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

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

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

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

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

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

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

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

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

Is it PMDD or Pre Menstrual Exacerbation?

I was wrong.  In my last post, I thought I was experiencing an episode of PMDD.  I felt like I had an iron band around my head and it pounded all day long.  It had been going on for four days with no relief.  Turned out, though, it was my allergies acting up. 

About 15 years ago, I started having sinus and breathing problems during the changing of the seasons.  For a few years I had a prescription I would dutifully take for 30 days each spring and fall.  Gradually, I switched to homeopathic remedies.  Then, as I specifically began to concentrate on my diet and nutritional needs, the need for even that went away.  But the allergy medication (bought on sale, as it was by now available over the counter) remained in the medicine cabinet, unused except for when nothing else would work.

So the other day, with my head pounding as it had been for days, I opened the medicine cabinet for something else, and all of a sudden the allergy medication was front and center in my vision.  It's always been in the same spot, I just haven't paid attention to it in a while.

But that day it practically jumped out at me.  Since I practice awareness, I thought, hmmm....you know, it *is* allergy season...maybe that's my problem. 

I took one and my headache cleared right up.  I took one for the next five days, until I ran out, and haven't had a problem again until...this month.

Imagine that.  Is it a coincidence or what?

It's *or what*. What's happening is called pre-menstrual exacerbation (PME) of an underlying condition.  That's when your body might be able to handle (insert condition here) during the rest of the month --  but during the week prior to your menses, it can't, and you have breakthrough symptoms of whatever your underlying condition is. 

When this happens, many of us seek treatment for the underlying condition, not realizing its connection to our menstrual cycle.  When the symptoms ease off, we feel the medication we are now (quite often unnecessarily) taking daily has solved the problem—until the next time around.  At this bewildering and frustrating point, dosages are increased, medications are changed, or we simply give up looking for help and try to cope on our own because our doctors don’t know what else to do for us.

So here's a primer on (just some!) Conditions That Can Be Exacerbated During Episodes of PMDD:

Acne                      

Allergies

Arthritis

Asthma

Bipolar Disorder

Blood Sugar Problems

Chronic Fatigue Syndrome

Depression

Dysthmic Disorder

Eating Disorders

Endometriosis

Fibromyalgia

Headaches

Hypoglycemia

Insulin Resistance

Irritable Bowel Syndrome

Joint Pain

Lupus

Migraines

Panic Disorder

Peri-menopause

Personality Disorders

Seizure Disorders

Somatoform Disorders

Thyroid Disorders

A Special Word About Bipolar Disorder

            The depression in PMDD is similar to that experienced in Bipolar Disorder, but PMDD does not include the manic phases of Bipolar Disorder.  Many, many, women have been misdiagnosed as bipolar, and have been put on a wide array of bipolar medications, one after the other, to no effect, when the real culprit was PMDD.

            Manic Episodes

            This can not be stated enough.  There are no manic episodes with PMDD.  That’s one thing that distinguishes it from Bipolar Disorder.  With PMDD you have time periods when you feel good, and time periods when you feel miserable, overwhelmed, out of control, snappish, sluggish, and/or depressed.  With PMDD, you may spend a lot of time in what may look or *feel* like a manic frenzy, trying to catch up on all the things you weren’t able to do during a PMDD episode, but this is more a function of your personality than genuine mania.  Genuine mania can include any of the following:

Euphoria

Extreme optimism

Inflated self-esteem

Poor judgment

Rapid speech

Racing thoughts

Aggressive behavior

Agitation

Increased physical activity

Risky behavior

Spending sprees

Increased drive to perform or achieve goals

Increased sexual drive

Decreased need for sleep

Tendency to be easily distracted

Inability to concentrate

Drug abuse

An Additional Word About Major Depressive Disorder

            The only difference between PMDD and clinical depression is that the PMDD woman’s episode of depression will end with the onset of her period.  This, and the fact that a PMDD episode can last up to two weeks, the essential feature of a Major Depressive Episode, is why so many women with PMDD are misdiagnosed with Major Depressive Disorder.  Also, depression is most prevalent in women, period, which further confuses the issue.

