMDD I uncovered in less than two hours of searching.  If you think the list is dry reading, imagine reading the studies themselves :).  But like I said, it keeps my brain sharp. Not to mention I'm a total research geek and love it.

If you wish to read any of these studies yourself, you can Google the name provided.  I typed the titles exactly.   Just retype it yourself, or cut and paste the title into your browser.  These can all be found on the PubMed.gov site, which is part of the U.S.  National Library of Medicine, and the National Institutes of Health.  Many of them are abstracts, but you *can* find the full studies if you look hard enough.  Update: the first comment below tells you exactly how you can get copies of the full studies.

Enjoy!

2013

Comorbid bipolar disorder and PMDD: real patients, unanswered questions

Elevated gray matter volume of the emotional cerebellum in women with PMDD

Allopregnanolone serum concentrations and diurnal cortisol secretion in women with PMDD

Examination of premenstrual symptoms as a risk factor for depression in postpartum women

Luteal serum BDNF and HSP70 levels in women with PMDD

PMS and PMDD among Jordanian women

Circulating insulin and leptin in women with and without PMDD in the menstrual cycle

Abnormalities of dorsolateral prefrontal function in women with PMDD; a multimodal neuroimaging study

Lamotrigine augmentation in PMDD : a case report 

Depressive mood and frontal alpha asymmetry during the luteal phase in PMDD

PMDD and severe premenstrual syndrome in adolescents

Selective serotonin reuptake inhibitors for PMS

Premenstrual disorders and rumination

Anger in women with PMDD: Its relations with PMDD and sociodemographic and clinical variables

Non contraceptive benefits of oral hormonal contraceptives

Premenstrual symptoms and posttraumatic stress disorder in Japanese high school students 9 months 

after the great East-Japan earthquake

Personal history of major depression may put women at risk for premenstrual dysphoric symptomatology

A review of treatment and management modalities for PMDD

Biopsychosocial aspects of premenstrual syndrome and premenstrual dysphoric disorder

2012

Pilot investigation of the circadian plasma melatonin rhythm across the menstrual cycle in a small group of women with PMDD

Bipolar disorder and PMS or PMDD comorbidity: a systemic review

Survey of premenstrual symptom severity and impairment in Korean adolescents; PMDD subthreshold PMDD and PMS

Intercountry assessment of the impact of severe PMDD on work and daily activities

2011

Work stress, PMS and PMDD are there any associations?

Lifetime discrimination associated with greater likelihood of PMDD

Posttraumatic stress disorder and trauma characteristics of PMDD

Reduced Phase-Advance of Plasma Melatonin after bright morning lithe in the luteal, but not follicular menstrual cycle phase in PMDD: An extended study

Exposure to American culture is associated with PMDD among ethnic minority women

Health advantage for black women: patterns in PMDD

2010

Histories of major depression and PMDD: evidence for phenotypic differences

Neuroticism related personality traits are related to symptom severity in patients with PMDD and to the serotonin transporter gene-linked polymorphism 5HTTPLPR

Predicting response to leuprolide of women with PMDD by daily mood rating dynamics

Estrogen receptor alpha (ESR-1) association with psychological traits in women with PMDD and controls

Increased sensitivity to light-induced melatonin suppression in PMDD

Prefrontal brain asymmetry and PMDD symptomatology

Explorative evaluation of the impact of severe PMDD on work absenteeism and productivity

2009

Safety, efficacy, actions and patient acceptability of (Yaz) contraceptive pills in the treatment of PMDD

2005

Lack of beneficial effects of clonidine in the treatment of PMDD: results of a double blind, randomized study
Histories of sexual abuse are associated with differential effects of clonidine on autonomic function in women wit PMDD

2004

Historic sexual abuse and current thyroid axis profiles in women with PMDD

2003

The prevalence, impairment, impact and burden of PMDD

Biological correlates of abuse in women with PMDD and healthy controls

2002

Prevalence, incidence and stability of PMDD in the community

Prevalence and predictors of PMDD in older premenopausal women. The Harvard Study of Moods and Cycles

2001

Characteristics of women with PMDD who did or did not report a history of depression: a preliminary report from the Harvard Study of Moods and Cycles

Allopregnanolone levels and reactivity to mental stress in PMDD

Is it PMDD or Not?

