May is Mental Health Month - A Primer on PMDD

The following guest post was written by the blogger Cheekyminx. With her permission, several of her posts about PMDD are being featured on this blog. To find out more about her work as a PMDD Advocate, please visit her Facebook page, PMDD Life Support.

Many women the world over experience the usual discomforts associated with the premenstrual cycle. PMS is a well-known condition that often includes irritability, bloating, and physical pain. But if you feel like PMS takes you out of commission every month, there may be more to it for you. Could you be one of the growing numbers of women who realize they are suffering from Premenstrual Dysphoric Disorder, or PMDD? What many women, and indeed many doctors, do not know is that in 2013, PMDD was officially recognized as a mood disorder (this classification will have to do for now) experienced by about 10% of all women who menstruate.

Now word is getting out. So how do women who have PMDD discover they have it? PMDD is caused by a sensitivity to normal hormone fluctuations rather than a hormonal imbalance, and getting tested for hormone levels usually reveals nothing. Many women discover it when they are at their wit’s end, having tried birth control, antidepressants, and other treatments to target symptoms they often think are the result of something else…like bipolar disorder or depression. In fact, many women with PMDD report not only PMS-like symptoms that are extreme and debilitating, but also much more dramatic and difficult-to-manage changes in mood and thought patterns, often leading to misdiagnosis. But intuitively, they know there’s something about their monthly cycle that seems to be playing a role, so they begin to chart their symptoms.

These symptoms are numerous and vary from person to person but generally involve anxiety, increasing irritability, hypersensitivity of the senses, depression, rage and other uncontrollable emotions. Thoughts can become insistent and feel “uncharacteristic” to the person having them. It is as though the mind becomes polluted, distorting everything. PMDD also seems to exacerbate underlying medical conditions, making it unique to every woman and can include dizziness, sluggishness, bloating, heavy bleeding, and sore muscles. But by and large, it is the increasing loss of patience and intensifying irrationality that makes PMDD such a nightmare, not only for the women, but for the people they love.

In fact, many find that during the 10-15 days of their hormonal sensitivity, they lose interest in their partners…not just sexually, but often to the extent of detesting them altogether. Some report regularly breaking up with their partners on a monthly basis. This Jekyll and Hyde transformation wrecks havoc on relationships of all kinds, not just romantic ones. It’s difficult for mothers to parent and for employees to continue with duties as usual. Overwhelmed by fatigue, cravings, paranoia, or even suicidal thoughts, normal life remains out of reach until the sensitivity ends, usually with the onset of menses–though there is debate the sensitivity fluctuates for some women at other times in their cycle. What’s important to realize is that the symptoms do disappear, sometimes instantaneously, whether it is the day the menstrual cycle starts or several days later. And suddenly, things are back to normal…but often leaving a great deal of destruction behind. In fact, women with PMDD often feel as though they spend two or more weeks a month in hell and the other two or less making up for it.

Think you might have PMDD? Here’s what you’ll want to do:

1. Start by paying attention to your cycle and taking notes. Get yourself a pocket calendar or use and app like iPeriod or PMS Tracker. Then start keeping track. When do symptoms hit? When do they stop? What are the main symptoms and to what degree are they experienced? Do they progressively get worse? Think not just of physical symptoms. Consider your emotional and mental states as well. Are you more prone to tears or anxiety? Is it more difficult to think positively? Have others commented about a change in your mood?

2. Take several months of your notes with you to your doctor if you decide to take a Western approach. Explain that you think you may have PMDD. If he or she dismisses you, find another doctor–one who will help you determine whether or not you have it, explain your options (they aren’t all that great at the moment and there is no known cure), and work with you to help you cope.

3. Educate yourself and find additional support. As a relatively new disorder, there is still much to be discussed and researched about PMDD. Read up on it online and talk to others who have it. Women who realize they have a condition with a name to it are usually very relieved when they realize they are not alone…and not crazy! Facebook has several groups, both open and closed, including a support group for family members of PMDD sufferers that offer insight, coping strategies, the latest science, and a safe place to vent.

If you do indeed have PMDD, now that you know, you can give yourself the support you need to get through it. It may call for changes in your diet, supplements, exercise and meditation, or even medication. And if you don’t have it? Chances are you know someone who does, and she might not realize what it is. So share what you’ve learned with others and help spread the word about PMDD.

