A PMDD Valentine: Not All Chocolates Are Equal

For Valentine's Day, a post about chocolate (and a few other things), first written in 2009, but updated and still relevant today.

Having come freshly off a week of spending up close and personal time with my evil twin, who kicked my butt so badly the last day she was here I had to take a three-hour nap in the middle of the day, on top of getting a full night's sleep, today I feel uber-qualified to write about how it feels to experience PMDD. The thing is, now that the episode (aka her latest visit) is over, it's the last thing I want to think about.

I look around and see all that didn't get done over the week, the laundry piling up, the floors that need to be cleaned, the clutter of all I didn't feel up to coping with and simply set aside, and would much rather regain some semblance of control over my life—if only its external appearance—than write about the dark place I inhabited for eight full days and change this time around.

Why such a long visit this time? I think I know. I think it had something to do with my recent road trip: the stress of travel, the staying up later than usual, sleeping in strange environments, the change in diet, the miniscule amount of alcohol consumed, although in comparison to my usual alcohol intake, it was a big jump. Add that to the copious amounts of caffeine I consumed while on the road, the pasta-heavy fare at the conference, and I think I'm getting the picture. At home, I'm usually alcohol and caffeine free-or close to it. An occasional cup of coffee, usually one cup of caffeinated tea in the morning, if I feel the need, and chocolate only when "the cravings" come.  I hadn't had pasta or bread in weeks before the conference.

Why? All of these are bad for women with PMDD. Caffeine, alcohol, sugar, flour, hence the bread and pasta. But why am I so sensitive to their effects? I know women who practically live on caffeine and sugar, others who drink freely, others who love their bread and pasta. Is it possible they feel as miserable as I do, or more so, but deny their misery and continue to self-medicate with food and drink?

Because attempts to self-medicate is what these addictions (for lack of a better word) are. My research is showing there are very few true physical addictions in life. Most compulsions are emotionally or psychologically based. Only in rare cases is an addiction physiological.

That's not to say we can't get cravings. But cravings are cravings, temporary urges for some kind of substance to relieve our mental, emotional, or physical discomfort. Cravings are not addictions, although when you are in the throes of one, it can feel like an addiction. But as someone writing a book on dealing with addiction recently pointed out to me, "You're not going to stick a gun in someone's face for a piece of cake."

Cravings are the body's signals that some physiological need is not being met. You're low on some vital nutrient, to be exact. Your body is saying, for instance, "I'm low on magnesium," and you feel a sudden urge to eat a banana, or some almonds, maybe some oatmeal, or, yes, some chocolate.

Chocolate is one of the best known substances we crave. What confuses the issue with chocolate is not only its physical healing properties (of which there are many), but its emotional associations. We associate chocolate with feeling good. But not all chocolate is equal. Some are better for us than others. Much better. Others are almost useless, physiologically speaking. In the example above, a banana would provide as much magnesium as a 1.5 ounce chocolate candy bar, but a handful of almonds or cashews would provide almost three times as much magnesium as either the banana or candy bar.

So why do we reach for chocolate? It's as much for the emotional fix as the nutrients needed. More confusion arises when we don't know the difference between types of chocolate, due to the marketing and advertising claims of their manufacturers. Manufacturers is the key word here. Quality chocolates from true chocolatiers abound with the beneficial properties of chocolate. True dark chocolate is a rich source of flavanoids and antioxidants, with the cacao bean containing more than twice as many antioxidants the so-called superfoods like blueberries, kale, spinach, or broccoli.

It's the cheap, mass-marketed brands that—while they may contain tiny amounts of chocolate's beneficial properties—have processed most of the antioxidants and flavanoids right out of the chocolate. To derive any benefit from eating these lower quality chocolates, you need to eat way more than is healthy for you. When this happens, the negatives outweigh the positives—and you could end up outweighing all your friends.

If that's not enough, did you know that adding milk to your chocolate, or even drinking milk with your chocolate can negate its good effects?

Meanwhile you're bewildered, thinking, "Chocolate is supposed to be good for me, right? Milk is supposed to be healthy for me. Isn't that what the ads say? By eating chocolate and drinking milk, I'm doing something good for my body, right? So why do I feel so miserable?"

Because all the chocolate in the world isn't going to solve your problems, honey, and while I may crave it like mad at times, neither is it going to make my PMDD go away. For all its mood-enhancing abilities, even the finest Belgian chocolate won't "cure" dysphoria.

Dysphoric is the opposite of euphoric. Euphoric means happy, dysphoric means depressed. As in depression. But only pre-menstrually, which I suppose can be considered a blessing.

In some atypical cases, however, the dysphoria can come AFTER a woman begins her period. Lucky me, I'm atypical. Mine usually starts on Day 3, if it's going to come. It doesn't always come. Which is what drives me batty, trying to keep on top of what I need to do—or to avoid—to keep it from returning.

I lead too full and rich a life to keep being knocked flat by this unwelcome change in my body. It makes me feel like I'm constantly behind—on everything.

As women, we all know "it will never get done," but to have something come along and steal a full week or more out of your month, something that no matter what you do or don't do seems to be totally beyond your control...it's more than frustrating. It's crazymaking.

I'm here to tell you you're not crazy. I'm here to tell you there are scientifically proven physiological reasons for why you crave the things you do—like carbs—and what happens to your body as a result of that. I'm here to tell you there's help, and hope, but it's far from easy, living in a body that seems to have a will of its own at times, and a manufacturing and marketing culture that promotes unhealthy foods as healthy because of their base ingredients, while completely ignoring the toxic effects of their processing processes.

