PMDD: Suddenly it All Makes Sense

Now I know why!

I know why two weeks out of every month I am waiting to feel like myself again. I know why for two weeks I suddenly don’t give a crap about anything I was excited or cared about in the weeks before. I know why I feel contempt for everyone and everything when I recently felt so in love with it all. I know why I suddenly doubt my abilities and talents. I know why I isolate myself on certain days…when I just know I’m not going to be able to accomplish the simplest of tasks without getting irritated or downright angry. I know why I am afraid to schedule anything in advance, lest whatever I have to do falls on a day when I am incapable of behaving reasonably. I know why hateful thoughts become so insistent and pervasive despite the fact that just two weeks ago, I was 100% certain I had finally transcended them all. I know why I can’t stand to be touched, when just last week, I couldn’t get or give enough hugs. I know why I suddenly feel so disconnected from my friends, doubt their friendships, and suddenly want to walk out on my husband.

In my quest to understand, I’ve been given plenty of opinions. I’ve heard some labels, and some I even tried to make fit. But in the end, I knew they didn’t. I knew I wasn’t “bipolar”. I knew I wasn’t “borderline” or “mood disordered” (even though that’s still the involuntary category in which I’m pegged). I knew I wasn’t “just imagining things” either. Nor was it the whole story that I was “just hormonal”. Something inside me had changed in the last couple of years and something was happening throughout my menstrual cycle to make me feel like two completely different people. Only recently, it had gotten much worse.

The Fighting Bell Rings

In one corner: a woman full of radiance and quick to smile. She can be so full of love inside herself to the point of bursting. She is centered and enthusiastic, bright and cheerful, optimistic and strong. She’s not perfect, of course, but she’s so okay with that. She’s on top of her thoughts and more than willing to be alive. She is excited about projects and new ventures…even if they are challenging. Anything seems possible…anything reasonable, that is. (She isn’t about to jump off a building or into traffic.) She believes in an abundant universe and that she has something to offer the world. She enjoys the company of others and lives to laugh, create, and feel gratitude. She would never dream of hurting herself or anyone else. She may have bad days, but she recovers quickly.

In the opposite corner: a bedraggled, wild-haired psycho who has to apply every ounce of her will to not lash out…though she eventually does, usually by imploding on herself or exploding at those closest to her. She is the wily animal who shudders at her own hateful attitude as she mourns the loss of her other self. She is the one who simply CAN’T control anything. She is full of shame for her inability to control herself. After all, hasn’t she learned anything? She cannot forgive or forget. Everything is the end of the world. She stomps to feel she exists, yet the very force of her enraged feelings lifts her off the ground. There is no justice, no joy, no purpose, and no comfort to give or receive. All is bullshit. She isolates to protect herself and others from this “thing” that has overtaken her, but life pokes and prods all the same.

Eckhart Tolle, author of The Power of Now, talks about the pain body in his work which comes close to matching the insane being that shows up in my mirror every month. There’s also this idea in spiritual circles about embracing and integrating the shadow-self. I wholeheartedly agree with the importance of doing that. It’s powerful stuff, but I don’t think it is the whole story for me. Always favoring the holistic over the quick fix, I’ve been exposed to a lot of different teachings in my quest for well-being. But none of them have satisfied this itch under my skin that what I was dealing with wasn’t just some egoist resistance on my part, wasn’t just some weakness in my character, lack of awareness in my being, or deep wounding from childhood . In fact, I have LOADS of awareness and more strength than a lot of people. So, something wasn’t jiving.

Something else is going on. Whatever it is, this pain body feels universal…not personal…yet it attacks in a personal way for sure. It isn’t a permanent state of being but it is one that, when I’m in it, feels like the only state of being I will ever know. Sometimes, it turns on a dime…a cruel word, a task gone wrong, a frustration or irritation that sends ever-widening ripples of tension out into my environment…but, and here’s the key, only at certain times within my cycle.

What I’ve discovered is the term PMDD or Premenstrual Dysphoric Disorder. Though I don’t agree with a lot of the psychological/medical establishment bullshit (excuse my language…but let’s call it what it is) behind it, it has come closer than anything else I’ve ever encountered to explain what’s been happening increasingly so with me since going through a period of intense and prolonged stress.

I feel like I have to start by saying that I’m not interested in excuses for bad behavior. I’m not looking for a convenient explanation for bouts of anger or anxiety or anything else. I’m not trying to protect my identity as a “got my act together--no problems here” person, nor am I holding my shadow aspects in a closet of denial. I’m not interested in using the label of PMDD to explain away or justify crazy-making, just as I’ve never been interested in the label of “depression” to explain away unexamined pain and the absolutely natural waves of ups and downs that society would rather call a disease than a sign of being human in the world in which we live. What interests me about PMDD is that elements of it actually fit and explains myself to myself.  What fascinates me is that there are other women who feel like I do…that it is a real phenomenon to be examined and explored. It is a real phenomenon to be healed.