This week I want to revisit a past post that gives several reasons (but not all!) why PMDD is so often misdiagnosed.  It was originally called Confusion City.

I'm on my way back into the hospital for a follow up cerebral angiogram so prayers and positive thoughts welcome...  Hope to be back here with a brand new post soon!

Confusion City

This post was completely updated September 23, 2015

One of the main problems I find in researching PMDD is that every woman’s hormones fluctuate daily in concert with her menstrual cycle, so it’s hard to separate what’s caused by normal female hormonal fluctuations and what’s caused by PMS or PMDD. To be clear: PMS and PMDD are not the same. PMDD is *not* PMS on steroids, although it can feel like it when you’re having an episode.

There is a definite brain component to PMDD that is not present in PMS. PMS mostly deals with physical symptoms (aches, pains, tenderness, cramps, bloating, etc.), with some minor mood fluctuations…a little irritability, a lack of energy or motivation, some weepiness, maybe more anxiety than usual.

PMDD ratchets these symptoms up a few hundred notches, to the point that these mood disturbances affect your ability to function and maintain stable relationships.

A lot of books and websites discuss the more mild symptoms of PMS, and then simply transfer the same thoughts and theories to PMDD. A lot of these sources even call PMDD a more severe version of PMS. This is not true. They are two separate conditions that unfortunately have enough in common to confuse everybody. But in the end, they take two different paths.

However, since they are often treated as similar, even interchangeable, by many media, for years I thought I had PMS, and couldn’t figure out why—if more than 80% of all women experience some form of PMS—why couldn’t I cope like everyone else did?

Because it wasn’t the same thing, and I didn’t know that.

So, while PMS affects (mostly) your body and (mildly) your mind on more or less a regular cycle, with more or less the same cluster of mind/body symptoms each month (specific to you as an individual), PMDD affects your brain’s ability to regulate itself, and therefore affects just about every other hormone in your body, too.

This is why you often feel as if something or someone else has taken over your body. You think one thing, and something totally different comes out of your mouth. You think you’re eating right, getting enough sleep and exercise, and suddenly one day you have no energy and your body simply won’t cooperate. There’s a missed connection there, and while it’s not “all in your head,” as many friends, relatives, co-workers, and even medical personnel would have you believe, it is happening in your brain.

So what are some of these hormones, and what do they do?

Here (in alphabetic order) are the ones most likely to affect your levels of PMDD.

Aldosterone – Never heard of it? Doesn’t matter. It still contributes to excess water weight gain when your progesterone levels are high, like in the second half of your menstrual cycle, when you feel all fat and bloated. Now you know (in part) why you get that way, and why (short of diuretics) there’s really nothing you can do about it but avoid salt, celebrate the fact that you’re a woman, and know that this, too, shall pass…

Androgens (DHEA and others) – When levels of these are too high they enhance your sex drive and aggressive tendencies, produce unwanted facial hair and apple vs. pear-shaped bodies in women, stimulate your appetite and contribute to waistline weight gain.

Cortisol – This affects your metabolism and tells your body to store more (more! more!) body fat, and is produced in even higher amounts under stress. (Remember, a woman with PMDD is more sensitive to stress to start with, so don’t be surprised if your levels are off the charts.)

Think about this: Our bodies have not changed much biologically since prehistoric times, and so are designed to respond to stress in a certain way that back then was perfectly normal and balanced. But stress back then might be due to a natural disaster, imminent death or starvation, attack by a wild animal, or, in later times, attack from a warring tribe.

Now our stress comes from sources like electronic devices, over-commitment, dashed hopes and unmet expectations, financial strain, unsafe drivers, emotional upsets, and major life changes like birth, death, marriage, divorce, surgery, change in employment or living location, to name just a few.

But our bodies still react in the same way they did in prehistoric times to these threats and upsets—as if we were literally under physical attack.

