Living with PMDD - Realize, Relief, Repeat

REALIZE, RELIEF, REPEAT
[Living With PMDD]
By: Danni Hanna
When you REALIZE it’s time, it’s already too late
Being engulfed in its flame is always your fate
Depression sets in.. in its bi monthly routine
Next comes the anxiety and the fatigue
Panic attacks make their appearance
And the joys in life make their disappearance
Suicidal thoughts fill your brain
But you know soon enough you’ll be off this train
The train runs on an endless track
Circling, circling, circling back
Exercise, medication, eating right
Won’t help you win this fight
Two weeks free, two weeks trapped
Two separate identities on constant relapse
One identity starving for control
The other is on an easy stroll
Career and relationship changes fill the void of sleepless nights
But freedom is coming into sight
The day of RELIEF has arrived
As per usual, right on time
An exchange of pain occurs in an instant
From mental to physical, it’s always consistent
Anxiety and depression leave your side
Feelings of comfort and amusement fill your mind
Quickly forgetting the two weeks of hell
You become trapped within its spell
You never seek help
Because this is the best you’ve ever felt
Unaware you’re still riding the train
Two weeks pass by and the hormones enter your brain
Once again the exchange has been made
Those joyous feelings briskly fade
So go ahead and take a seat
The journey of this train is about to REPEAT

PMDD Quote of the Week - A Doctor's View

April is PMDD Awareness month.  I can't begin to imagine how much further we would be along the path to health and healing if we only had more doctors like this.  This woman "gets" it.

What is PMDD?

"A reproductive disorder whereby women experience transient physical and emotional changes around the time of their period, PMDD is associated with a level of impairment that is similar to major depressive disorder and poorer quality of life compared with community norms, therefore it should be considered a serious health condition. PMDD can have adverse consequences on a woman's social functioning, relationships, work productivity and healthcare use..."

and

"Treatment generally continues for duration of a woman's reproductive life.  If one considers that a female typically menstruates 300 - 500 times during her lifetime, timely identification and initiation of appropriate treatment may prevent impairment.  This, together with support and TLC from loved ones or spouses, can go a long way in improving the quality of life of PMDD sufferers."

~Dr. Eileen Thomas, a specialist psychiatrist at Akeso Clinic, Milnerton (Cape Town, South Africa)

To read the full article, go here.

As Dr. Thomas so rightfully points out, a female can experience up to 500 menstrual cycles during her lifetime. I also mention this in my books, PMDD and Relationships, and PMDD:  A Handbook for Partners.  Below are a couple of sample excerpts:

Let’s do the math. The average age of female puberty is 12; the average age of menopause is 51. Round that off to 40 years of menstruation. Multiply that by 12; that gives you 480 months of periods if you never have children, less if you do. Let’s go with 450 periods for now. That gives you 900 weeks of pre-menstrual issues. Divide that by 52 weeks per year, and you get 17+ years that a woman can spend in the living hell that is PMDD.

Seventeen years, people!

and 

Seventeen years is a long time to feel and/or be out of control. Seventeen years is also a long time to be on medication, especially medication that studies now show doesn’t work more than half the time.

Listen, nobody knows for sure what causes PMDD. All scientists know is 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/expresses 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 have looked at the most are estrogen, progesterone, and now a metabolite of progesterone, called allopregnanolone.

Some schools of thought are convinced it has something to do with the levels of these hormones in your body, and whether they are in the right balance or not. But you can’t detect PMDD with a blood test, and every estrogen/progesterone blood test I have taken has shown my levels to be perfectly normal, even when I was in the middle of a PMDD episode.

I think the best science has come up with so far is that yes, PMDD does have to do with your hormonal fluctuations, but it’s more that something goes awry in your brain when processing these normal and natural 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, but not during the rest of the month?

As part of PMDD Awareness month, I invite you to share in the comments section below any adverse consequences YOU have experienced in your social functioning, relationships, work productivity and/or healthcare use due to your PMDD.  Share to help make aware!

PMDD, Prostaglandins, Pain, and YOU

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

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

Sounds simple, right?  It is.

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

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

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

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

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

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

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

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

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

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

Prostaglandins help with many things, such as:

Blood vessel dilation

Muscle contractions

Inhibition and promotion of blood clotting

Regulation of secretions, including digestive hormones

Cell division and growth

Body temperature regulation

Lowering (or raising) blood pressure

Immune system responses

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

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

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

Tell me something good about prostaglandins, then.

