PMDD and Your Brain

A while ago, I read the book Women’s Moods: What Every Woman Must Know about Hormones, the Brain, and Emotional Health. It was a great book about overall hormonal health and described how hormonal issues are physiological occurrences in the brain that manifest as emotional behavior, because the hormones involved affect the areas of the brain that regulate our emotions.

On the one hand, I wished I’d read this book years earlier than I did, as it was first published in 1999. On the other, I’m glad I didn’t. While the authors completely explain the devastating effects women's hormones can have on your emotional life, they are firmly in the camp of using medication to treat these brain disorders that affect women throughout our reproductive years.

That’s fine if you want to go that route, but there are other options available now to women who suffer from hormonal issues. In 1999, these options were given a cursory mention and dismissed. Which means if I’d read the book any earlier than I did, I would have come to the conclusion that there was no alternative to my PMDD, short of medication.

That, for me, would have been very depressing indeed.

I know there are millions of women out there who have severe hormonal issues that may well require medication to control them—notice I say control them—not manage them. Me, I manage my symptoms through nutrition and exercise and positive lifestyle choices. If I took medication I wouldn’t need to be so vigilant about my health—the medication would theoretically handle the problem for me. But in my case, with the PMDD, I can’t see taking medication every day for something that only occurs a few days a month.

Still, there are days when the thought of it tempts me. But most days it does not.

As I said, to have read this book any earlier would have been devastating for me. Because the authors insist over and over that without treatment, your hormonal issues will only get worse. That there is no light at the end of the tunnel without treatment—this is absolutely true--but their treatment of choice is not mine.

That aside, I was able to read the book and learn much about the causes of hormonal issues and how and why these issues can and do get worse later in life without some type of intervention.

Hormonal issues are a very serious and practically rampant problem for women. Yet some days it seems like the only people paying any attention to us are those who can profit from our condition(s). Most of the information women receive regarding "hormonal imbalances" (a term I take exception to) comes from companies whose drugs have been approved for treatment of these "imbalances."

We need more than to be told a certain medication (or two, or three) can solve  our problems. We need to understand the underlying causes of our hormonal issues and find ways to heal ourselves from within and prevent the need for chemical solutions. We need to understand the unique female brain/body connection and how it makes us vulnerable to mood problems at the most challenging times in our lives. Puberty, pregnancy, post-partum, peri-menopause, menopause, and post menopause.

Every time you have a child, your hormones undergo an enormous amount of stress, and yet society acts as if there’s nothing to it. Life goes on and you cope.

But what happens when your ability to cope fails you? What happens when, as these authors aptly describe it, you have an internal “earthquake” and mood disorders erupt?

All this attention is given to heart health, but brain health is equally important. We need to learn to care for our brain as diligently as we do our heart. Not only the heart can be compromised by a woman’s genetic make up, life experiences, and stress load, but so can the brain.

If our brain doesn’t work right, we don’t work right, and all sorts of life-chaos can happen. No amount of "being strong" or "powering through" is going to re-regulate a brain that has gone askew. It just isn’t going to happen.

The way this book and many others describe it, our brains have neurological pathways that become worn over time like ruts in a road. When any situation arises, our brains immediately locate the memory of how we dealt with that situation in the past, so that we can effectively do so again. And each time we deal with that situation again, a new pathway is created over the old pathway.

This works fine if your brain is healthy, or operating at optimum level. But what if your brain is not? Then your brain is creating new pathways over damaged roads, and only more damage ensues.

Genetics plays a factor in this, of course, but so do your thought processes. In short, how we deal with stress affects our hormones, which in turn affects our brain. This stress can come from any and all sources, trauma from an accident or abuse, be it physical, emotional, sexual, mental, spiritual, financial, you name it, or from naturally occurring life events such as birth, death, marriage, divorce, loss of a job or health or relationship, to name just a few.

When your hormones are doing what they should, your body deals with these stresses in a normal and healthy way. When your hormones are compromised, your body and brain do not. Little stresses can be magnified into big stresses, completely out of proportion to the situation. When your hormones are compromised and your brain is dysregulated, you can feel like you are under attack 24/7. Your brain makes no distinction between the threat of an oncoming car or someone who simply disagrees with your point of view. Both, to your dysregulated brain, are threats to your very existence.

It’s not logical, in fact it is completely irrational, but that’s what it is. Your dysregulated brain is not properly processing the threat.

This is why women with mood disorders like PMDD or even simple hormonal fluctuations seem so irrational at times.

But we’re not crazy, or imbalanced--far from it. Rather, something has compromised our hormonal system, something that has yet to be scientifically identified and verified, something we have no more control over than we do an allergic reaction.

This is not to say there is nothing we can do to prevent our hormonal eruptions.  We all know that once one begins, it is unstoppable, because the PMDD brain is out to win at all costs.  But there are ways to minimize our eruptions, and this blog* is full of tips for that.  If you're looking for the information all in one place, try my book, PMDD and Relationships, or, for the supportive partner, PMDD: A Handbook for Partners.   Both are based on the posts in this blog.

*Use the search box at the top of the page to locate topics you are interested in reading more about.  Type in the subject, and if I have written anything about it, a list of posts will appear.  This will save you a lot of time spent scrolling past stuff you're not interested in.