So up goes your cortisol, which, among other things, suppresses your normal immune functions, leaving you susceptible to every cold and flu that comes your way. In time your body can get so run down that you develop something serious, even terminal.

The Estrogens – Estradiol, Estrone, and Estriol These three wonder hormones are involved in over 400 crucial functions throughout your body and brain, including your metabolism, moods, body heat regulation, insulin sensitivity, pain levels (think muscle and joint pain, and headaches), and carbohydrate tolerance. Both too much and too little estrogen are bad for you, in ways too numerous to go into here. But know this—you have estrogen receptors in your brain, bladder, bones, muscles, blood vessels, skin, breasts, uterus, eyes, heart, and colon. It’s not just about sex anymore.  With all those receptors, you can easily take in too much estrogen—or, more appropriately, too much of the WRONG kind of estrogen (aka xenoestrogens).

Insulin – Lowers your blood sugar, stimulates fat storage.

Melatonin – Regulates your sleep cycles and body rhythms, promotes fat storage for hibernation (remember those cave dwellers) and increases your appetite for carbs. Melatonin also plays a role in Seasonal Affective Disorder (SAD) syndromes that affect your energy levels, weight gain, daytime sleepiness, and depressed moods.

Norepinephrine and Epinephrine – aka your Adrenaline Hormones. These govern your “fight or flight” responses. They increase your heart rate, lift your mood (or in excess cause anxiety), increase alertness, and dilate your arteries to provide more oxygen, glucose, and nutrients to your key organs in times of distress.

Remember what I said about how our bodies were initially designed to respond to threats and the differences between threats then and threats now? Some of us are living in a nearly constant state of fight or flight simply due to the lifestyles we live. But on top of that, when a woman enters her PMDD zone, her fight or flight switch comes on, but because of some missed connection in the brain—it does not shut off. 

Until her period comes.  That can last up to three weeks in the worst cases. 

Being trapped in that fight or flight state is exhausting, to say the least. You know how you feel when you're exhausted...apply that to a woman with PMDD ten-fold and you may begin to understand her emotional instability during her episodes. 

Progesterone – The jury is still out on this one. Some sources say too much progesterone can increase your appetite, increase fat storage, reduce insulin sensitivity, make you sleepy, depressed, and depress your sex drive.  Fatigue, breast tenderness, bloating, and vaginal dryness are also symptoms.  Other sources say too little progesterone can cause many of these same symptoms—in addition to anxiety attacks, insomnia, dizziness, irritability, difficulty concentrating, extreme changes in mood, muscle pain, joint pain, and urinary incontinence.

Who to believe?  All I know is progesterone supplementation is something that needs to be fine-tuned over the course of your cycle    .  I have found that, much like an upside-down U-curve, there seems—for me—to be a sort of sweet spot at the top of the curve; too little progesterone creates symptoms, too much progesterone creates symptoms.  The dosage needed can vary daily.  I have to constantly adjust and readjust my progesterone intake, using supplementation and nutrition.

So be wary of progesterone creams, especially over-the-counter brands.  Depending on what else is in them, you can get too much, too little, or none at all.  They are not regulated.  Other ingredients in the creams can also clog your pores and provide added fake estrogens if you do not read the label carefully.  Only a precious few progesterone creams perform the way they are intended to.  I use a cream when symptoms are particularly bad, but for the most part I take a 100 mg capsule of micronized progesterone daily, and double that on symptomatic days.  If you would like to know which brands I use, contact me directly. (info (at) livingwithpmdd (dot) com.)

Testosterone – It’s not just for guys. Too little testosterone can negatively affect your bone and muscle growth, metabolism, mood, energy level, and sex drive.

Thymosin – This little-known hormone plays a major role in the development of your immune system. Be good to it or be betrayed by it.

Thyroid – Affects your metabolism, nervous system, muscles and bones, energy levels, heart rate, body heat production, and brain activity. (Hello? Brain activity? Remember this.)