PMDD Quote of the Week

~Just yesterday I could not stop eating.  It was like I was keeping myself from being dragged under.~

Chemical Sensitivities and PMDD

 Over the years I've become increasingly more sensitive to chemicals, fragrances, and any kind of scented products, be they cat litter, candles, or cosmetics.  If a product has a petroleum base and a name that is clearly made up--such as Ocean Breeze or Home Made Apple Pie--I need to stay as far away from it as possible.  I first discovered this over twenty years ago when a woman walked into the office where I worked and offered to sell me knock-off versions of expensive perfumes and proceeded to spritz them all over the place.  She left without a sale as I instantly developed a massive headache that lasted the rest of the afternoon. 

My list of substances to avoid grew from there.  Wood smoke, treated lumber, paraffin candles, any kind of scented candles or room deodorizers, home cleaning products, paints and stains, body lotions, soaps, shampoos, deodorants, and eventually, even the real brands of premium perfume. I now can't go to the mall, pet store, electronics store, furniture store, home improvement store or beauty shop without taking a Benadryl.  I need to stay out of the cleaning products, pet supplies, paint, tire, shoe, furniture, and home accents aisles in discount and department stores. 

As for seasonal items like the Christmas aisle with its scented pine cones and stuff?  Forget it.  Neither can I visit used book stores anymore, without succumbing to the smell of mold and must.

Recently, we uncovered water damage to a house we bought three months ago and have yet to move into.  My husband wants to strip the wallpaper, re-paint and re-carpet the house, then air it out before I move in.  The last house I moved into eight years ago was new.  I moved in early February and by mid-April was so sick I collapsed.  It took another two months to recover, once I discovered problem:  off gasses from the building materials such as my carpet, vinyl, and laminate flooring (didn't help that this was winter and my floors are heated), paint, kitchen counters and cabinetry.  I thought I was just getting older.  I did a lot of the move myself, moving one mile down the road from my previous house, one carload at a time.  Eventually I was sleeping all the time, but unable to get any rest.  My mind became so foggy I couldn't get much of anything right.  I recall my boss asking, "Liana, what is wrong with you?" 

A recovering perfectionist, I rarely made mistakes, and suddenly I was making them all the time.  I was sitting at my desk, staring dumbly at no doubt my latest mistake on the computer screen, and I remember telling her, speaking very slowly because it was hard to form the words in my mind, "I...don't...know...all I want...to do...is sleep."  I called the builder to ask if there could be a reason I was so tired and fuzzy-minded all the time, and he suggested it was because I had no curtains and was getting too much light in the house.  Turned out all I needed to do was open the windows.  My super energy efficient house was trapping all these off-gasses inside with me, and I was breathing them over and over and over again.  Within a week the house was cleared out, and I was on the road to recovery.

But yesterday I took a trip down memory lane.  Due to the water damage in our new home, my husband and I had to go door shopping.  We also had an appointment to speak with a kitchen designer for a remodeling project.  To price doors, we stopped at another builders supply store on the way.  The salesman was wearing such strong cologne I had to stand at least 15 feet away from him while he spoke with my husband.  As we left, I told my husband I suddenly had the urge to eat anything and everything in sight, which is something that happens when I get hormonal prior to my period.  The thing was, we had just eaten breakfast before leaving for the builders supply store, so I knew I wasn't hungry. 

It was a combination of the man's cologne and the smell of new building materials making me feel like I was starving.

We got to the second builders supply store, where we had the appointment.  Halfway through, my husband said, "Your face and neck are turning bright red."  The store was filled with carpet and flooring samples, tiles, and kitchen and bathroom cabinetry.  My husband left to get me a diet soda, which for some reason I have yet to discern, always cuts my reaction to various substances. When he returned, I took a Benadryl, which also helped to ease my symptoms somewhat.  But by the time we had been in the store an hour and a half, even with taking the Benadryl and drinking the diet soda--it has to be diet for this to work for me--my fingers started swelling and tingling.  By the time we left, my wrists were tingling.  It usually moves up my arm and into my shoulders if I don't take a Benadryl and/or remove myself from the situation.  But once it starts tingling, I know it will get painful very soon, as my insides will swell up and press on the meridian nerves in my arms.  I had this constantly when I was pregnant, so much so that nightly I would sit in my rocking chair with my big belly and cry from the sheer pain of it.

(Pop quiz. What happens when you are pregnant?  You are an estrogen factory.)