Today is World Mental Health Day - PMDD

This from the Gia Allemand Foundation:

Today is #WorldMentalHealthDay and this year's #WorldMentalHealthDay focuses on mental health in the workplace. Coping with PMDD in any aspect of your life is a challenge. Dealing with PMDD at work can be especially difficult.

Maintaining a business demeanor when you are experiencing violent mood swings, fatigue, anxiety, and often physical pain related to PMDD can seem an impossible thing to do. You may find that you need to be absent from work while your PMDD symptoms are at their most severe. You may wonder if you can do that without losing your job. Thankfully, in the United States, there are some measures you can take to ensure that you can take the time off work that you need in order to cope with your PMDD symptoms without losing your job.

For more information, and for access to valuable tools that may be helpful to you in your journey no matter were you live, please visit this Gia Allemand Foundation page.

Liana adds:  Remember, PMDD is an explanation, not an excuse, and is something that happens to you that you don't have any control over it happening. The only thing you can control is how you respond to your PMDD.  Just know you are not crazy, and that you are never alone.  Even though, I know, it totally feels like you are.  But you are not.  Help is available.  

PMDD - When Women Who Don't Have it Do Harm to Those Who Do

April is PMDD Awareness Month.  Last week, I presented a Quote of the Week from a psychiatrist in South Africa who does indeed understand what PMDD is about and the need to treat it.  This week we present the flip side of the coin--the side most of us are unfortunately all too familiar with--in the form of a guest post by fellow blogger Twilah, written in response to a TED Talk in which a woman psychologist proceeds to negate the validity of PMDD by, among other things, dismissing PMDD and its sister disorder PMS as a cultural myth.

Twilah: This TED talk came to my attention because it was posted on a PMDD forum online. Other women complained that the talk seemed invalidating and dismissive of the illness they live with. I tend to agree with the feedback of the women affected by PMDD. This is my analysis.

The speaker, Robyn Stein DeLuca, opens by gauging the audience’s familiarity with the concept of PMS. She establishes that PMS is a familiar concept with easily recognizable symptoms. She goes on to point out that mainstream American media accepts and propagates ideas and assumptions about PMS.

DeLuca then drops her bombshell that after five decades of research the jury is still out on PMS. It’s poorly defined, treatment protocols vary… it may not even be real! She explains how historically the symptoms of the disorder described by psychologists varied so greatly that the very definition of PMS became meaningless! 

She goes on to outline the shabby research techniques and protocols that characterized the presumably five decades of research she referred to earlier. She claims that the DSM “…in 1994…redefined PMS as PMDD, Premenstrual Dysphoric Disorder.”

Actually the DSM didn’t distinctly include PMDD until DSM 5, which was released in 2013. Prior to that, the DSM 4 included PMDD not as a distinct mental illness, but as a “depressive disorder not otherwise specified.” The speaker heralds the clarity established by the diagnostic guidelines offered in DSM 5. She then points out that under the new criteria in DSM 5 the number of women affected by PMDD turns out to be only 3-8%, which she considers “not even a lot of women.”

So DeLuca opens with a claim that five decades of research hasn’t supported the premise that PMS exists. Then she points out how poorly conducted much of that research was. 

Okay…you are using five decades of research that by your own reports doesn’t count for anything to support your premise that PMS is a dangerous and erroneous cultural creation? It’s generally a bad idea to use volumes of poorly conducted research as support for anything. And a mere 3-8% of presumably the world’s female population is affected? If women are slightly less than 50% of the estimated 7 billion humans on this planet, and about 2 billion of these women are menstruating, then 3% of menstruating women translates to roughly 60 million women with PMS/PMDD…whichever she is calling it right now…because she wants to undermine a PMDD diagnosis by conflating it with a cultural concept of PMS!  (Liana speaks up:  I want to say here that PMS and PMDD should never, ever be used interchangeably, as they are two separate conditions, and while PMDD affects 3-8% of menstruating women, PMS is said to affect approximately 80% of menstruating women. That means this woman, aside and apart from the huge disservice she is doing to women who do have PMDD, is also dismissing the monthly experiences of possibly another 1.6 billion women and calling it "good news".) 

Head spins…

She goes on to posit that, “the PMS myth” persists because of cultural limitations on the role of women.

Now I won’t argue for a minute that many cultures, especially the American one to which she is primarily referring, frequently limit the roles of women. Popular conceptions of PMS have been used by sexist people to minimize women’s speech and self-advocacy. That is undeniable. But the irrational interpretations of a sexist culture have zero bearing on whether a medical condition is real. Many well established medical conditions are stigmatized and used to oppress individuals affected by the conditions. Think of any disease that might cause a person to wear a colostomy bag, think leprosy, think any one of legions of mental illnesses. Simply because a culture uses a diagnosis to oppress a person with the diagnosis does not mean there is no validity to the diagnosis. The cultural interpretation of the illness needs to be addressed, the disease doesn’t need to be denied. 

DeLuca’s assertion that PMS is a largely Western concept is irrelevant also (Liana: as well as totally untrue). Lots of women’s health issues are more marginalized in non-Western societies. That has no bearing on their realness or validity. If society at large and physicians in particular choose not to discuss the high infant mortality rate in any country that doesn’t hold women in high regard, that doesn’t mean high infant mortality doesn’t exist in that country. That means it isn’t talked about or researched in that country.