That said, the first step is to forgive yourself for falling short of your own expectations, and to understand that what is happening to you is as involuntary a response as an allergic reaction. You cannot control it. You can try to soften it, to be sure, by living a universally healthy lifestyle (once you understand what that truly is) but you cannot control it.

Nor can you deny it and simply plow through it, as most women do. We have commitments, responsibilities, schedules, and deadlines. We have people counting on us to be there for them.

But first, we have to learn how to be there for ourselves. My book PMDD and Relationships, addresses this topic in detail. I can hit on a subject here and there in a blog post, but the book...the book covers it all, from start to finish. And if you are a partner here looking for information about PMDD and how to live with the woman you love: PMDD: A Handbook for Partners is for you. Click on the book covers in the sidebar for more information.

So be good to yourself today, and every day, and when it comes to chocolate—insist on the good stuff. 

Because you are most definitely worth it.

Happy Valentine's Day, all!

Remember: When it comes to chocolate, the darker, the better.  You might have to work your way up to it (I'm now at 70% cacao), as it can taste bitter at first.  But the darker it is, the better it is for you (and your blood pressure!).  And don't drink milk with it because that interferes with your body's ability to absorb the antioxidants in the chocolate and therefore dims its beneficial/healing effects.

Liana Laverentz is the award-winning author of two books on PMDD, PMDD and Relationships, and PMDD: A Handbook for Partners.  Both books are based on the most asked questions by her readers, and therefore the most popular posts on this blog. Both books are also an excellent resource for understanding your PMDD and for starting a meaningful conversation with loved ones who want to know more about this debilitating disorder we live with daily.   More information on PMDD can also be found on Liana's Facebook page, Living with PMDD.

PMDD, Prostaglandins, Pain, and YOU

How do our bodies experience pain?  Through chemical messenger hormones called prostaglandins that exist throughout the body (but do not physically move around in the body—despite being called messenger hormones).  Prostaglandins pass messages of pain to the brain.  Basically, they take care of their own little backyards, and do their work, good or bad, without straying too far from the cells that created them.  

So...If you could find a way to cut these "chemical messengers of pain" off at the pass, your brain would not register your pain. 

Sounds simple, right?  It is.

Even better, if you can keep your prostaglandin production in positive balance, there won't be any menstrual pain messages for your body to send. 

First, some important background:  Just like with cholesterol, there are two main types of prostaglandins in our bodies.  (Actually, there are three, but let's keep it simple.)  And just like with cholesterol, there are good and bad prostaglandins.  Sort of like Dr. Jekyll and Mr. Hyde, a reference every woman with PMDD understands.

The short version is:  Series 1 (and 3) are the Good Guys, Series 2 are the Bad Guys. 

The Bad Guys are also called antagonistic prostaglandins.  Think of it this way: They antagonize your body, making it, and you, feel uncomfortable. 

Antagonistic prostaglandins are made from a fatty acid that comes from ANIMAL products.  We're talking meat and dairy here.  These bad-for-you prostaglandins can also be found in corn oil, soybean oil, and other light vegetable oils.  (At least one of which is in most, if not all, processed baked goods.  I point this out, because PMDD women tend to flock to baked goods (aka carbs) when having an episode.)

So what are these prostaglandins anyway, and why do we need them?

Have you ever touched a hot pan?  It's prostaglandins that let you feel that pain.  Have you ever burnt or cut yourself and then stared at your hand for a split second, knowing you did something painful, but it hasn't kicked in yet?  And then it does...like wildfire?? 

That's your prostaglandins rushing to the rescue, while telling your brain to make sure you move away from the danger, and starting clotting procedures to save the burnt/cut/bruised part of your body.

This is a good thing.  Something we all need for survival.

Prostaglandins are a subset of a larger family of substances called eicosanoids.  Eicosanoids are hormones that help with regulating different body processes.  As a side note, eicosanoids are found in chocolate.  Could this be why we reach for chocolate to dim our pain?  Is it possible that in craving chocolate, we subconsciously seek a way to create some good prostaglandins?

Prostaglandins help with many things, such as:

Blood vessel dilation

Muscle contractions

Inhibition and promotion of blood clotting

Regulation of secretions, including digestive hormones

Cell division and growth

Body temperature regulation

Lowering (or raising) blood pressure

Immune system responses

PMDD women are mostly concerned with the first few on the list above.  In addition to those, we need prostaglandins for several more reasons, including ovulation, ending our monthly menstrual cycle, sperm motility and fertility issues, immune system interactions, and uterus contractions in childbirth and when we menstruate.

For instance, there's a normal surge of prostaglandins at the end of your menstrual cycle, which causes your period to come.  And those painful contractions and cramps you get during your period?  The ones that radiate down your legs into your thighs, knees, calves, and even into your feet?  The kind that make you want to vomit, they're so intense?  That's your prostaglandins in action, as well. 

So why do our uterine muscles even have to contract? To help us shed our uterine lining during menstruation.  The problem is, some women release more Series 2 prostaglandins than other women.  These higher levels of Bad Guy prostaglandins create more cramps and PAIN.  And yes, unruly prostaglandins can even cause constipation, diarrhea, and/or a fever at that time of the month. The first two because prostaglandins can affect the muscular movements of your intestines and the third because of prostaglandins' connection to fighting infections and regulating your body temperature.