So we wrapped up that appointment and headed for the paint store, to get sample cards of the color we had chosen for the kitchen.  I was not in the store three minutes before I noticed I was firmly massaging my arms, something I do when my body gets stressed from chemical exposure and starts to hurt.  I didn't smell a thing, but then I don't need to smell anything before my body reacts.  I discovered this one night when leading a faith sharing group at a friend's house.  She knew I couldn't be around burning candles, but the moment I walked into her house, the words "Something's wrong" blurted out of my mouth.  No one heard me, and I took my regular seat on the floor in front of the couch, as due to back problems I cannot sit on soft furniture. I saw no candles in the room, but as the meeting progressed, my head started to spin and pound and first my hands, then arms, then whole body began to ache until the pain felt like it was deep in my bones and all I wanted to do was curl up in a fetal position and cry. 

If I hadn't been leading the meeting, I would have left.  Finally, I asked my hostess, "Are you sure you didn't burn any candles in here before we came tonight?" and she swore she hadn't.  I said, "Well something's wrong with me and I can't figure it out."  Did you do any special cleaning for the meeting?  "No," she said, "all I did was spray the couch with Febreeze." 

The same couch I had been sitting on the floor leaning up against all night.

My intuition knew something was wrong the moment I entered the room.  My mouth even blurted it out.  I didn't smell a thing, but my body reacted instantly and painfully.  To this day I cannot be anywhere near Febreeze.  I wince just watching the commercials, people spraying it all over their homes, laundry, and cars.

But back to our shopping trip.  After the kitchen design appointment, my husband stopped at two more building materials stores to check prices.  I did not go inside.  I was feeling a bit battered by then.  After he came out of the first store, instead of turning the car around and leaving, he made a circle by driving thorough the warehouse, where contractors pick up loads of lumber.  I groaned inside as the fan system in our air conditioned car pulled in the scent of all that treated lumber.  After we visited the second store, and then the paint store, I announced, "We're going to get something to eat.  Right now."  We went to a sub shop, and I wolfed that baby down so fast you would think I hadn't eaten in three days.  Thank God it wasn't our first date or my husband would have wondered about this woman who eats like a Doberman. 

As soon as I finished my sub, my husband says..."There she is.  My wife is back again."  During the appointment and shopping stops, I had become listless and withdrawn, my energy sapped.  I could barely focus on the choices they wanted me to make.  I just wanted to get out of there.  I had chosen that store because the woman and I had worked together before twice.  We hadn't seen each other in nine years though, and since then, I'd entered perimenopause.  She was tall and thin and stylishly dressed, while I was feeling fat and puffy, dim-witted and inadequate.  Afterward, I determined (in my building-materials-chemical buzzed mind) that I was a failure in life and wouldn't return to that store ever again because the differences between us threw into stark relief her success and my failures.

Hello?  I'm now descending into a full-blown case of PMDD.  My insecurities are rising, and my mind is starting to go irrational.  By now every word my husband speaks is starting to irritate me, so I withdraw even further into myself and look out the window and keep my mouth shut, because I know if I open it, I will explode with anger and resentment and he will get this shell shocked look on his face.  

We get home, and all I want to do is go to my computer, where behind the veil of the internet, I can answer questions about PMDD and help people to understand the disorder and feel like I am making a difference in someone's life.  I need this feeling in this moment to feel any sense of self-worth. 

This is how badly these building materials chemicals have distorted my thinking processes. 

Instead, I ask my husband if he wants to go for a walk.  Maybe the fresh air will clear my head and make me feel better, because by now I ache all over and just want to go to bed and curl up under the covers and cry. 

Instead, we pass a few lawns freshly treated with pesticide, and I come home feeling worse than ever.

The evening is a loss.  The only option for me is to take another Benadryl and go to bed. 

Where it turns out I cannot sleep, my mind is so agitated and upset.  I can't stop thinking about how insecure and inadequate I felt during my kitchen design appointment.  How overwhelmed I was by the whole process.  That is not me.  I have designed and built two houses and remodeled two others.  I can do this stuff in my sleep.  But inundated by the scent of building materials, I lost my self-confidence and sense of self-worth, and in essence brought on an episode of PMDD. 

If I hadn't turned red and my husband hadn't noticed it, I would never have known what happened. 

If this had happened years ago (and maybe it did, I've simply forgotten), I would never have known what happened.  Instead, I would have spent a few hours looking at building materials, chosen the cabinets, tile, flooring and paint for what promises to be a beautiful kitchen, and come home feeling overwhelmed, worthless, insecure, sad, angry, frustrated, combative, weepy, and ravenous, and never understood why.  That, in turn would have made me wonder if I was crazy.  Here I am, getting everything I want, and yet all I want to do is snap my husband's head off.  I want to lash out at him so badly I hurt from containing all my rage inside. 

Or so I think.  In reality, my body is being chemically disrupted by what are called xenoestrogens, and they are playing havoc with my hormones, and that is f*****g with my brain.