To say that diagnosis and treatment of PMS or PMDD is anti-feminist is more hurtful to 60 million women than much run of the mill sexism. To have other women, who we would hope are our allies, take a stand to deny us diagnosis and treatment for a life threatening condition is morally reprehensible. 

Because that’s what PMDD is. It is a life threatening condition. The 3-8% of women who are affected by this disease experience job loss, relationship difficulties, relationship loss, depression, and potentially suicide. And this woman thinks it is helpful to stand up in a forum like a TED talk and tell people that it’s really no big deal that over 60 million human beings deal with this disease every month? To suggest it is a cultural problem and not a medical problem? She criticizes what she calls “the medicalization of women’s reproductive health.” I criticize the politicization of a medical disorder. I criticize speech that discourages further well conducted research into a life threatening illness.  (Liana:  Up to 30% of women with PMDD regularly experience suicidal ideation or attempt suicide.  15%  those succeed.) 

The root of the problem is not a cultural misperception about PMS. The root of the problem is that an endocrinological disorder is being treated as a mental illness. The problem is that the hormonal health of women is being handed to psychologists and psychiatrists for treatment. Imagine going to a psychiatrist for your diabetes or your hypothyroidism. What do you think the outcome would be? What do you think the data would show? Imagine a man being told to go to therapy instead of being given testosterone supplementation for age related testosterone production changes.  (Liana:  I half agree, but also disagree.  If psychiatrists and psychologists are the only medical professionals attempting to take PMDD on, then I would gladly go to them over accepting no medical help at all.  But I do believe PMDD is more an endocrinological disorder than a mental one.)

DeLuca says that, “…the success of medication in treating PMS symptoms vary from woman to woman.” She uses that as evidence to support the invalidity of a PMS diagnosis. Of course the success rate of using psychiatric drugs to treat a hormonal disorder would have varying rates of success! Considering the efficacy of antidepressants to treat depression is disputed, with estimates ranging all over the place, it’s not surprise the efficacy is unpredictable when you prescribe a psychiatric drug for an endocrine condition. I’m sure you’d find the same kind of inconsistency if you prescribed Prozac for erectile dysfunction. A man just might get an erection because increased serotonin made him happier overall. (Liana:  If the medication doesn't work, that does not mean the condition is not real.  It means the medical options provided are not addressing the medical issue.)

But wait, we’re talking about women.

This presentation is so off base. The problem isn’t that a make believe, culturally based illness is being given credence. The problem is that a hormonally based illness is being investigated by mental health professionals, simply because one aspect of its presentation is similar to recognized mental illnesses. The problem that American society uses the term PMS to dismiss or demean women’s emotional states is a completely separate issue from research and treatment of a disease that may affect more than 60 million women. The problem is that an educated women would stand up in front of an audience of thousands and undermine the health concerns of millions of fellow women.

Let’s not back away from helping women because existing research is incomplete or inconclusive. Let’s fund more and better studies. Let’s take seriously the complaints of millions of women that their health is being affected by their hormones. Let’s listen to women’s voices instead of dismissing them. 

Twilah's blog can be found here.  

The Voices of PMDD: Our Seven-Year Struggle With My Wife's PMDD

Recently on Facebook I came across a conversation where one couple who had experienced PMDD was reaching out to help another. The first woman had asked her husband to write a letter to the other woman, to help the second woman explain PMDD to her husband. She then posted his letter on Facebook. I knew right away this man's wisdom and clarity could help so many others...so I asked the couple if I might share the letter on my blog, and they graciously agreed.

Her name is Twilah, and she has a blog of her own, one having to do with navigating the American medical system. His name is Alec Johnson, and here is his letter:

I was asked to write this in an attempt to explain PMDD from my perspective as a husband who has experienced PMDD. I am also a Clinical Scientist with a quarter century experience in medicine and healthcare. I can tell you from my experience, PMDD is one of the most difficult disorders [to diagnose and cope with], for both the patient and her family.

I speak from seven years of experience living with my wife, who was Jekyll and Hyde. I only hope to provide some assurance to you that your feelings of frustration, anger, hurt, and disbelief are normal and understandable.

I also wish to convey from a clinical standpoint that your wife is not making anything up, nor is she able to control her disorder. Even if she had the greatest willpower of any human, she cannot will a hormonally-mediated disorder away.

My wife is a very intelligent, driven, and willful person whom I adore. That's why I married her! When we met she was a runner who ran 4-6 miles every day of the week. She was less than 10% body fat, and thus did not have periods. It is common for women with this low amount of body fat to stop menstruating. When we began dating we went out to dinner often, and shared more than a few bottles of wine. This slight change in her lifestyle over approximately 2 years caused her to gain a small amount of weight. Maybe 8-10 pounds on her 105-pound frame was enough to restart her hormones and periods. She began to change.

I noticed her becoming moody and anxious as well as not being very nice to me. I marked it off as stress from our upcoming wedding and honeymoon as well as normal work and life stress. Things were mostly fine and then one morning she called me from the emergency room saying she wanted to kill herself. This was all completely from left field. I had no idea what was going on.

My wife had been experiencing PMDD for a number of months at that point, and was doing okay at suppressing the symptoms. On this particular day she could no longer control the most powerful human chemical, hormones. Hormones are intensely powerful chemicals for both men and women. I would imagine you and I are at least similar in experiences as teen men. You most likely remember the intense desire for girls. Hormones, and particularly testosterone, were front and center in that. You and I could no more control that intense desire that my wife could control her desire to die due to progesterone and PMDD.