Tell me something good about prostaglandins, then.

Well, prostaglandins metabolize quickly.  So your body can not store prostaglandins, but instead creates them as needed.

The good news is you DO have a say in what kind are created, Series 1 or Series 2, by your food and nutrition choices.

Since we want the good guys to win, we'll start with the bad.

 Series 2 Prostaglandins (the Bad Guys)

These are produced by trans fatty acids, or trans fats, found in hydrogenated oils, meats, fried foods, junk foods, and dairy products.  There is a special enzyme in our bodies that helps to create Series 1 prostaglandins.  High stress, too much sugar and flour (baked goods) slow this special enzyme down, so that the Series 1 prostaglandins aren't made fast enough, which allows the Bad Guy Series 2 prostaglandins to get the upper hand.

Trans fats are also bad for the structure of your nerve and brain cells, areas in which PMDD women need to be particularly protective.  Trans fats also hamper our ability to create Good Guy Series 1 prostaglandins.

There is much hope though: Series 2 prostaglandins are formed at a slower rate than Series 1 prostaglandins.  So if you eat the right foods and avoid the wrong ones, you can easily tip the scales in your favor and avoid much of your monthly influx of pain and inflammation.

Series 1 Prostaglandins  (Our Heroes)

Series 1 prostaglandins are made from a fatty acid primarily found in fish and fish oils, known as EPA. (The most critical of the Omega-3 essential fatty acids).  This EPA is the ONLY material that our body uses to make the Series 1 prostaglandins that reduce pain and inflammation.  

Our bodies need three types of Omega-3 fatty acids to stay healthy:

ALA - which comes from green plants, and provides the building blocks for EPA

EPA - which comes from marine plants and fish, and provides the building blocks for DHA

and

DHA - which comes from marine algae plankton, fish and mammals, and are especially helpful for maintaining healthy eye and brain tissue (something I am especially delighted to hear).

And here's more good news:  The essential fatty acids found in olive oil and nut oils, while they don't make/create Series 1 prostaglandins, they do block the paths of your Series 2 Bad Guy prostaglandins.

 

Here are some more items you can stock up on to help combat your Bad Guy prostaglandins:

(and I'm not talking about any heat-processed stuff you get off the shelf...be sure to read your labels!)

evening primrose oil

naturally fermented fish oil

flaxseed oil

borage oil

starflower oil

a high quality Vitamin B-complex vitamin (B vitamins are essential for creating Series 1 prostaglandins)

with an extra dose of Vitamin B-6 on the side for your PMDD

Most of these you have heard of before as being beneficial during an episode of PMDD.  Now you know why they have been suggested.  And get this: painful menstrual cramps are not considered to be a symptom of PMDD, but rather PMS.  You can indeed have both PMS and PMDD at the same time.  You can also reduce your symptoms of PMDD until all you have left is PMS.  But cramps?  That's pure PMS.

Other ways to combat Bad Guy Prostaglandins:

Aspirin and other NSAIDs do block prostaglandins produced in inflamed or injured parts of our bodies.  These NSAIDs also act on prostaglandin sites in the central nervous system involved in transmitting messages of pain.  This is why ibuprofen is usually the drug of choice when the cramps begin.   

However:  The enzyme bromelain from the stem of the pineapple has been proven to inhibit the Series 2 prostaglandins and reduce pain at a much higher rate than that provided by painkillers. 

This is great news, especially because of how toxic NSAIDs are to your gastrointestinal tract.  At a minimum, NSAIDs can cause erosion of the stomach lining and ulcers, and at a maximum, death by gastrointestinal bleeding without warning.  PMDD women bleed enough.  God knows we don't need to bleed any more.  NSAIDs can also raise your blood pressure and push you along the path to heart disease, the number one killer of women.  More on NSAIDs in another post.

Why this Prostaglandin and NSAIDs information is important to you, outside of your PMDD

If your body is not in balance, and you have too many Series 2 prostaglandins, you can be susceptible to diseases linked to excessive inflammation (such as heart disease, cancer, diabetes, and Alzheimer's) and/or developing blood clots, which can also lead to strokes and death.  The latter connection is especially dangerous for women taking birth control pills for your PMDD, or HRT for perimenopause.

So, to recap:

Your prostaglandins will do the job they were meant to do.  What type of prostaglandins your body creates is entirely up to you.  The fuel (or fatty acids) your body uses to create prostaglandins (as needed) builds up in your body over time...so you want to make sure you have the right fuel on hand when the time comes.

Series 1 prostaglandins have the opposite effect of Series 2 prostaglandins.  Series 1 prostaglandins reduce inflammation, dilate blood vessels, and inhibit blood clotting.  They help us to recover from injuries by reducing pain, swelling, and redness.  They are part of our natural defenses against infection. 

Series 2 prostaglandins are created in response to trauma or stress, including trauma or stress on the body created by our food and drink choices.  Series 2 prostaglandins supply blood to the traumatized area, which in turn causes inflammation and pain.  On one level this is a necessary protective measure for injury to the body, but on the other, such as when the Series 2 prostaglandins supply more blood to your uterus, swelling it up and aggravating your cramps, this process works against you.  However, if you have more Series 1 prostaglandins in your system than Series 2, your period can be pain free. 

Basically, your cramps are letting you know your prostaglandins are out of balance. 