So the next time you're out shopping and come home feeling any of the above, or visit a friend's house who uses petroleum-based cleaning products, candles and/or air fresheners and come home feeling weird and moody--know that it is not you.  It is the chemicals in the air around you messing with your mood and mind.  They may also be making you feel physically miserable, which brings on that endless loop of negative thoughts we're all so familiar with, which in turn makes us feel sad and/or angry.

Look around you.  Look in your home.  Do you use these sorts of petroleum-based products?  Are you unknowingly making yourself sick?  Some women report that they feel like they are in the PMDD zone all of the time.  Sometimes this is due to perimenopause, but it could also be due to what you touch and breathe in all day.   Do you work in an auto parts store?  A furniture store where most of the items are made of particleboard? At the mall?  A lumber yard?  A kitchen and bath store?  An electronics store?  Do you clean houses for a living?  Are you a flight attendant?  Did you just move your office into a new building or remodel your home?  Are you a cashier and handle thermal paper receipts all day?

There are any number of options for how and where you can be exposed to these xenoestrogens that wreak havoc on your hormones.  Awareness is the key.

But most of all, when you start acting all funky and not like yourself at all...look around you for a possible reason.  Did you just buy tires and sit in the waiting room while they were put on?  THINK about this. Think about where you go and what you do.

I bet that suddenly a few things will start to make a lot more sense.

PMDD and Why Me?

Okay, we’ve heard enough stories for a while of what it’s like to have PMDD.We all know what it is by now.  And we know there is not much we can do about it once an episode hits.  The best we can hope for is to ride out the storm.  So a question I’m sure all of us have asked at one point or another is Why Me?

 Well, today I’m going to look into the possibilities I’ve uncovered so far.   First, however, a little background.  When does PMDD happen?  And How does PMDD progress? 

You don’t get it before your first period.  Girls, on average, in part due to the tremendous amount of environmental toxins being dumped into our lives, are now getting their first period at age 12.  Your probability of developing PMDD increases with each hormonal event in your life thereafter: pregnancy, miscarriage, abortion, or birth.  (You do not experience PMDD when you are pregnant, because you are not menstruating.) With each new pregnancy, your chances of developing PMDD increase.  And unless your PMDD is addressed, it will continue to worsen with each hormonal event, and as you age, becoming increasingly difficult through perimenopause, until it stops when you reach menopause.

But don’t start cheering yet…if your PMDD is not addressed before menopause, you run the serious risk of developing Major Depressive Disorder after menopause. 

The average age of menopause is 51. 

So, that means, on average, women have approximately 40 years during which we can develop PMDD.

What causes PMDD?

Nobody knows for sure just yet, but scientists do know it is a biological event that manifests as emotional symptoms.  What does that mean?  It means PMDD is caused by something that happens in your body and shows itself in your moods.  The closest science has come to defining what happens is that whatever happens, happens in concert with your menstrual cycle, and involves your hormones.  The hormones they are looking at the most these days are estrogen and progesterone.  It’s not that you have too much or too little, or maybe not even the balance between them, as this is still being studied, but that something goes awry in your brain when processing these hormonal fluctuations in your body.

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

But I won’t go into all of that right now.  For now it’s good enough to know there is a biological “something” that happens where our brain does not properly process the fluctuating levels of our reproductive hormones during the second half of our menstrual cycle.  This leads to a disconnect in the brain, like when an extension cord comes apart from a plug, or when your cell phone coverage drops.  The result of this disconnect is a depletion of serotonin in the brain, the neurotransmitter that in part governs our moods, and our ability to be happy. 

This is why we crave carbs.  Carbs increase the level of serotonin in our bodies, and therefore improve our moods.  Problem is, most of us reach for the WRONG kind of carbs.  You know who you are and what you eat.  Not just any carbs will do.  But that’s the subject of another post. 

This is why doctors prescribe anti-depressants.  Certain antidepressants, called SSRI’s, help to increase the level of serotonin in our brains.  Problem is, we’re not low on serotonin all the time, and antidepressants come with a bunch of side effects that can make your symptoms worse.  Plus they don’t work at all for at least 40% of the women who take them.  (So if you’re one of the 40% or more, don’t blame yourself!)

This is why doctors prescribe birth control pills.  Birth control pills keep you from ovulating, which is the main cause of this shift in your hormones that your brain does not process correctly.  But again, this is treating only the symptoms and not the underlying cause, and birth control pills have their own array of side effects -- including death. 

Never mind that some women would rather be dead than suffer from another episode of PMDD.  I, for one, am not interested in taking something that could kill me when there are so many less drastic options to try.