I will not bore you with many details, but she and I went through hell for 7 years before her PMDD was eventually properly diagnosed and treated.

PMDD primarily manifests as a mental disorder. It appears as if the woman is depressed, or anxious, or suicidal, or any number of mental disorders or combination of mental disorders. My wife was treated with every depression, anxiety, and mood compound known to man—with no positive effect. There were numerous bad side effects though. After 4 years it was obvious that it was directly linked to her hormonal cycle. For about 2 weeks of the month she was perfectly normal. Then every month without fail she would wake up as a person I didn't recognize.

She was suicidal, depressed, and most of all had the worst anxiety imaginable. We told every physician we could tell that her symptoms were hormonal and directly linked to her cycle. They gave her more mood drugs and ignored the hormonal aspect.

Finally quite by accident she saw a reproductive endocrinologist doctor. This physician not only recognized PMDD, she knew how to treat it appropriately. Some women can be treated successfully with birth control pills or psychiatric drugs. Some women can't take those because of side effects or other reasons. For some women there are only 2 cures for PMDD, either a COMPLETE hysterectomy, or menopause.

To prove that it was PMDD, the reproductive endocrinologist prescribed a drug named Lupron. This is a once a month or once every 3 months injection. My wife was to take the injection for 6 months. Lupron shuts off the ovaries and hence mimics menopause or hysterectomy. After a couple of weeks on Lupron my wife was back. It was completely obvious that what we had been telling many doctors for years was true. She had PMDD. No amount of willpower or mood drugs was going to fix or control my wife's complete [and biological] inability to tolerate progesterone.

Progesterone intolerance made her crazy and out of control, and controlled our lives for 7 years.

After 4 months the side effects of Lupron became debilitating, so the doctor referred my wife for a complete hysterectomy. That's when the real hell began. From the time between when the Lupron wore off and before the surgery could be arranged, my wife's ovaries rebounded. They produced massive amounts of hormone in an attempt to bring her absent hormone levels back into range. It was so bad I truly believed my wife would be arrested and put in jail before we could get her into surgery. I could tell you stories...

She finally had surgery on 24 December 2014. Literally the next day my wife looked at me and said, "I feel a calmness I've not felt in many years."

She was cured and our life together saved. This is our story.

I would imagine that right now you are experiencing the worst PMDD has to offer. Please understand that your wife can't will her PMDD away. She cannot "just try harder." She cannot simply "pull herself up" and "get it done" at times you might feel she should. I COMPLETELY understand. I'm sure I was not the nicest husband all the time when we were going through our hell. There were times I could barely maintain my sanity.

The only things that got me through was my love for my wife and knowing it was not her fault or choice. If I ever thought she could have chosen to act differently and she just chose not to, I would have left. Thankfully I knew it was not her fault.

From someone who has been in your shoes, I ask you to please understand your wife needs you more than ever. I know how completely maddening and frustrating it is to deal with right now. Get her to a reproductive endocrinologist who understands PMDD. Make peace with the fact that she may need birth control, psychiatric medication, or even a complete hysterectomy, and do what you can to get her the necessary treatment.

If surgery is appropriate do not allow a doctor to leave either of her ovaries. Ovaries are the problem.

As an aside, both my wife and I had our DNA sequenced for genealogy purposes last year. After that we found a website that would analyze our DNA and give us health information. It shows my wife has a known genetic mutation that makes her unable to metabolize her own progesterone.

I didn't need a DNA test to know that, but it was a nice confirmation of what we had experienced. 

The Monster I Am Living With: PMDD

Crushing weight sinks deep into my fragile chest. Insomnia, I'm already weary but have no hope of finding rest.

Switch in my brain has flipped, can't hold back as the monster inside bursts free. Losing all control, wreaking devastation wherever I go, it's then that I know, that as sure as gravity on earth I am back in its throes.

Depressive Tsunami overtakes me, washing clean away all of my self worth. Tormented woman desperate to stop it... Defeated despite the hard fight put forth. It's like a psychotic carnival ride, can't stop going around and around in my broken mind.

Anxiety and fear no one can understand brings salted tears ʼtil I am virtually blind. How can this damn life be so unkind??

Misery is embodied in me, taking away my hope for good life, hatred for the man who loves me most taking away my hope to be a good wife.

Migraines. Body aches. Sensitivity. Short fuses. Darkness. Hysteria. Forever on edge, pushing me to LOSE it.

I mean really how many times can my kids hear mommy's having a bad day, before they too feel abandoned and pushed away?

We stand on opposite sides of the same door secretly pleading: I've done nothing wrong why do I still have to pay?

Heartbreaking.

I hide out in my restroom cuz it's the only place I can truly be alone, keeping everyone safe from me, staring into a mirror and seeing nothing but the monster I am living with: PMDD.
~Carrian Troxler

PMDD and Holiday Stress

Offhand, I can think of four good sources of holiday stress: family, food, finances, and expectations.  Each causes its own manner of stress, but like a toxic family with a volatile history, they all intertwine.  For example: Your family has expectations that involve your finances, either via hosting a food-laden event, traveling to a food-laden event, or simply exchanging gifts. 