What, specifically can you do to put things back in balance? 

Well this is the part nobody wants to hear, so if you want to keep on having cramps, stop reading now. 

Otherwise, to cut down on the amount of Series 2 pain-producing prostaglandins only you can create in your body through your food and drink choices...

Avoid these top ten culprits.

1.  Sugar

2.  Wheat

3.  Caffeine

4.  Soy

5.  Alcohol (which also depletes your vitamin B levels)

6.  Dairy products, especially milk and cheese. 

7.  Red meat (plus that steak you so love may well contain growth hormones that include estrogen, another big problem area for women)

8.  Saturated fats and oils - palm oil, butter, margarine, lard, and fried foods (especially when eating out, where you have no idea what kind of oil they used.)

9.  Refined carbs - white bread, pasta, flour, pastry, and cakes. Stick with whole grain breads and pastas, etc.

10.  Food additives and preservatives  -  Virtually anything processed, frozen, and or pre-packaged for your convenience.

You don't have to give these up, but if you don't, the cramps will continue to come. It's that simple.

At least now you will understand what causes cramps, and understand that the key to making your period a lot less painful depends entirely on YOU.  

The Voices of PMDD, She's Just a Devil Woman

I posted Juliet's story once before, but then moved it to another page, and am now moving it back again, as I am rearranging my blog.  So, if you think you have read this before, you may well have, but it is well worth reading again.  If you are new to my blog, then welcome.  Once you read a few pages, you will learn you are not as alone as you might think you are, but in very good company!  Thank you so much, Juliet, for sharing your story with us, not once, but twice! 

She's Just a Devil Woman

Today, if you’ll forgive me, I’m allowing myself a small indulgence, little bit of self-therapy if you will. I’m having one of my PMDD days. Have you ever had that feeling that some other power or entity was taking control of your mind, orchestrating your feelings and directing your actions? Well, I get that once a month, and it’s never a positive experience. Thanks to a complicated cocktail of brain chemistry and raging hormones, on a four-weekly basis I find myself mutating into a fearsome, irritable, totally unreasonable monster.

Now, the vast majority of friends and not-so-close family will probably find this quite unpalatable. Most of them know that I pride myself on trying to keep an air of affability and co-operation, in fact my job demands that I maintain this, and 90% of the time, this comes as the result of a heartfelt personal passion that people are nice, deserve a fair break and should be treated with kindness. 

I’m so glad that these people don’t live with me.

When the time comes and the internal switch within me trips, you really wouldn’t want to be around me. Ask my family, I border on the psychotic, with episodes ranging from a disgruntled huffiness and tactical withdrawal to an all-out psychotic rage-monster screaming abuse for the smallest infraction.  It’s not something I’m proud of. It’s also something I’m not in control of. It’s called Pre-Menstrual Dysphoric Disorder, what I would only describe as PMT’s Evil Twin. It’s a condition that the medical world has only really started to recognise in the last couple of decades, but, you betcha, it’s been around a long time before then. History is peppered with tales of Mad Women, those possessed by demons and hurled into flaming pits, burned at the stake, drowned on ducking stools or thrown into archaic asylums. I can’t help wondering if a fair majority of these women were fellow sufferers of PMDD, especially as the whole ‘possessed’ moniker rings such a familiar bell. I know that, when I am in the throes of a particular bad rage episode, it feels like the ‘Red Mist’ has come down; I want a fight, but I don’t even know what I necessarily want to fight about. No amount of calm negotiation, reasoning or fair discussion can drag me down from my self-created pedestal of indignation. What makes it all the worse, is that, once the dust has finally settled down and I’ve returned to my ‘normal’ self, the whole episode is nothing but some misty half-memory. That wouldn’t be such a problem had I been the only victim of my angst-ridden screeching, however, it is my nearest and dearest that suffer too. As I slump in my chair, cup of coffee and much-needed chocolate bar in hand, I am forced to face the wreckage  of my emotional explosion- frightened children, an affronted husband and maybe even a terrified cat. It is then that the guilt floods in at the horror and turbulence caused by my ‘other self’ kicks in, and I find myself desperate to make amends. It is this desperation that usually sparks off stage 2 of my condition, the deep, hopeless depair.

A great amount of credit must go to my family for suffering this too long. My children are still too young to understand why Mummy flies into unprecedented rages over behaviours that, sometimes just hours before, elicited nothing more than a wry smile and an exasperated sigh. It must be a very confusing time, especially exacerbated by my repulsion at that time for any unsolicited physical contact. Poor kids, one minute they’re the butt of their mother’s rage, but then the usual offer of a cuddle just doesn’t make it better. As for my husband, well, the poor man has endured twenty years of the monthly Screaming Harpy episodes, and has done me the favour of never threatening to leave (even though he’s been shown the door or many an occasion). Together we have worked through many coping strategies and he has finally seemed to have settled on a vague acceptance and the eternal knowledge that it is only a passing phase. He is, indeed, my rock in the tumultuous seas of my hormone-addled mind, and I am forever grateful for the times he has held me as I weep on his shoulder in waves of remorse asking, yet again, “am I really like this every month?”
My PMDD has ruined more holidays, trashed more days out and screwed up more anniversaries then I care to remember. 