How MDD predisposes women toward PMDD and vice versa

            Just as the physiological origin of Major Depressive Disorder resides in an imbalance in the neurotransmitters in a woman’s brain, our reproductive hormones (estrogen, progesterone, testosterone) influence those same neurotransmitters, including dopamine, serotonin, and norepinephrene.  This can therefore increase the risk of depression in women during any time of life related to reproductive hormonal fluctuations, such as the menstrual cycle, (PMS and PMDD), the peri- and post-partum period, peri-menopause, and menopause.  Also, women who suffer from Seasonal Affective Disorder (SAD) are more likely to suffer from PMDD and vice versa.  There may be a genetic link between SAD, PMDD, and PMS.

PMDD and Dysthmic Disorder

            It is not clear that Dysthmic Disorder (previously known as Dysthmia) is really separate from Major Depressive Disorder. It may only differ in terms of severity and the course of the illness.  Therefore, Dysthmic Disorder, too, can be confused with PMDD.  But only if you ignore the fact that Dysthmic Disorder can only be diagnosed when you have had depressive symptoms for two straight years without a break.  Unfortunately, many doctors do.

Peri-menopause and Menopause  --  Confusion City

            When a woman enters peri-menopause, her reproductive hormones begin to fluctuate wildly from month to month as their levels start to decline as part of her natural aging process.  Still, to a woman experiencing these wild fluctuations, it’s as if the body doesn’t know which way to go, and a fierce battle to maintain the status quo is being waged inside her hormonally, while at the same time she's trying to hold on to (what's left of) her shape and mental abilities.  If she’s been able to manage her PMDD episodes up to this point, the added instability in her hormones can bring on a double whammy of symptoms, leading to increased episodes of :

Depression

Tension, Anxiety

Lability

Irritability, Anger

Foggy Thinking

Lethargy, Fatigue

Overeating and Food Cravings

Hypersomnia or Insomnia

Physical Aches and Pains

Bloating and Weight Gain

            Considering that during peri-menopause a woman is still having some periods, the sheer unpredictability of when her period will come—or won’t—combined with the increased hormonal activity in her body, and the effects of these wildly fluctuating hormones on her brain, can lead her to think she’s truly going insane. 

 

The Bottom Line  --  PMDD Makes Everything Worse

            The bottom line is if you have PMDD, whatever you're feeling will get worse pre-menstrually, including any underlying depressive or anxiety disorders, and/or the naturally occurring fluctuations in your perimenopausal hormones.  Even reactions to food and drink and drugs will intensify during an episode of PMDD.  This includes cravings and allergic reactions.

So the next time you feel an upsurge of symptoms, no matter what they are, take the time to stop and ask yourself...is it PMDD or PME?

The answer can make all the difference in which path you take to treatment. 

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.

Women and Insanity -- Pioneers with PMDD?

A little something extra today in honor of Halloween. PMDD is not a new condition. It's been around in one form or another since at least the time of Hippocrates. Back then it, and just about any other condition relating to women's hormones, was called hysteria, hystera being the Greek name for uterus.

This is why anyone with a uterus is considered hysterical at times, and why they call the removal of your uterus a hysterectomy.

But I digress. PMDD is not, as some believe, a disorder made up by the drug companies to sell more drugs. It's a condition happily exploited by drug and supplement companies, to be sure, and even some doctors (more on this in a future post), but it's far from a made up condition. You know it, and I know it, and anyone who has ever lived with a woman who has PMDD knows it.

That doesn't mean we're not accountable for our actions. PMDD is an explanation--not an excuse, or free pass--for bad behavior. We owe it to ourselves to understand the condition (and therefore ourselves) as fully as we can, and to then promote a positive awareness of PMDD everywhere we go. It's only by focusing on the positive--what works, what helps, what provides solid help and answers--and not the negative--the fear, the stereotyping, the ridicule--that we will get mainstream medicine to pay any genuine attention to PMDD and other women's health issues.

