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.

PMDD - After the Hysterectomy

In my first post, I shared what it was like for us in the trenches with PMDD.  This installment, I want to discuss what happened after my wife's hysterectomy, or how we finally got to life without PMDD.

The decision, I remember, was discussed a handful of times regarding whether my partner should have a hysterectomy. I remember us doing a lot of due diligence on the topic, mostly surrounded around her health. We knew we were at peace with the idea that we would no longer be able to have children—we already had two beautiful, healthy kids and we were truly blessed. The larger conversations centered around "then what?" What are the guarantees? What are the potential complications? What if the surgery doesn't work and what would the domino effect be, knowing she just had her entire reproductive house torn down and she still had PMDD?!

The decision was ultimately hers. She decided it was worth the risk of everything we had discussed, knowing the reward would mean so much more.

She had her surgery. It went well and we were told there would be no major side effects, just 6-8 weeks or physical recovery time. All good, right?

Let's harken back to PMDD and how most of us, even doctors, are learning on the fly. I obviously wasn't prepared for the three months after surgery and how PMDD kept creeping into our lives. It wouldn't go down without a kick in the gut, a roundhouse right to the head, and headlock for good measure. One of the hardest battles lied ahead and I was not any wiser to what the hell it was—again my preparation—or lack of it—didn't matter.

My wife fought for three months after her surgery. It was probably just as hard as when she had PMDD. I remember the emotional strain it took on her—how her body would never be the same. How the same place that had housed our children for almost 10 months was gone. It was an emotional rollercoaster. The fights still existed, the threats of divorce were still present, and it seemed at times as if one of my fears had come true—IT DIDN'T WORK!

As each day went by I was looking for a ray of hope. After she was fully recovered physically (try more like 3 months, not 6-8 weeks) some normalcy started to happen and it felt odd. We were always waiting for the next fight to happen. I was always tracking her episodes on my iPhone, trying to prepare for the next hostile takeover. We went back and forth at times really questioning if the surgery worked 100%.

It was a long road back emotionally for my wife post-surgery. It was harder, and took longer than any of us expected. PMDD gave us one last fight and didn't go down quietly...why should I have expected it to?

For whoever reads this, I leave you with this: It can and will get better. There are options for you and your partner. You don't have to live this way any longer. I know it is easier to run like hell than to stand and fight. I chose to stand and fight when at times I wanted to run far, far away.

I leave you with three points to help get you through it all:

1) Remember why you fell in love with her. It will carry you at times through the muck even though the woman you fell in love with might be a shadow of herself during PMDD.

2) It's okay to feel the way you do, no matter how much you might feel guilty for feeling a certain way. Things will cross your mind during her PMDD episodes that will have you questioning your sanity. You will feel like snapping at times. You will feel like doing irrational things just in the hopes that your wrong behaviors or attitudes are not so much payback for PMDD, but a pathway between staying balanced and losing your mind.

Talk about the way you feel with others even if they might not fully understand it. Just letting it go and letting out a good cry is also therapeutic. Don't hold it in. Find an outlet for yourself too. Your health still matters.

3) Lastly...Don't give up. She needs you still. She is fighting a swarm of demons that she doesn't want around. She doesn't want this any more than you do. [Whichever treatment option(s) you choose] Work towards achieving healthy solutions for both of you. There are solutions out there. Do your homework, reach out to PMDD survivors and their peers, and never, ever give up Hope.

You are stronger than you ever realized, partner, and God wouldn't give you anything you couldn't handle. Call it cliché but it's true. You were built for this for now, but it is not yours or hers to live with forever.

Liana's note: For more information on the basics of PMDD, please read my posts Dealing with PMDD - Advice for Men, and Confusion City.   Also worth reading are Top 20 Tips for Dealing with PMDD, and More Tips for Men Whose Partners Have PMDD.  All four posts are included in my book PMDD: A Handbook for Partners.  For those who prefer to have all this information (and much more!) in one convenient place, it's the book with the blue cover at the top of the sidebar. 

PMDD - One Woman's Prayer

Below is a poem written by a young woman before she had children.  I asked to post it here because I spent many years hoping the same--and for the very same reason.