Funny, but our current culture would have us believe that the more we spend, the more we care.

Is that messed up or what?  Then, of course, there are the guilt purchases.  You know, the sometimes extravagant but almost always expensive gifts you buy to convince someone how much you care when you won't be showing up in person.  Or maybe you will be there, but you'll have to leave early, or it's the only time you've seen this person since whenever, and you feel guilty about that.  Then there's the keeping-up-with-everyone-else spending. Your gift can't possibly come in at a dollar value less that the gifts "the others" are giving, or you'll look bad.  So you either buy something you can't afford, or pony up your share of a gift you didn't choose and can't afford. 

But I digress.  Above are only a few examples of generic holiday stressors.  A PMDD woman doesn't handle stress well to start with, and so when the holiday madness begins....

You can understand why all she wants is for it to be over, or at the very least, to get through it without a meltdown.

So let's stop for a minute, just stop and think.  What are all these holiday gatherings supposed to be about?  Connecting, making memories to hold you through until you see each other again, right? (Or, if you're all local, celebrating another year of life's ups and downs together.) 

But somewhere along the way, everything shifted.  Away from Jesus and family, peace and goodwill, and toward fueling a selling season that accounts for 40% of the year's retail revenue. 

Connecting more deeply with friends and family is not about two months plus of frenzied shopping to see who comes up with the biggest, best, shiniest gift.  It's about coming to the table well-rested and healthy, comfortable and caring.  It's about making eye contact (put those electronics away!!), feeling genuinely happy to see each other, and connecting in a special way...but not a deep and forever-bonding kind of way.  If you come to the party expecting that, you've fallen into the trap of unrealistic expectations, and you'll only be disappointed. 

Holiday gatherings are for having lighthearted fun and making good, positive memories.  If a heart to heart connection happens, consider it a bonus.  But don't go into the event expecting anything more than a good time.

Happy holiday gatherings are about spending time with people who share common interests, values, and beliefs.  And if that doesn't happen—which is most of the time—it's about managing to enjoy the day and company as best as you can.  In a worst case scenario, it's about keeping the peace (and your peace) for as long as you and these spiritual, mental, and emotional strangers spend time together.

Not everyone is blessed enough to have a group to gather with.  If you are, but can't stand to be around them, and absolutely, positively can not escape attending the festivities, the prevailing advice is to limit your visits to a couple of hours at a time.  If you've traveled long distance, take breaks to visit friends in the area, or maybe revisit familiar local haunts, or even show your partner or kids where you grew up.  If you don't want to do that, or don't know anyone else in town, maybe you can visit some sort of tourist attraction in the area for a break between bouts with relatives.  Or you can offer to be the gofer who runs errands.  Somebody always needs something they forgot to bring at these things.  Offer to fetch it, and use the time to regroup.  If you're not from the area, just take a walk or a drive to explore the surroundings and clear your head.  What is it with people acting as if there's something wrong with wanting to spend more than a few minutes alone?  Could it be they envy your independence? Wish they could break away from the herd as well?  Think about it.

If you have no relatives nearby, find some friends and start your own traditions. Traditions are important, but creating new traditions can be equally important.  Families no longer look the same as they did in the past--we've got single moms and dads, same sex moms and dads, bi-racial couples and children, adopted children, foster children, blended families, events where all parties and their current significant other show up, presumably for the sake of the kids—so why should family events always be the same?  Consider incorporating something new into the mix.  Maybe you can all go to church together, or to a restaurant for dinner, or to a movie or bowling after your meal.  Mix up the traditional menu but try adding something new.  Maybe even ditch the whole thing and have a theme party.

Or maybe you can agree to go to the big family shindig only every other year, or only participate on alternate holidays.  Spend one any way you want to, (whether it be by staying home or planning a ski chalet weekend) and the next by attending a family gathering.  Or schedule the family event at a different time than the true holiday.  Think of all the stress you'll avoid, not scrambling out there with all the other holiday travelers. 

But don't go at all if you know the event will only bring more pain and destruction to yourself and the family.  Family gathering time is not the time to resolve family issues, conflicts, or make major family decisions.  The discussion about your cousin's financial woes or addiction or whether or how to move someone into assisted living is NOT one you want to have at a holiday gathering.  Ditto details about selling, renting, or discarding family property.  True, it may be the only time you are all together, but the holiday celebration itself is NOT the forum for such undertakings.  Those require a separate family meeting.

Just as the holidays are stressful for all of us, most of these suggestions could apply to anyone.  To specifically address your PMDD, I'd have to return to the line of "coming to the table well-rested and healthy, comfortable and caring."  If you are feeling none of these things on the date of the event, then you are not wrong in wanting to cancel, and if you do, please do not feel guilty or accept any blame for doing so.  Would you stay home if you had the flu?  Negative moods are just as contagious and can ruin a party just as easily.

Feeling guilt and accepting blame only escalate your PMDD symptoms.  By staying away from the event, you are protecting both the event and taking care of yourself.  Nothing in this world is more important than seeing to your own health and well-being.  Especially when it comes to your mental health.

Because if you don't care enough about yourself to take care of you, believe me, nobody else will either.

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

Holiday Treats for Those with PMDD

Two Christmas treats I've uncovered this month...