Of course, in this storm, there is a rainbow. Today, the medical world is coming to terms with the fact that such a condition of mine does exist, and we have progressed a long way from being diagnosed with “women’s troubles” and sent away from the doctors with a prescription of “deal with it, it’s part of the wonders of being a fertile female”. Medical experts the world over are still pondering over the actual causes of PMDD, some argue it is purely hormonal, others think it is cerebral. Some again cite environmental and dietary factors. For me, what seems to work best is a daily minimum dose of Prozac. It seems to help a lot, not so much in altogether preventing the attacks of irritability and rage that strike me, but more in allowing me a ‘buffer zone’ between my Jekyll and Hyde, the balanced me and the monster. With this buffer I have the opportunity to examine the causes of my anger for what they really are, and not to pick a monstrous fight over a pointless issue.

The best medical breakthrough for me, however, is not the treatment of the condition, but the recognition. To a degree, I feel vindicated, I’m not entirely mad. There have been many times, believe me, that I truly wondered if I was a mental-case, and therefore better off removed from normal society. That’s what PMDD does to you, it divorces you from your normal, rational self and throws you into a pit of rage and despair. The only positive thing for me, is that it’s a transient thing, relieved later in the month by the realignment of my hormones.  So many women dread the arrival of their period, I warmly welcome it. I cannot begin to understand those who suffer from other mental health problems from which there is no respite,  that must be another level of Hell altogether.

I only wish that this disabling condition had been recognised sooner in my life, and then, maybe, some relationships may have been different. My own mother, with whom I have good relationship today, openly admits that she “hated” me during my adolescent years, a feeling, no doubt derived from my sporadic and undeserved outbursts. Add to the mix an alcoholic father, whose own moods were driven by an entirely different but no less unpredictable ‘chemical’, and no wonder my teenage  home-life was sometimes a difficult and dysfunctional one.

Still, I live to tell the tale and I hope that my own daughter does not suffer in the same way that I did. Although, even if she does, at least I have the advantage of understanding her in the way my own family did not have the capacity for.

Thank you for reading my tale. If any of you are fellow sufferers, I hope you gleaned a small amount of understanding and knowledge that you are not alone. And for those of you who are fortunate enough not to suffer, at least you know when best to avoid me. Or better still, leave large gifts of chocolate at my doorstep before ringing the bell and running for your life!

The Queen of Denial

She’s baaaack! And I’m not talking about me, writing this blog post. I’m talking about The Alien, or my PMDD self. After several months of relatively mild episodes, suddenly I’m hit with a humdinger. You know from my previous post, A Perfect Storm of PMDD, that I am one of the unfortunate many who have atypical PMDD, in that it occurs both before and after I menstruate. Kind of like a hurricane, with menstruation in the middle, serving as the eye of the storm, where I might feel lousy physically, but I’m clear-headed and things are relatively calm.

So, about ten days ago, I could feel a storm blowing in. I notice I’m starting to get agitated about things that don’t usually faze me. I realize I am emotionally looking for a fight, anywhere I can find it. I check the calendar, confirm it’s about that time of the month, and warn those closest to me that it may be a rocky few days. I back away from conversations and situations I know will set me off, and postpone any important decisions or discussions for a few days.

The storm came and went, no major incidents, other than a couple of afternoon naps due to extreme sleepiness. Menstruation started, and life was good again, aside from the physical discomforts of having a period. Usually, the second half of my PMDD begins on Day 3 of my period. So when Day 3 came and went with no trouble, I thought I was in the clear, home free, another PMDD episode averted. Kudos to me once again for not letting my PMDD get the better of me and wreaking all sorts of havoc in my life and personal relationships.

But this was not my usual period. This one lasted six days instead of three. Not a problem. I’m okay. Life is still good.

But then yesterday morning, I started noticing things. Like I tried to address an envelope, and my handwriting was all jumpy and spiky. My hand couldn’t control the pen the way it usually does. My typing was off, too. Kept hitting the wrong keys.

No matter. I’m just in a hurry.

Then I went to a funeral, at a church I had never been to before. I got lost. Suddenly I’m feeling anxious, confused, and my thoughts are scattered.

No biggie, it can happen to anyone.

At the funeral, all I wanted to do was weep.

Not a problem. People are supposed to be sad at funerals.

I came home, fixed myself something to eat. I work at home (in part due to my PMDD), so I started to work in my sun-drenched living room.

Suddenly I couldn’t keep my eyes open any longer.

Nothing unusual there, I told myself. The room was warm and I had just eaten.

Never mind that the room is equally warm and sunny most days, and I eat lunch every day about the same time and don’t get sleepy.

Finally I give in and take a nap, unable to concentrate or stay awake. It still hasn’t dawned on me, what is happening.

I wake up, totally ravenous, and wanting nothing but CHOCOLATE.

Still haven’t caught on. Or if I have, I’m in denial. I don’t have time for this nonsense. I have work to do.

A friend calls. We’re supposed to meet later on, go to Qigong class together. I want to know how soon “later on” is. Is it 4:30, 5:30, 6:30? If it’s sooner rather than later, I’ll wait to eat with my friend. If it’s later, I’ll eat now. No big deal either way, I just want to know, so I can plan my evening accordingly.

Somehow that simple conversation goes totally awry, and I end up in tears.

Bingo. The Alien has struck again. Now I know what’s going on. My PMDD has returned for round two. My head hurts, my eyes hurt, all I want to do is cry, and go back to sleep. But I’m too agitated and upset to go back to sleep, and I’m so effing hungry I want to scream. But I just ate a full meal a couple of hours ago. There’s no logical reason to be so hungry.