I Hope I Never Have a Daughter

I hope I never have a daughter

I don't want to see her cry

I don't want to have to tell her

That sometimes there are no reasons why

Why you feel completely alone

And that no one really cares

Why you cry yourself to sleep at night

And, get angry/upset unawares

Other people just don't get it

But your Mama she understands

Because she went through the same thing

And will be there to hold your hand

Some people just think it's an 'excuse'

Well, I'm here to tell you it's not

Don't blame it on yourself, love

This isn't a disease that you've got

It might have a few names or titles, if you will

But, if you haven't suffered from it

Others usually tell you to just 'chill'

Chilling doesn't really help

'Cause the pain doesn't disappear

I can't quite put my finger on it

'Cause nothing at all is clear

If I ever have a daughter

I hope she isn't like me

I don't want her to suffer

incessantly

because of

PMDD

©Sarah Prais - 2016

How Carbon Monoxide Poisoning Can Mimic PMDD

You know I’ve written about how PMDD can be (and has been) confused with several other conditions, like thyroid problems, insulin resistance, anemia, or even bi-polar disorder--which is just one part of why PMDD is so hard to diagnose--but last week I got an unwelcome surprise when I encountered yet another condition that mimics PMDD…

Carbon monoxide poisoning.

That’s right, the silent killer that’s the leading cause of accidental deaths in America. You can’t see it, smell it, or taste it, but the Centers for Disease Control estimates that more than 400 Americans die from unintentional CO poisoning, more than 20,000 visit the emergency room, and more than 4,000 are hospitalized annually due to carbon monoxide poisoning. Fatality is highest among Americans 65 and older.

On Saturday, I joined the ranks of those ER visit statistics. I started feeling badly on Wednesday. I work at home, in a relatively new house that is extremely air-tight and energy-efficient (something I’ve been rather thrilled with to date, as it keeps my heating and electric bills low.). I do a lot of work at my dining room table, which is less than ten feet away from my kitchen stove.

Little did I know I had a gas leak at the stove. All I knew was I was having an enormously hard time concentrating on my work that afternoon. I couldn’t think straight, and had absolutely no motivation to work. Thinking it was my PMDD kicking in, I ate some carbs...then ate some more. I took some 5-HTP...then took some more. No dice. All I wanted to do was take a nap. The thought of going for a walk kept entering my mind, but my body and mood simply wouldn’t cooperate, and I just couldn’t muster the energy to put on my sneakers and coat and go outside.

That evening I opened the windows for another reason, and inadvertently resolved the problem. Thursday and Friday I went out of town and felt fine, which lead me to believe I’d simply had a fleeting episode of PMDD. I returned home Friday night, and within an hour again felt tired and listless, with no desire to do much of anything besides sleep. Again thinking my serotonin level was down and I needed some carbs, I went out and got a pizza for dinner.

The expected boost in energy and clarity of mind didn’t happen. Instead I got more and more tired, until I just couldn’t stay awake any more. Plus I started to feel nauseous, and wondered if I’d gotten a bad pizza.

Nothing to do for an unrelenting case of PMDD but go to bed, right? So that’s what I did. The following morning, I overslept by two hours. When I went to make my morning tea, I was shocked that the clock said 8:00 a.m. instead of 6:00. What was wrong with me? I’d gone to bed at my regular time, and slept an extra two hours. Why was I so tired? Why did my head hurt and my joints ache so badly? And why the hell couldn’t I think straight?

I checked my PMDD calendar. The timing didn’t seem right, but since I’m in perimenopause nothing comes on schedule any more, so that didn’t help much.

Okay, time to start my day. After being gone for two days, I had a lot of work to catch up on.
But I just…couldn’t…get…started. Couldn’t even figure out the first thing to do. I thought of some errands I needed to run, but had absolutely no desire to get going, to move in any way.

Finally, I simply stood in my kitchen and went inside myself, trying to figure out what was wrong. What was different about this episode of PMDD and why none of my usual tricks to boost my serotonin level and mood were working.

All I knew was everything ached, and I felt miserable---like when I’ve been exposed to too many chemicals or fragrances. Chemical sensitivities and heightened allergies are a symptom of PMDD as well. My insides swell up and the pain caused by the pressure on the meridian nerves in my arms can reduce me to tears.

It felt like that. It felt like I was being poisoned.

I got the idea to call the gas company, and have them come and check things out. So I found the number and called---and they called 911. Next thing I know, I’m being told to get out of the house and wait for emergency services. The gas company, fire department, and an ambulance arrived within minutes.