Which brings me to the question of what contributes to PMDD?  Weight, lifestyle habits, including smoking, drinking, drug use, caffeine and sugar consumption, stress, trauma, abuse, and yes, genetics.  We’ll get more into genetics in another post.  For now it’s enough to know that in some cases, you really “can’t” help what happens to you when you’re experiencing an episode of PMDD.  It could be in your genes.

And if it’s in your genes, you’re not going to be able to cure it with a magic pill, be it synthetic or natural.  The best you can hope to do is manage the condition.

So what can you do about your PMDD?

You can address the things that apply to you. I’m not going to touch weight, because there are sooo many factors that go into a woman being overweight that it’s the most difficult of all for us to address.  (That’s a whole other blog post in itself as well, maybe even two or three.)  But yes, you can quit smoking, yes, you can cut down on your drinking, maybe even eliminate it altogether.  Same goes for caffeine -  you can cut out caffeine and not die – not like other options mentioned above.   You can cut back and even eliminate eating sugar.  And please do not make the mistake of thinking sugar substitutes are the answer to the situation.  If you’re determined to go that route, you’d be better off to keep eating sugar.  Raw sugar if you must, but no sugar is the best route of all.  Sugar feeds PMDD, and it also feeds cancer.  So think about it, and do what you can.

If you’re a sedentary soul, you can get more exercise.  Two to three half hour walks a week will do wonders for your PMDD.  45 minutes is even better.  Work your way up to whatever time you can spare.  Really, how can you not spare the time, when your life is at stake? 

Over-exercising is just as bad as not getting enough exercise.  More on why some other time.

Stress – starting to sound like a broken recording here, I know.  The stresses in our lives are as numerous and varied as our PMDD symptoms.  You know yours.  Get rid of them.   Don’t you deserve a better life? 

Rest – get as much as you can, especially during an episode.  Learn how to “Just Say No.”  Start small and work your way up.  And do it gently.  Don’t put it off until it becomes a snarl.

Nutrition – there’s a reason fresh, whole foods are good for you.  They’re packed with the nutrients your body, including your brain, needs to function properly.  You can’t get good nutrition from a box any more.  It just doesn’t happen.  And taking high quality, pharmaceutical grade vitamin supplements (not the cheap ones!) does help, but it doesn’t by a long shot make up for what you can do to make yourself feel better by simply eating foods as close to their natural state as possible.  Vitamins are meant to boost your nutritional balance, not replace what you lost from not eating right and depleting your body’s nutrients when you drink, smoke, and/or take drugs -- even common over the counter drugs. 

So there are a lot of things you can do to make your PMDD better.  Most, however, require time and effort.  It takes time to make good, healthy meals.  It takes time to listen to your body and become aware of what makes you feel better and what makes you feel worse.  It takes time to find the right treatment for your particular symptoms.  It takes time to make time for you, take time out for rest and relaxation, or deal with those messy stresses eating up your life.  It takes time to become comfortable with your emotions.  It takes time to work on your relationships.  It takes time to quit using the crutches you’ve been using to get through your however many years of PMDD.

But think of how many more years you have to go, and how it will only get worse if you don’t do something about it.  Do you want to spend your golden years depressed?

I know I don’t.  And I don’t want you to have to do it, either. 

You didn’t ask for the hand of cards you were dealt.  The best you can do is learn how to play them.  The information is out there. The willpower is inside you.  Are you going to sit around asking Why Me?

Or are you going to come to the table and say, Not Me. Not Today.

One day at a time.  That’s all you need to work with.  One hour at a time, if that’s all you have.  Pick one positive thing mentioned in this post, and do it for yourself, do it today.  Do the same thing tomorrow.  Keep doing it, one day at a time, until you have it down.  Then pick something else, and start the process all over again.  Baby steps are still steps in the right direction.

You can do it.  Because PMDD women are strong.  Super strong.  We have to be, with all that we have to deal with.

Liana is the author of PMDD and Relationships, a book written to help a woman with PMDD gain personal awareness, and insight into why she says and does the things she does.  PMDD: A Handbook for Partners, was written to help explain the unexplainable to partners of women with PMDD.  Either one of them can be used as a resource on tips for how to handle PMDD, or as a conversation starter for someone who wants to explain their PMDD to a loved one to someone they care about.  Both are available in ebook from Amazon and Smashwords (Kobo, ibooks, Nook, and Overdrive), and in print from Amazon, and the International Association for Premenstrual Disorders, or IAPMD.  For more information, please check out Liana's Facebook Page, Living with PMDD.

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!