Okay, now I’m no doctor, but if you take the major symptoms of PMDD and bump them up against these hormones, you’ll find that too much or too little of eight of them can lead to weight gain, five of them can cause problems with your metabolism, five of them can affect mood disorders, six can cause problems with your energy levels, two can make you anxious, two can make you aggressive, three affect your sex drive, two reduce insulin sensitivity, two affect sleep cycles, two can depress your immune system, and two can affect your brain function…which can affect all of the above.

Let’s break that down into something more understandable.

Imbalances (for lack of a better word) in the following can cause weight gain:
Androgens
Cortisol
Insulin
Melatonin
Progesterone
Testosterone
Thyroid
Aldosterone (water weight gain)

Imbalances in the following can cause metabolism problems:
Cortisol
Estrogen
Testosterone
Thyroid

Imbalances in the following can cause mood disturbances:
Estrogen
Progesterone
Melatonin
Testosterone
Thyroid

Imbalances in the following can cause your energy levels to plummet:
Estrogen
Insulin
Melatonin
Progesterone
Testosterone
Thyroid

Imbalances in the following can compromise your immune system:
Cortisol
Thymosin

Imbalances in the following can reduce insulin sensitivity:
Estrogen
Progesterone

Imbalances in the following can cause problems with brain function:
Estrogen
Thyroid

Or, to cross-match it another way…

DSM-V Symptoms of PMDD affected by hormone levels:

Markedly Depressed Mood (feelings of hopelessness, or self-deprecating thoughts)
Estrogen
Progesterone
Melatonin
Testosterone
Thyroid

Marked Anxiety, Tension, Feeling Keyed-up or On Edge
DHEA
Norepinephrine
Epinephrine
Thyroid

Marked Affective Lability (feeling suddenly sad or tearful or increased sensitivity to rejection)
Estrogen
Progesterone

Persistent and Marked Anger, Irritability, or Increased Interpersonal Conflicts
DHEA and other Androgens

Testosterone
Thyroid

Decreased Interest in Usual Activities (work, school, friends, hobbies)
Estrogen
Insulin
Melatonin
Progesterone
Testosterone
Thyroid

Subjective Sense of Difficulty in Concentrating
Estrogen
Progesterone

Testosterone
Thyroid

Lethargy, Easy Fatigability, Marked Lack of Energy
Estrogen
Insulin
Melatonin
Progesterone
Testosterone
Thyroid

Marked Change in Appetite, Overeating, or Specific Food Cravings
DHEA
Cortisol
Insulin
Melatonin
Progesterone
Testosterone
Thyroid

Hypersomnia or Insomnia
Estrogen
Melatonin
Thyroid

Subjective Sense of Feeling Overwhelmed or Out of Control
Estrogen
Progesterone

Thyroid

Physical Symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of bloating, or weight gain.
Aldosterone (water weight gain)
Estrogen
Progesterone
Cortisol
Insulin
Melatonin
Testosterone
Thyroid

Do you see where I’m going with this? You could have PMDD, or you could have some kind of hormonal excess or deficiency that is exacerbated pre-menstrually (called Pre-Menstrual Exacerbation). It might actually be an insulin problem, or a thyroid problem, an auto-immune system problem, and not PMDD at all. Some doctors have been making great strides with theories of inflammation. Your problem might be PMDD or it might be something entirely different.

The reason to get a diagnosis of PMDD is not to brand you with the PMDD label, but rather to rule out any other treatable causes for your symptoms.

Once you get that something else identified and dealt with, you might be left with only PMS to deal with.  And wouldn't that be wonderful?

The bottom line is only you and a caring, knowledgeable, and forward-thinking medical professional will be able to identify and separate the many connected hormonal threads in your body and figure out what's working right and what is not. 

You are a beautiful, complex system of individual ups and downs, highs and lows, checks and balances.  Don’t let medical professionals simply hand you prescriptions for one-size-fits-all blanket treatments and/or try to make you feel to blame or as if you are not trying hard enough when they don't work. 

And most of all, don't let anybody tell you you’re crazy.

Because the only things out of kilter here are your hormones.

Keep searching until you find the right practitioner and answers for YOU.