It seems I had not one, but two leaks. One from the stove, and one from the boiler in the garage. Both were putting out carbon monoxide and my wonderfully energy-efficent house was not allowing the air to properly circulate.

I declined a trip to the emergency room via ambulance, but got a friend to drive me to the ER to be checked out. Fortunately, my levels were not dangerously high, but my symptoms were quite evident. They included:

Headache
Dizziness
Nausea
Flu-like symptoms, fatigue
Impaired judgment
Confusion
Depression
Agitation
Drowsiness
Memory problems

All of which can also be experienced by a woman having an episode of PMDD.

I credit the fact that I’m still alive to two things—my awareness of my body, due to my constant attempts to keep my hormones balanced, and to my Qigong classes, which include deep breathing, and therefore keep a strong, steady supply of oxygen circulating through my system.

Which only goes to underscore my belief that a woman with PMDD needs to take better care of herself than most. While every woman could benefit from relaxation techniques, quiet time, good nutrition, and exercise…women with PMDD are more sensitive than most to just about any life event, environmental toxin, or ingested food, drink, or substance that can stress the body, so we need to be extra vigilant about our health and well-being.

That said, as a public awareness announcement, here are some sources of carbon monoxide you need to be especially careful around:

Gas water heaters
Kerosene space heaters
Charcoal grills
Propane heaters and stoves
Gasoline and diesel powered generators
Cigarette smoke
Propane-fueled forklifts
Gasoline powered concrete saws
Indoor tractor pulls
Any boat with an engine
Spray paint, solvents, degreasers, and paint removers

Take care and be well. Be especially vigilant when the cold weather comes, and if you don't have them already (I didn't, but do now), get yourself a carbon monoxide detector or two.

And the next time you're having an episode of PMDD that just won't quit--try looking at your external environment for a possible cause.

A Perfect Storm of PMDD

Unfortunately, I’m one of those atypical types who has my PMDD served up in three different courses, which is one big reason it took me so long to get diagnosed. All the sites and information said specifically that for it to be PMDD, all symptoms must abate at the onset of menses, or when your period begins.

But mine never did. Mine came in three separate stages. Which I finally learned is possible as well. God knew I’d been living it long enough—but to see it actually mentioned in a book? Finally I could go to my doctor in confidence and get diagnosed.

I often compare my symptoms of PMDD to the course of a hurricane. Prior to the onset of my period is the building storm, the wind and the rain, with symptoms of irritability, edginess, an inexplicable, almost ravenous hunger, and cravings for salt and three specific foods---cheese, chocolate, and oranges. I have yet to figure out why, although occasionally I get glimmers of understanding and I am sure I will find the answer some day. But for now it’s enough to know that that’s what I crave, and when I find myself reaching for nothing but those three things, I know a storm is about to blow in.

On my pre-period days I also get jittery, clumsy, confused, and distracted, unable to focus on any one task for any length of time. My handwriting even changes. Usually, it’s comfortable, loose, flowing. When I’m having an episode of PMDD, it’s spiky, jerky, and messy. At times it looks like the handwriting of a much older woman. I’m always startled to see it come out that way, but not totally surprised, because as I’m writing, my hand doesn’t seem to work properly—which might also account for my tendency to drop things more than usual during those periods of time.

Anyway, the unfamiliar handwriting is generally one clue that something is happening in my brain. My typing is also affected. I have a friend who pointed out that I don’t bother to capitalize in my emails when I am having an episode of PMDD and I don’t do a lot of smiley faces. It’s as if to do either would take too much effort.

So in my case first comes the storm of irritability, anger, and rage. Snapping out at the drop of a hat. Lashing out at someone who didn’t say anything out of the ordinary, but just struck me as wrong. Feeling under attack and wanting to hit someone, anyone. Just give me a chance. Not a reason, but a chance. I call these my wanting to “drink, smoke, and be bad” days. Impulsive behavior does its best to take over, and I can fully understand in those days why some women go out and do completely irresponsible things they later regret. I’ve felt like doing so more times than I can count, and have complete empathy for those who give in to these bizarre urges. If I didn’t have a core of responsibility inside me that keeps me anchored in good times and bad, I would go out and do the same.