The first is the best overall medical write up of PMDD I have ever read, and I do mean ever, starting with the first line where it defines PMDD as "a diagnosis to indicate serious premenstrual distress with associated deterioration." 

What I like about this write up is that it DOES NOT, anywhere, or anyplace, or at any time, refer to PMDD as a "more severe form of PMS," which PMDD most definitely is not.  You can have both PMS and PMDD at the same time, but they are not interchangeable, as so many articles and essays and websites either claim or imply, and they are not the same disorder, with one simply being a more severe version of the other.  The fact that so many PMDD resources say they are only muddies the already murky waters of PMDD, leaving everyone searching for help more confused than ever. 

So...I heartily recommend that you read this emedicine Medscape article and learn the latest about PMDD.  I'm sure there's information here you haven't read before.  And if you have just recently discovered you have PMDD, there is no better place to start your research than with this overview.

The second treat I've uncovered is this delightful free PDF entitled Let's go menstrual! by Miranda Gray. This 34-page PDF is a super easy read that helps us to understand our monthly changes, and provides a great way to enjoy and take pride in (rather than dread and loathe and curse) your menstrual cycle.  Ms. Gray breaks our cycles down to four seasons.  PMDD women would benefit the most from the section entitled The secrets of the Autumn and Winter phases.  

Seriously....this PDF "gets" what it's like for us, provides excellent tips and resources on how to cope, and finds a way to put a positive face on our periods and PMDD.

Couldn't we all use a little positivity going into 2014?

So let's welcome the new year and our new beginnings and successes with these two excellent resources for women with PMDD.

Should Your PMDD Symptoms be Classified as a Mental Disorder?

Here is a link to a National Public Radio (NPR) News Morning Edition segment that asks the question, Should Severe Premenstrual Symptoms Be A Mental Disorder?  Listen to the eight minute segment (play it while you're working on something else at the computer if you're short on time) and decide for yourself.  You might also recognize the names of some ladies interviewed for the segment.

The embedded YouTube segments below the written version of the NPR post are also well worth watching. 

Thank you for stopping by, and I know it's a lot to hope for, but may you be having a PMDD-Free Day! 

PMDD Crisis Guide - The Mental Realm of PMDD

This week we continue with Cat Stone's PMDD Crisis Guide...welcome back, Cat!

You can find the Introduction to Cat's Crisis Guide here.. and her post on the Physical Realm here.

The Mental Realm

This realm is where you will find your thoughts, and inevitably, the things you say. Over time this realm is programmed with reactions and responses to things that you are told, or things that happen around you. This realm for a PMDD sufferer is usually very chaotic.

During the hormonal changes in a woman's cycle, her body will undergo changes and present physical problems. These are a little easier to deal with than the changes that go on in the mind during this time.

This is probably best represented by the term, 'mood swings' although that would suggest the problem is just an emotional one. It isn't. The chemical changes in the body actually create false moods, which often bring about 'false thinking'.

A PMDD sufferer will experience random thoughts, seemingly crazy thoughts during their 'bad' time of the month. Thinking outwardly becomes impossible. Seeing the bigger picture seems impossible. All thoughts become inward and bad memories surface. Reactions to what people say, can trigger a negative spiral of thinking that can be overwhelming.

For me, it's like a constant battle in my head. I KNOW how I would normally react, what I would normally think, but during that time, things are not normal. I begin thinking I'm the worst person in the world, that my kids would be better off without me. I think about my past and all the painful things that have happened. I think people should leave me alone, not bother with me.. I lose all my self esteem and belief. All the things that normally get me through no longer work... The clothes I wore last week don't look right, even though it's the exact same outfit. I look in the mirror and see something completely different. This change in perception is quite common in all women who suffer from PMS, but when it means you don't leave the house because you have tried on 10 outfits, are full of tears, anxious, stressed out and frustrated, you know you are suffering from something worse.

My thoughts spiral out of control during my PMDD time, but I am learning to control them. Realising that your thoughts are not really your truth, takes time to happen. I often say... 'In my good head, I know this is true... but right now, I think that blah negative blah' I can recognise what I would think if I were in a good week, and what I am actually thinking. Dealing with the emotions that these bad thoughts bring up is harder than trying to control the thoughts, but keeping your thoughts in check goes a long way to steering a breakdown off course.
After talking to many women who have PMDD, it is obvious that they all feel like 'Jekyll and Hyde'. In fact, you will find that term used quite often when describing PMDD.

A woman with PMDD will find herself thinking about abandoning her kids, and how she'd do it, and how she'd get away. Or leaving family, friends or job. She may think the answer is suicide and spend many hours debating suicide, going through plans or writing her note to leave behind. She may think about drinking till she sleeps, or hurting herself. Her thoughts will turn to guilt, and she'll sit and think about all the damage she has done to her family or friendships, how lonely she is, how no one will ever understand. I know this to be true because I have done all these things, on repeat... for years. These thoughts are what drive people to harm themselves, along with the negative emotions, and it's why it is important to try and get these thoughts under control.