My friend calls back to see if I’m all right. How do I explain that everything is fine…but it’s not? How do I explain PMDD? This isn’t the type of conversation you want to have over the phone. It’s best that the other person can see the glassiness in your eyes, the exhaustion on your face, the lack of energy and slump of your body.

I fix something to eat (healthy carbs!) and work on a small project that only needs minimal concentration for an hour or so.

My friend arrives, and I try to explain what happened. He asks, “What can I do to help?”

The only answer I can come up with is, “Just be nice to me. I’m fragile today. Oh, and you might need to run interference for me at class. I’m not feeling very social right now.”

We go to class, and all goes well. I manage to muddle through the social aspects of class. The Qigong exercises get the blood circulating, produce the necessary boost in endorphins and serotonin. By the end of class, which was the absolute last thing I wanted to go to—I’d much rather have crawled back into bed and tried to sleep away my exhaustion—I was feeling 100% again, and had bought myself a couple of PMDD-free hours.

Because in my PMDD-induced confusion and misery I had forgotten what I could do to help myself. Light aerobic exercise. When I’m in the throes of a PMDD episode, and the last thing I want to do is get up and move, that’s the very thing I need to do. A simple walk is all it takes. After about 30 minutes, I start to feel better. By 45, I’m back on an even keel. An hour of any kind of light cardio activity and all symptoms are gone…

For about two hours.

So by the time I got home, I was back to being myself again. A totally different person. I was able to make it through the rest of the evening without incident.

But as soon as I opened my eyes this morning, I felt that heavy wet blanket of depression closing in on me again. The iron band around my head, the irritated eyes, like I’ve been crying (but I haven’t), the mental fuzziness, the sense of exhaustion even before I get out of bed.

There’s no denying it this time. It’s going to be another PMDD day.

Liana Laverentz is the award-winning author of two books on PMDD, PMDD and Relationships, and PMDD: A Handbook for Partners.  Both books are based on the most asked questions by her readers, and therefore the most popular posts on her blog, Living on a Prayer, Living with PMDD.  Both books are also an excellent resource for understanding your PMDD and starting a meaningful conversation with loved ones who want to know more about this debilitating disorder we live with daily. 

Taken By Surprise...

This has been an odd month for me. After a couple of years of only experiencing PMDD symptoms every few months--due to the onset of menopause--for the past two cycles I’ve been back to my regular clockwork schedule of symptoms and a refresher course of how miserable PMDD can be.

But now, I also know how to manage and minimize it. I now know I am not my PMDD, and my PMDD is not me. After nearly forty years of cycling through it, being buffeted by first regular, then random storms of PMDD, I have finally learned to separate myself from my PMDD.

To do that, however, takes a great deal of self-attention and self-awareness. You have to listen to everything your body tells you. The body never lies.

But a PMDD body does lie. Imagine that. Your own body lies to you.

No wonder you feel like you’re going crazy sometimes.

I am a very much a positive thinker. Calm, creative, goal-oriented, and optimistic. Generally I sail through my days without a problem. I don’t sweat the small stuff, and half the time don’t even sweat the big stuff. Life has a way of working out for me, and for that, I am grateful. The more it happens, the more I learn to trust—to trust in myself and my higher power—that all choices made from that quiet place within me can be trusted and will lead me to good and positive outcomes.

So imagine my surprise last week, when a day I had willingly chosen to give over to helping a loved one get the medical help he needed, for me turned into an endless loop of mental frustration. What is this? I kept asking myself. This day is no surprise, and I chose to spend it this way, and yet….

And yet I can’t seem to stop the thoughts of anger, resentment, and frustration from welling up inside of me.

I did not let them out. I knew well enough that the person I was spending the day with was not the problem. But Lord, how I wanted to. Just wanted to let loose with every negative thought on my mind. We even joked about it.

Did you catch that? I was able to joke about my feelings in the midst of a PMDD episode.

And I didn’t even know I was having one. I just knew something was “off.”

It wasn’t until the following afternoon that I began to suspect it was PMDD. Thursday morning I procrastinated until it was too late to leave for my Qigong class, which I absolutely love. There’s no reason for me to miss the class, as everyone there knows about my PMDD and accepts me as I am. They welcome my arrival no matter what my mood, which I often announce upon coming in the door.

“Brain’s not working right today,” I will say, and everyone will know I’m a little off my stride.

So I skipped class—all the while asking myself, “Why would you skip something that brings such good things into your life?”

Remember, PMDD doesn’t make sense. It just is.

That afternoon, I found myself unable to focus on what I needed to be doing. My handwriting was off, and I kept getting distracted by the latest shiny thing—a new email, a new link to explore, a phone call to answer, a note to write, a snack to make.

Speaking of snacks, suddenly, for the first time in weeks, I wanted chocolate.

Should have been another clue, but I wasn’t thinking PMDD yet.

Not until the next morning, Friday morning, when I literally did not want to wake up. I swear to you, it felt exactly like when I woke up to a carbon monoxide leak in my house last November. Debilitating, bone deep lack of motivation and fatigue. All I wanted to do was sleep.

The phone rang and I dragged myself out of bed. An hour and a half later, I’m still yawning, yawning, yawning. It took extreme effort to keep my eyes open. Coffee didn’t help. At all. I don’t normally drink coffee, so if I do have a cup, the effect is immediate.