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

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

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

 Series 2 Prostaglandins (the Bad Guys)

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

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

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

Series 1 Prostaglandins  (Our Heroes)

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

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

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

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

and

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

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

 

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

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

evening primrose oil

naturally fermented fish oil

flaxseed oil

borage oil

starflower oil

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

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

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

Other ways to combat Bad Guy Prostaglandins:

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

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

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

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

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

So, to recap:

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

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

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

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

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

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

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

Avoid these top ten culprits.

1.  Sugar

2.  Wheat

3.  Caffeine

4.  Soy

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

6.  Dairy products, especially milk and cheese. 

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

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

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

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

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

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

The Four Seasons of PMDD

I know I mentioned this in my last post as a real treat to find, but I want to spend a little more time on WHY I think the 34-page free PDF called Let's go menstrual! by Miranda Gray is so amazing.  For one, it treats our menstrual cycles as something to be welcomed and honored and worked with, not cursed and concealed and ashamed of. Something that can be used as a positive force in our lives. 

We all know that with PMDD we feel differently on different days.  This booklet shows you in simple, easy to understand terms, how to make the most of your good days, and even how to make the most of your bad days. 

So I encourage you to use this booklet to raise your awareness of the different *seasons* of your monthly cycle, and to tailor your expectations to match what is naturally going on in your body during any one of these four seasons.  In the end you will learn how to better meet your own mental, physical, emotional, and spiritual needs, and doing this will help you to feel good about yourself.   In particular, the author says (and I heartily agree), you will feel more:

Comfortable with (and in) your own body

In control because you know WHY you are feeling the way you do

Confident in your abilities (as long as they are tailored to your moods or seasons)

Empowered to created positive feelings about yourself

Now what PMDD woman couldn't use a little more comfort, control, confidence, and empowerment?  Tell me what woman anywhere couldn't use a few more positive feelings about herself? 

PMDD women in particular need to read the section about the Autumn/Fall of our cycles, the problem-finding (and solving!) portion of our cycle, where the booklet tells us we can feel the need to "clear out our (mental, physical, emotional and spiritual) rubbish, to curl up alone, and to sleep more."

Ms. Gray then tells us the Winter Phase is a time when we tend to reflect on the year (or cycle) just over, daydream about the future, what we want to do in the year ahead, and commit to our new resolutions.  It's a time of rest, relaxation, and meditation, among other things.  I personally use it to curl up in my big cozy chair and catch up on my reading.  

Do not miss the list of suggestions for your Winter Phase, which coincides with the time of your bleeding.

Of course, the Spring and Summer Phases have equally invaluable lists of characteristics and suggestions for maximizing your well-being.  The suggestion I liked best for the Spring Phase, (when we are full of confidence and are our normal, non-PMDD selves) is to "Use your self-confidence to do something different from your usual routine."

That's right, the time to take on something new and unfamiliar is your Spring phase.  But the KEY to success is to only work on that project in your Spring Phase.  Set it aside when Fall and Winter come.  Do not let the innate negative energy and thoughts that those seasons bring to you undo all the positivity you have created in your Spring and Summer seasons.  Both Spring and Summer will come around again (that's the beauty of cycles), and there is no harm in working toward your strengths.

Use your Spring and Summer seasons to discover just what those strengths are.  The booklet even tells us what to watch out for in these highly positive and productive seasons, such as doing too many things at once, or doing too much for others, and ignoring our own needs.

Ms. Gray also tells us that Summer is the best time in our cycles to be sociable and work on relationships.  But also to be wary of wishing we could be this light and cheerful and confident forever.

Then, in the Fall and Winter seasons, we are to (among many other things) focus on NOT BELIEVING the negativity in our minds, and not to try to maintain a Spring or Summer schedule when our body is crying out for some rest and relaxation. 

We need this rest and relaxation to prepare us for the renewal that comes with Spring. 

So, to recap: 

Cycle Days 1-6 are your Winter Phase (rest, relaxation, take care of yourself)

Cycle Days 7-13 constitute Spring (a time of renewal, rebirth, and creative energy)

Cycle Days 14-20 should be your social and sharing Summer phase;  (but is often where the problems begin in PMDD women instead); and

Cycle Days 21-Day 1 (first day of bleeding) is your Autumn/Fall phase (when PMDD strikes the hardest)

For more information, please visit www.optimizedwoman.com.  There is a newsletter you can sign up for, and all sorts of good articles there, on how to increase your awareness of your body and its cycles.