What also changes at this time of the month is the way you speak. This is governed by your feelings, and the things that are going on in your head. A chilled-out, mild-mannered woman will turn into a screaming, shouting, crazy, scary beast. You think I'm joking? This is one area the most damage can be done to your family and friends. The things you say. I would bet that every woman with PMDD has had an episode, and when the storm has died down, has had to think about what she has said to the people she loves. Nasty, spiteful, bitchy, outrageous things. Stuff you would never let leave your mouth. Goddess forbid you argue or fight with a PMDD woman having a bad episode.... Sanity has left the room. Like a caged animal, you want to fight. You are feeling so tired, so low, frustrated, wired, scared, you want to die, you don't care what happens. In your head, your mind is telling you you are terrible, shameful, worthless, then it tells you you will never get away from this nightmare, you will have to do this till the day you die. You worry about every aspect of your life. Will my partner stay with me? What if I hurt my kids? How can I keep doing this? I'm tired... oh so tired... I just want to go to sleep and not wake up.... What will happen if I just walk out the front door now. Mind is on OVERDRIVE.

There is a great lyric, by one of my favourite 'bands'.

How hard is it to decide to be in a good mood, And then just be.. in.. a good mood?
Dan le Sac vs Scroobious Pip - Waiting for the beat to kick in.

Ha.. yes, it's a man talking, and he has never experienced PMDD, but sometimes, you do HAVE to just decide to have a better day! FOCUS on having a better day. Focus on other things other than the thoughts.

Writing or creative outlets can help focus the mind on other things. Baking a cake, going for a walk, going to the library. Having a job can be a great focus... Distraction, distraction, distraction.
If you cant work, volunteer.. or use your time more wisely. It is too easy to let yourself dwell on the past, and mistake hormonal thoughts for the truth. It's easy to let yourself spiral. It's much harder to find the strength to change your thoughts. (Italics added by Liana.)

Some days, it is too hard to get out of the spiral. Some days, you just CAN'T. So what do you do?
Allow the thoughts to come, acknowledge them, then let them go. It's holding on almost compulsively to negative thoughts that feeds the downward spiral. You can even start talking to yourself (assuming you don't already!) and by that I mean...

'Oh hello, negative thought... what was that? I am crap mother?'

'Yes.. you are the worst mother ever, look at you, you hardly take the kids out anywhere, and most the time you are so caught up in your selfish head, You are so selfish. You slept the whole day away and someone else looked after your kids... '

Now this can go two ways.... You can either agree, or totally kick its ass.

'So, you think I'm a bad Mum? Who else cooks for the kids and washes their clothes? Who else finds things to do on a shoe-string? Who else creates a tea party in the garden, with 5 mins notice?

I have seen my kids through everything, to the best of my ability... I love them, I put 100% in when I can, and when I can't, I may sleep, or be a bit distant, but isn't that better than screaming and shouting at them. I am not a bad Mum, and will not accept that. Next?

'You dont have a life.. you sit on your fat arse all day, and never go out. What career have you got? People think you are a sponger, you drain everyone. Your friends never ask you out, cos you never go. You might as well be dead.'

(Are you going to take that?)

'Of course I have a life! I'm here, aren't I? I have this and that, and am planning on doing lots of things in the future. Just because things have been difficult, doesn't mean I will always be like this. I do have friends! And the ones that don't bother with me, aren't worth worrying about. I'm happier with a few close friends, doesn't mean I'm not liked. I give what I can to others, when I can, so, NO, I don't accept that, today I'm feeling vulnerable and a bit depressed, but thats today. Not tomorrow.. or forever...'

Don't commit the future by how you are thinking or feeling on a bad day. (Again, Liana chiming in!)

If you can learn to remain calm, and blow up every negative with a missile of positive you will soon feel stronger and more in control.

We often feel we need outside help, but there is much that can be done by you, by just changing your thoughts.

If you feel you would like more professional help with your thoughts, I would recommend looking into CBT – Cognitive Behaviour Therapy, which helps you to define your thinking patterns so you can begin to change them, and NLP – Neuro Linguistic Programming, which helps you learn about your own ways of communicating and has an excellent way of re-shaping the way you perceive yourself, others and your thoughts and words..

We only use about 20% of our brains, and unfortunately, with PMDD sufferers, we have created such strong neural pathways, that we really do end up in one cycle of thinking. The connections our brain first started making years ago, that created the chemical imbalance, have become stronger and stronger. The more you sit back and allow it to happen, the more the brain feeds off the same thinking patterns. By attempting to break the cycle of negative thinking, you can start re-training your thoughts to support you, be your friend, rather than be your enemy.

Be careful of your thoughts, for your thought become your words.
Be careful of your words, for your words become your actions.
Be careful of your actions, for your actions become your habits.
Be careful of your habits, for your habits become your character.
Be careful of your character, for your character becomes your destiny.
~Author unknown

"Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius -- and a lot of courage -- to move in the opposite direction." ~Albert Einstein

Sharing Our Stories of PMDD

Today we have a guest blogger, Joya, who has graciously agreed to share her story of PMDD. I invite others to contact me who would like to share your story of how you discovered you had PMDD, were diagnosed, and what treatments--both successful and unsuccessful--you have tried in an effort to cope with this debilitating disorder. This helps every woman with PMDD to understand that while you are not alone, every case is as individual you are.

Welcome, Joya, and thank you for sharing your story with us.

I was diagnosed about three years ago.

Before I was diagnosed I felt awful & sick. I also thought I was losing my mind. It took a while for me to realize the awful feelings and the craziness were associated with my monthly cycle. I began to dread my cycle, but always looked forward to getting my period because I felt such a relief. There were times when I literally thought I was going insane. And the awful physical symptoms were at times too much to bear. I am grateful for my diagnosis as I have been empowered to find ways to help myself.