I’ve joined a couple of online PMDD groups, and what I’m noticing is that a lot of women feel they have no choice but to treat PMDD with very toxic antidepressants and hormone-related treatments that further disturb the delicate balance of the body. Some even decide to remove a part of their bodies, having hysterectomies, and are overjoyed with the results. I know many women get absolutely ill with vomiting. Why is the newly established “disorder” which was recognized in 2013 seem to be increasingly prevalent? I have my own theories circling around my head…the poisoning of our food supply perhaps or our increasing exposure to radiation and toxins. Who knows?

For me, it is mostly a mood challenge though I also get headaches, stomach aches, sleep disturbance, and other physical manifestations. Nothing like vomiting, thankfully. I feel incredibly blessed by and grateful for the management tools I’ve found that are side-effect free and have a great deal of sympathy for those who are buying into the system of big pharma (whose sole interest is to get everyone on their drugs regardless of whether it actually helps or even does more harm than good) and a patriarchal medical system (with a track-record of locking women away for their complaints). We can be products of the system that would call us “mentally disordered” offering us only what they deem as the answer or we can access inner qualities we can cultivate to cope and turn to more natural therapies until we discover what combination works for us. I know what my choice will always be. And that means that sometimes, I choose to live with a very difficult, very challenging state of being with very little outside assistance at my disposal. So be it.

Not just regarding treatment, PMDD is a hot topic of debate. In addition to being controversial in the medical community, there is, as with all conditions, a lot of general ignorance around PMDD. As I mentioned, it’s only been acknowledged since 2013. Right away, people assume it is PMS with a different name or an excuse for why a woman suddenly gets bitchy, tired or crampy. Or they draw other ill-informed conclusions. One woman made the mistake of sharing her condition with her employer to be told they feared she posed a threat to either herself or coworkers at work. I suspect there are people in their employ at far greater risk of flying off the handle, the ones they’d least suspect. Others are told, even by well-meaning friends, that it is all in the head and are told to chill out or get over it or try some quick fix. Clearly, those who don’t experience it are not in a position to offer advice!

Here’s the thing about PMDD. We may think about bludgeoning judgmental, self-righteous ignoramuses who think they know all the answers, but we tend not to act on it. Good thing, because there are plenty of them around.

Just as I have been (unprofessionally) mislabeled before discovering what is known as PMDD, I am sure there are women ascribing their behavior to PMDD when it truly belongs in another camp altogether. Supposedly, 40% of women who seek treatment for PMDD may have either what is known as PME (premenstrual exacerbation) or even an underlying mood disorder such as bipolar. It’s complicated. Of course, the professionals will continue to debate if any of this is real or not, some kind of anti-female rhetoric or not, or whether it is a mental disorder or not. This just muddies the waters, but what’s to be done? Human beings are intricate and unknowable and this “dis-ease” is extremely complicated because there are so many variables! In the meantime, there are those of us who live the spectrum. There are those of us who know.

Speaking of the spectrum…

There is PMS, the catchall that pertains to the mild, acute fluctuations of mood, irritability, fatigue, appetite changes, and cramping that affect 30 to 80% of menstruating women. It may be uncomfortable, but it is not generally debilitating.

There is PME. This is when a condition from which a woman suffers, such as asthma or an eating disorder, is worsened during PMS. So, PMS disappears after one’s period whereas PME symptoms merely improve.

Now there is PMDD which affects 3-9% of menstruating women. (With a female population of over 3 billion on the planet, 3-9% of those with periods is no small number!) With PMDD, the symptoms associated with PMS become debilitating and can include: depression or hopelessness, anxiousness, irritability, low energy, lack of interest, sleep and focus disturbance, loss of control and feelings of overwhelm, and suicidal thoughts. These symptoms tend to intensify as a woman nears her period and finally begin to abate a few days into her period. Women with PMDD generally feel themselves again for 7 – 10 days after their menses before entering the cycle again.

I’m not crazy about another label…another diagnosis…especially one categorized as a depressive disorder which, to me, shows very little understanding of the scope of symptoms different women have. I’m not crazy about listening to “experts” tell me about myself and never have been. What I am interested in is knowing my own truth for myself, suffering less, finding ways to cope and relate, and living as fully as I can. And I want to help other women reeling with this monthly curse and feeling that they are robbed of half of their lives to do the same.

Do I believe in PMDD? Not as boxed-in psychological babble and checklists, certainly. I’ll never see a doctor for it myself. But it is a condition with which I resonate with unquestionable certainty. I’ve charted my cycles. I know when “the shift” is about to occur. I know when it is over. I know it is linked to my cycle. I know the changes I feel are described by other women who think they have PMDD, too. I know the challenges such changes bring and the impact they have on my life. I know my perspective goes out the window. I know some months are worse than others. And I totally relate to the increasing amplification of symptoms as I near my period and that feeling of complete and utter relief when suddenly the sun is shining again a day into it.

Maybe we need another word for it…one not bound up with so much baloney…one immune to the twisted machinations of men who hate women and women who hate themselves. I don’t know. Here’s what I do know: this is my experience. Maybe it won’t be mine in two years. Maybe it wasn’t mine two year ago. But it is mine now. Bravely facing that self and being open about it with others going through the same experience is crucial. There is power in numbers, and we’ll learn more by exploring this together. If nothing else, maybe the diagnosis of PMDD will simply prove to be a means for women to talk about what being alive as a women today is like for them. That itself is a relief.