Not today. Not a blip of relief. I felt like I had an iron band around my head, my tongue was made of cotton and was also thick and swollen (which is one of my PMDD symptoms—allergy aggravation), I couldn’t get enough water to drink, and I was ravenous both before breakfast and less than an hour after.

I finally realized I wasn’t truly hungry…I just wanted to eat. Believe it or not, there is a difference. My stomach was full. But my brain was sending distress messages. What those messages were, I have no clue, because there was nothing distressing that I know of going on in my life—you know, like the kind of situation that spurs emotional eating…

I just know the signals my brain was sending were manifesting as a nearly overwhelming desire to eat.

It was hard, but I didn’t succumb. My food charting (another experiment I hope to share the details of some day) told me I had already eaten as much as, if not a little more than, I had on any other day. So this was not true hunger. This was my PMDD talking, not me. I was not hungry. The chart clearly showed that on any other day, I wouldn’t have been the least bit hungry…and believe me, I am not one to deprive myself of basic nutrition, because I learned long ago that it will only make my PMDD worse.

So I compromised with my PMDD, and spent the day sipping my favorite chocolate drink, because suddenly all I wanted was chocolate.

I did, however, go to bed really early that evening, in deference to my fatigue. Added to that was now a strange aching in my legs, all the way down into my arches.

What had happened? Had I pulled/strained a muscle somewhere? Somehow? How could I, when I’d skipped class on Thursday? It didn’t make sense.

I woke up 12 hours later, still sleepy. Still ravenous. Still wanting chocolate. Still aching.

Okay…by now I am beginning to realize what is happening here. It must be my PMDD. By noon it was confirmed. I started spotting.

Suddenly everything that happened the previous three days made complete sense. The strange and unreasonable irritability on Wednesday, the clumsiness, disorientation, and inability to stay focused on Thursday, the lack of motivation, intense lethargy, fatigue, and ravenous appetite on Friday. The chocolate craving, the sensation of an iron band tightening around my head, the urge to weep, the dull ache in my legs.

I continued to eat normally, despite the ravenous hunger, sip my favorite chocolate drink, and headed off to the gym to walk around the track, even knowing it was the last thing I wanted to do. But exercise had helped before, and I wanted to experiment, wanted to see if there was actually something I could DO to make it better.

The first twenty minutes I felt like I wanted to vomit. No lie. Around the half hour mark, I started to feel a little better. By the 45 minute mark I was heading back toward an even keel. Came home, made a healthy, carb-laden supper, then went to church.

Things weren’t completely right, however, until I went out for a salty bowl of chicken noodle soup afterward.

Go figure. But for some reason, after the soup, I came home full of more energy than I’d had in three days. I was psyched, ready to take on the world.

Instead I rested and read and had a cup of tea. The storm wasn’t over yet; that was just the eye of it. Been here, done this enough times to know this thing comes in waves.

Sunday morning I was dozing again when the phone rang and woke me up. I didn’t have nearly as tough a time waking up as I had on Friday morning. Huge difference between then and now.

Why? The menstrual blood was flowing.

And because of that, I made it to my next Qigong class and the grocery store and was able to focus on a couple of creative projects I needed to complete.

The first wave of the storm had hit, and I weathered it. Mostly by repeating this is not me, this is my PMDD. I am not angry, resentful, mad—that’s my PMDD talking. I am not hungry, that’s my PMDD talking. I have no reason to cry—that’s my PMDD talking.

Unfortunately, there was not much I could do about the fatigue. But getting out for a walk definitely helped with that.

The good news is (except for one cup of coffee) I managed to avoid the quick-fix stimulants that so many of us use to get past our fatigue, stimulants that only make our PMDD hit back even harder. Tobacco, alcohol, caffeine, sugar, energy drinks.

You, too, can weather the storm, whether yours comes in waves, or all at once. It just takes an enormous amount of effort to do so. Not everyone has the time or energy or circumstances to be able to do it. I understand that. I accept that. You need to accept that too, and simply start wherever you are right now.

Start with what you have, start with whatever symptoms present themselves. Try to sort them out like tangled threads. This part is me, this part is my PMDD. I am not my PMDD. I am better than my PMDD. I am stronger than my PMDD. I will not allow my PMDD to define me.

And I will not allow anyone else to define me by it, either.

Because they have never slogged through the storm in my shoes.

Until you know how it feels to have a brain and body that sends basic biological signals contrary to all conventional wisdom and common sense, you will never understand.

To those who do, you deserve to be congratulated and applauded--not dismissed, discounted, and ridiculed.

We are the strong ones, we are the survivors, and we are not our PMDD.

Relationships and PMDD -- Doing Your Part

Last week I posted 20 tips for partners who live with women who have PMDD. While it would be ideal if your partner did all of these things, that’s still only 50% of the equation. You’ve got to bring something to the party as well. As any relationship book will tell you, it takes two to make a relationship—any relationship—work.

So if you’re thinking, “If I just love him enough,” or “If I just (do anything) enough,” it’s not going to work—not without you running yourself into the ground. Relationships are full of give and take, and only work well when each partner gives as much as he or she takes.

Even if you’ve got the best partner in the world, there are still things you can do to make your PMDD episodes run more smoothly. And if your partner is not supportive—then do it for you…because you’re worth it.

1. Chart your symptoms daily. It doesn’t have to be elaborate, one of those pocket calendars will do. Just write a few words each day: anxious, crabby, sad, sleepy, achy, bloated, cravings, weepy, snapped at __________. Use this to get in touch with your feelings and your body. Eventually you’ll discover patterns of symptoms.