Usually the worst thing I ever did was go shopping and buy all sorts of things I didn’t need or never wore. If I were to look at my credit card statements for those time periods I’m sure I would see a pattern of spending that coincides with the pre-menstrual portion of my PMDD episodes. Fortunately, now I understand what is happening and stay home on those days instead of going shopping. Because inevitably the bill would come, and I would wonder why on earth I had done such a thing.

When I worked as an analyst for the government, on my pre-menstrual days I would suddenly notice that I hadn’t received a response on this project or the other, and would call up the parties in question and remind them I was waiting to hear from them. On any other day it wouldn’t have bothered me. People get busy, people go on vacation, people have priorities, people forget. In the overall scheme of things, my projects were never that vital. Most of the time, I was tolerant and flexible.

But on a PMDD day, everyone I came across was either incompetent or personally holding me back from untold success. I might not rant at them directly--after all, even on my worst days I knew you catch more flies with honey than vinegar--but I would complain to anyone else who would listen about how I seemed to be the only person around who could get things done and do them right. I had no tolerance for even the slightest delay or mistake. On those days, you didn’t want to mess with me.

Then my period would come and I’d be miserable in a new way for a couple of days. Cramps, backaches, and pain that sometimes radiated as far down as my knees, and made me feel like I wanted to throw up. Breathing hurt. I would lie very still, hot pack pressed to my lower abdomen, which felt like someone was slowly trying to pull my insides out with a three pronged gardening tool. Every single month. That, if you want to believe it, was the eye of the hurricane. The first two days of my period.

Then the sadness kicked in. On Day Three. Always on Day Three. If it was going to come, that would be the day. It didn’t always come, still doesn’t. Now I know it has to do with whether I release an egg or not that month. No egg, no sadness. Woo hoo! Party time.

Not quite. But at least it’s a lot more pleasant around here when the sadness doesn’t come. Because when it does, I’m tired all the time, my head feels like it has an iron band around it, I sigh incessantly, big, deep sighs like the weight of the world is on my shoulders—and for me, it is. Most everything looks hopeless, every good idea I had during the month goes to s***, I want to weep at every turn, you don’t dare tell me a joke or tease me, and I spend a lot of time wondering why I even bother.

During this phase of my PMDD, I used to beat myself up incessantly over the people I had snapped out at the week before. Now, at least, I don’t do that any more. I know I didn’t mean it, and in most cases it doesn’t get that far anymore, because I have a much deeper awareness of what is going on and can catch myself in counterproductive behavior.

Now, when I catch myself starting to snap out, I apologize and explain I am having a bad day. Most of my friends know what that means. If the person isn’t my friend, it’s okay to leave it at an apology without an explanation. By all means, if at all possible, never ruin a perfectly good apology with an explanation. You don’t need to justify yourself or your behavior. You just need to acknowledge it, apologize for it if the incident warrants an apology, and move on.

But back then, as I said, I would beat myself up incessantly. Which only intensified my sadness and made me feel like a totally worthless human being. My friends couldn’t possibly be my friends. They wouldn’t be my friends if they knew the real me. How would I ever find anybody to love me if I was so impossible to be around. Yada yada yada. You know how it goes.

The bottom line is the first part of my personal hurricane is the moody, bitchy, out of control part. Then would come the eye of pain and two days of solid pain but surprisingly clear thinking. Fortunately, now, as I begin to enter menopause, it’s just the clear thinking part, and a huge surge of positive energy. It’s a definite reprieve in the storm.

Then the sadness comes. The first D in PMDD. My depression. Or The Fog, as I call it. Back then it was devastating. How could anybody not hate me? Now I am able to separate myself from it and while it is still not pleasant, I know I am not my depression. I rest, relax, take it easy, spend time reading or listening to music or doing something quiet and non-demanding, secure in the knowledge that it will pass. I do what I can to help it pass sooner. I take walks, take naps, eat right and take supplements. I do not allow my negative thoughts to take over. In fact, I smile at them, knowing I know better. God does love me and so do the people in my life. My ideas are good ones and I am full of creativity. I am strong, capable, and competent. Just running a little slower than usual today. Just a tad off my stride. It will pass and I will be fine.

And I am.

One day The Fog lifts, and its back to the torrid pace of my life as usual—until the next wave of cravings and irritability hits.

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 from within and starting a conversation with loved ones who want to know more about this debilitating disorder we live with daily.