That said, today I thought I'd offer up a special post on women and insanity, to let us know where we might have ended up, had we been born in another time.

Please welcome my guest blogger, Wild Rose Press author Loretta Rogers.

Because divorce was a rarity during the pioneer/frontier days, men devised other ways to get rid of unwanted wives and children, and that was by declaring them insane and placing this unwanted loved one in an insane asylum. Actually these early asylums were in reality prisons and not medical centers. These institutions were filthy, dark places where people were treated more like animals than human beings. The asylums usually provided only the basic necessities of life. Food was poor, cleanliness was not stressed and the rooms were often very cold. Diseases were quick to spread throughout the asylum.

Some of the reasons women were institutionalized are unbelievable. In the early 1800’s wives and daughters were often committed for not being obedient enough to their husbands or fathers. You’ve heard the term, “children are to be seen and not heard.” This applied to wives as well. If a woman spoke out and went against the “norm” she could be committed.

With no birth control, it wasn’t unusual for a woman to give birth to another baby while still nursing her last child. And a brood of six to twelve children wasn’t unusual either. With her body no longer firm and supple, her energy level somewhere between zero and double zero, and with the daily routine of cooking, cleaning, plowing, and all the other demands, a woman was run ragged. It’s no wonder she grew old long before her time.

All the husband and/or father had to do was simply write the word “lunacy” on the admission form. Lunacy was an acceptable reason for divorce. The woman’s husband would declare her insane, put her in the asylum and then file for the divorce. A few months later, his marriage records to a younger bride usually showed up.

Other reasons to be “put away”, were depression, alcoholism, just being a little different from the norm, and even going through menopause. Doctors just didn’t know how to deal with mental issues and the result was to put their patients in the asylum. These women were locked up and forgotten by their loved ones. The fathers/husbands often forbid the family members to visit. It was as if the wife or daughter had simply died. Most of these women did stay at the insane asylum until their death.

If a father had no sons, but didn’t want his daughter to inherit his fortune or worldly goods, he could have her declared insane, institutionalized, and leave his money to a favorite nephew or his ranch to a ranch hand he considered as a son. If a man’s wife had died in child birth and he couldn’t find a woman to wed who was willing to become a stepmother to his large brood, or if he couldn’t marry off any of his eligible daughters, he simply declared them as lunatics and placed them in an asylum. Sometimes daughters were committed for unwanted pregnancies. Other children were committed for being disobedient or for illnesses such as Down’s Syndrome or Autism. Being born deaf or mute, retarded or physically disfigured was another reason a child might be committed.

Oftentimes, the husband might tell others that his wife or child had died. If a newspaper office was available, he might even have an obituary printed. Yet the person was very much alive at the asylum. While it was rare for a sane person to be released from an asylum, it did happen. Imagine what it was like for this woman. Having been declared dead, she had no identity.

Some of these asylums were built next to, or part of, the prison system. This was to help cut back costs of care, food and facilities. Rape was prevalent in asylums. Because women had been declared insane, it was deemed they had no powers of reasoning, no feelings or emotions. In other words, they were considered walking zombies. Because of this deranged thinking, (no pun intended) prisoners and even asylum employees used the women for their own pleasures.

If you are into genealogy and have run into a brick wall trying to locate a female relative, the US census has a place on some of their census, example 1850, that had a place to mark if deaf, dumb or insane. The probate section may carry Lunacy Record Books at the county courthouses. Some Wills will declare if someone is insane or having lunacy. If someone seems to have disappeared, they may have been “sent away.”

Therefore, when we refer to the ‘good old’ days, we might remember these women and their lives, and be thankful that they paved the way for us.

Loretta C. Rogers, Isabelle and the Outlaw.