2. Consult your chart/PMDD calendar when considering social events, activities, creative or household projects, vacations and such. Making major decisions comes under this heading, too. Don’t set yourself up for failure by taking on something big when you know you won’t be feeling up to it. Don’t just try to slog through your life the best that you can…be pro-active!

3. Learn to recognize when you are symptomatic, and consciously postpone thinking about anything that needs serious thought until you are feeling better. If you don’t, your decisions will be colored by your PMDD, and you may well end up asking yourself, “What the hell was I thinking when I decided to do this?”

4. Understand that if it is not treated, your PMDD will only get worse. It could end up a major depressive disorder and who wants that when you know it can be avoided?

5. Find a doctor who will listen to you. If the doctor won’t listen, change doctors. It’s your life at stake here. No one has as much to gain from finding the right treatment for you as you do. So take an active part in your own health and well being. Don’t just do what the doctor says because “the doctor knows best.” The doctor knows what the doctor knows, and if the doctor doesn’t know anything about PMDD, you need to find one who does.

6. Try whatever you need to try to feel better. If you don’t feel better, then stop whatever makes you feel worse, and try something else. This goes for both medical and natural treatments. If medication works for you, go for it. If it doesn’t, don’t keep hanging in there, thinking it will get better. Your doctor is not you. Your doctor can’t feel what you feel or experience what you experience. Only you can know what works for you and what doesn’t.

7. Do not let anyone make you feel inadequate because something that works for others is not working for you. There is nothing wrong with you if this treatment or that treatment doesn’t work. All it means is you haven’t found the right solution for you yet. PMDD is not a one-size-fits-all disorder.

8. Move your body. Fit exercise in whatever you can, whenever you can. Isn’t a healthy you worth it? Find a few kinds of exercise you enjoy and mix it up so it doesn’t get boring fast. A class here, a walk there, maybe Tai Chi today and Zumba tomorrow. Just put on some music and dance around the house with the kids or by yourself for a song or two. See if that doesn’t put some energy in your step. Park your car a few spaces away from the door instead of in the closest spot. 30 minutes of some sort of aerobic activity a day is best, even if it’s just cleaning the bathroom or carting laundry up and down the stairs, but if you have to start with 5 or 10 minute increments, then start there. Anything is better than nothing.

9. It is essential that you get enough rest. Sleep is when your body re-regulates itself and if you don’t get enough sleep, your body doesn’t have the time it needs to complete its repair job from whatever abuses you subjected it to during the day. (aka substance abuse, smoking, stress, overexertion, poor diet). The more sleep you lose, the harder it is for your body to catch up, and you fall further and further behind each day. This explains why you are so exhausted.

10. Eat healthy. Whole foods, as close to their natural state as possible. Avoid alcohol, caffeine, sugar, sugar substitutes, anything made with high fructose corn syrup (yes, you might have to start reading labels), white rice and white flour, for starters. Start being aware of what you eat, and as you pour that cup of coffee, know you are contributing to your PMDD, and know that you are choosing to do so. Ask yourself, is this candy bar, energy drink, glass of wine, piece of cake worth feeling miserable two weeks from now?

11. Get yourself some high quality dark chocolate for when the cravings come. Not that mass-produced stuff that comes in a bag. No matter how good it tastes, it’s not going to help you like true chocolates from a chocolate store will. There are plenty online to choose from if your town doesn’t have a chocolate store. A bonus is you’ll need less of the high quality stuff to feel better, so you might even lose some weight.

12. If you snap out at someone, stop, apologize, and explain to them that it’s not them, it’s your PMDD. Don’t let hurt feelings fester, on either side of the relationship. If they’re not open to an explanation of PMDD, just say, “I’m sorry, I’m having a bad day,” and leave it at that. Everybody has bad days now and then.

13. If somebody is trying to bait you, walk away. Don’t let their bad mood spark yours. Tell them you’ll be back or continue this conversation when you’re both in a better mood.

14. Ask for help when you need it. If you don’t have anyone in your life who is willing or capable of doing this, find new friends who will be supportive and encouraging. Even if they’re just online. PMDD forums and discussion groups abound. You don’t need to go through any of this alone.

15. Do not let your negative thoughts and feelings get the better of you. Every day, all day long, our minds run rampant with thoughts. Good ones, bad ones, even strange ones. One way to get a handle on this is to learn how to still your mind. But that takes dedicated time and effort. If you’re not at a place in your life where you can take the time out to meditate or practice some form of deep breathing exercise that stills the mind, at the very least, when the negative thoughts come, push them right back out of your mind and refuse to dwell on them. Say to yourself, “That’s my PMDD talking, not me,” and consciously change the subject.

Remember (as long as PMDD is your only problem), you are in control of your mind…your mind is not in control of you (even though it very much feels like it). You need to refuse to give those negative thoughts any air time, because if you don’t, they will loop endlessly through your mind, creating deeper and deeper ruts, until negative thoughts are all you know and you end up with major depressive disorder. This is how PMDD women become suicidal.

Some wonderful ideas on how to mentally shift gears are in this article from Women to Women. The article is about perimenopause, but unless you die first or have your ovaries surgically removed, thus throwing you into instant menopause, you’re headed for perimenopause anyway. Why not learn how to deal with it in advance?

Be blessed, and keep me posted on your progress!