I am very fortunate I have a wonderful Doctor who listens to me and I believe he actually cares about my well being.

I have tried the following:

The Pill

Anti-Depressants

Accupuncture

Herbal treatments

Supplements

And I am currently using the Mirena IUD

Side effects & benefits I have experienced:

The pill was not a good choice, I cannot handle the extra estrogen at all. I completely lose it. For whatever reason the pill intensifies my symptoms.

Anti-Depressants-at first seemed like a cure! Then I started to feel depressed all the time, and I became listless and lethargic. I gained 25 pounds and felt awful and the benefits seemed to have flown out the window. I am not a fan of anti-depressants. I am no longer using them for treatment of my PMDD.

Acupuncture helps-mainly it helps with relaxation. It is also not a cure-all, but can be very helpful in terms of relaxation. It can be expensive and it takes quite some time before it actually reduces any symptoms. I would like to return to acupuncture if for nothing else, but the calming effect it as.

Herbal supplements & supplements: for me they help, but do not have the strength to reduce my symptoms to a manageable level. I use supplements in conjunction with the IUD.

The IUD has been helpful, it has reduced my symptoms. However, after a little over a year of using the IUD I feel the effectiveness wearing off. It makes me want to cry. And I do not really have a period at all and I don't like this part of it. The idea of searching for another effective treatment feels a little frustrating at the moment.

I consider myself blessed. I have very loving and supportive friends and family. I have been honest about my PMDD-it does affect my ability to socialize and I can withdraw pretty easily. I hate when I am unkind, or I lash out at someone I love when I am PMDD-ing. It is awful and I feel horrible, and guilty. In some ways I try to keep to myself so that I do not do anything I will regret later. I live alone and work primarily alone, so I do control my interaction with people as much as possible. I have recently entered a romantic relationship-I have been upfront about my PMDD, and he is a very understanding person. However, I am terrified I will scare him away, and I know this is a large part of why I keep to myself. I try to keep myself and others safe, but I am starting to feel that it is not the solution.

I cannot think of a shape for PMDD, as it tends to have several forms for me. At times it may be rigid and square, uptight and bound, whereas other times-it is wide open and expansive...It encompasses many colors...red would be the primary color, as well as black and dark blue...perhaps with flashes of purples and greens.

The worst thing about PMDD for me is the darkness, the sadness, and the nasty voice inside me that gets so loud that I believe it. I believe every ugly lie the voice utters. I have made some serious life decisions while under the influence of the PMDD monster, only to wonder later-'what the hell was I thinking'. The other thing is I feel like I cannot trust myself and I do not want to be around anybody. It sucks, I am for the most part a friendly, upbeat and kind person. The PMDD twists things and I get twisted with them and then come out the other side-wondering what happened. I hate that I listen to the ugly angry distrustful voice, rather than my true core voice.

I have changed my diet, I eat mostly vegetarian. I focus on nutrition. Whole grains, veggies, I do have fats, like peanut butter and such. I love fruit too! I make 90% of my meals at home, this is very helpful. Honestly, diet and exercise have had a profound effect on my ability to cope. I make sure I get enough rest as I cannot function without adequate rest. I LOVE to exercise and I LOVE yoga and walking outdoors! However, when the monster (PMDD) is in house, I have to literally fight with myself to exercise, and do what is best for me. As there are times when I drink wine, or eat too much, and usually regret it.

I also remind myself what is happening and that it is not ME-it is PMDD and it is chemical and biological, but this is not always helpful. I take hot baths and drink tea, I use drops of white chestnut for anxiety. Basically, I try to take of myself and be loving towards myself. I do struggle and sometimes I cave to the cravings for fatty food, wine, or cigarettes. I realize that this is a work in progress, and from experience I KNOW that taking excellent care of myself is my best bet!

I work with a master metal smith-he is my dad. We design and create custom wedding rings. I work with 30 stores and retail clients from all across the globe! I am very fortunate to have the work I have. I work alone as most of my correspondence is via email. I love working with an artist and I love working with my clients. I am grateful for all of my clients. So I do not have a career I have a job, a wonderful job. I long for a career, but that is a long and painful subject for me. I have searched for 15, plus years to answer the 'what am I going to do with my life'? question only to still not know the answer. It causes me extreme grief. As I have taken endless classes and been in and out of school, etc...

For now, I am letting it go. I just recently withdrew from school, as the combination of work, school, PMDD and my learning disabilities proved to be too much for me. I am struggling with not feeling like an utter failure and feeling like I have liberated myself. I do not have children, I have a cat, whom has been with me for 15 years. I care for her deeply and she has been a most loving and loyal companion over the years.

I would like to have a career that I can pour my heart and soul into. I would like to love freely and create. I would like to be of service to the people, the Earth and the animals. It is unfortunate that every single month for two weeks I kinda fall apart and lose my grip. However, I refuse to give up and I hope that I can find a way to do what I long to and be even with PMDD.

I believe yoga and meditation are helpful. Yes, they help me to relax and change my focus and help me to slow down and breathe.

"Love all, trust a few. Do wrong to none." Unknown.

"Everything we see or seem is but a dream within a dream." Edger Allen Poe