Liana's note:  The above guest post was written by the blogger Cheekyminx. With her permission, several of her posts about PMDD are featured on this blog. 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.

The Voices of PMDD, A Guest Post on Shattered Dreams

Continuing with my Summer of 2014 Voices of PMDD series, here is a post written in 2012 by a woman with PMDD that addresses the reality that what you see/experience of PMDD from the outside, as a partner, friend, colleague, or family member, is only the tip of the iceberg compared to the devastation that is going on inside the mind, body, heart and spirit of a woman with PMDD.  

Aside and apart from the episodes of PMDD themselves, there is no way on earth to measure/account for/quantify the cost of the shattered hopes and dreams of PMDD women (and our loved ones) due to our PMDD.  The fallout from these broken dreams is something a woman with PMDD has to deal with every single day of her life--not just during an episode.  The weight of our perceived failures, while staggeringly heavy when we are not in the PMDD zone, can prove unbearable during an episode.  This, I believe, is a good part of what leads to suicidal thinking. 

That said, I give you "The Hidden Injury of PMDD"

“I wanted to quit because I was suffering. That is not a good enough reason.” – Ted Corbitt

I almost decided not to write about PMDD.  The thought of sharing what is considered a mental weakness leads to an automatic assumption that I am a little off my rocker.
 
No one intentionally judges someone with bi-polar disorder or depression.  It is a slight shrinking away from the unknown and the unstable.  PMDD is similar to being bi-polar.  The difference is the consistency.  PMDD will hit every two weeks like clockwork.  About every third cycle, in my case, it is so severe I have to talk myself out of suicide.  My muscles and joints hurt so bad I feel my bones will crumble if I move too fast. Typing hurts.  Rolling over hurts.  The sadness is so deep there is no hope, no joy, no future.  It is only darkness for days and days.  And right as the pain is going to consume my mind and body, my cycle begins and the world is turned upright again as if the previous two weeks never happened.

It is vicious.  It is destructive.  It is painful and it is never ending.

I am told by those around me I am outgoing, extroverted and can do anything I set my mind to to. That is until they see me fall and wonder what happened.

I was just as confused until September 2011, when it became clear there was a pattern to the insanity.

My husband and I were in the middle of trying to start a photography and real estate business when it became clear we were facing something much bigger than we could have ever imagined.  I would soon discover my ambitions would be pulled out from under me like a ugly, worn out rug.

Up until then, I had hope I would one day shake whatever it was that tripped me up so much.   We thought it was connected to the abuse from my childhood or maybe my walk with God was really weak or maybe I was just a weak person in general.  Maybe, just maybe, if I tried harder, or prayed harder or exercised harder or ate better or something!!!!!  There had to be something I was doing wrong.

After we narrowed the diagnosis, I began facing the fact, I couldn’t do everything I dreamed of doing….and that pain is another post entirely.

I knew something was wrong, but I had no idea the symptoms grew worse and worse as you get older.  It made sense though, as I was moving into my 40’s, why the intensity was growing.
Friends only see me when I can leave the house. I venture out when I have energy and drive. This causes so much confusion when I meet new people.  I am vibrant and joyful at first and when I am pressured into social situations during the “luteal” phase, they see a quiet, sad often “sick” stranger they don’t recognize.

I can’t imagine how it is interpreted.

I cancel coffee dates, go two weeks without answering my phone, drop out of obligations I make during my good weeks.  I’ve since learned the crash will come and I have no business volunteering, working, serving or reaching out to anyone.

I’ve lost jobs, quit jobs, started and quit businesses, started and quit homeschooling over and over, lost friends, went on uncontrolled spending sprees, started arguments and walked away from relationships to save them from myself.

I wish at times, I had a physical ailment.  A limp, a scar, a broken bone or even cancer.  At least then, when someone met me they would have evidence of my disease.  They would be able empathize and process the injury in their own mind.

Instead, the injury is inside my mind.  It is not visible unless you live under the same roof.
It is hidden behind a mask I wear everywhere I go.  I can’t escape from the betrayal of my mind and body every month.  It is always taunting me…always waiting silently to paralyze me yet again and destroy everything I begin to build.

I’ve learned not to build anymore.  That is what hurts the most.

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 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:

Acne                      

Allergies

Arthritis

Asthma

Bipolar Disorder

Blood Sugar Problems

Chronic Fatigue Syndrome

Depression

Dysthmic Disorder

Eating Disorders

Endometriosis

Fibromyalgia

Headaches

Hypoglycemia

Insulin Resistance

Irritable Bowel Syndrome

Joint Pain

Lupus

Migraines

Panic Disorder

Peri-menopause

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:

Euphoria

Extreme optimism

Inflated self-esteem

Poor judgment

Rapid speech

Racing thoughts

Aggressive behavior

Agitation

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 :

Depression

Tension, Anxiety

Lability

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.