PMDD Symptom Play by Play Number 1

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

Talking and writing openly about Premenstrual Dysphoric Disorder is something I'm compelled to do, both for myself, other women, and the people who love us. I'm trying to understand myself and this very complicated phenomenon that seems to slip and shift into unrecognizable forms within a recognizable framework every month. Since learning about PMDD, I am now free to witness the cyclical changes taking place in my body and mind with some objectivity. As my body becomes more and more sensitive to the hormones surging through it, I'm less fearful about why I'm suddenly losing control, wondering how much worse it will get. It's easier to pay attention to the process, fascinated and taking notes.

Truly, as hard as it is to understand, things can be very different month to month. What I've done here is journal some of my symptoms in the days leading up to one period a few months ago. Were I to do this monthly, no doubt the expression of symptoms could be different each time. Typically, women begin to experience symptoms 14 to 11 days out from menstruation. The actual period tends to bring relief either instantly or within a couple of days. But again, this is only generally speaking. What I have garnered on the forums and from my own experience is there are exceptions to this rule, and a woman should not rule out PMDD just because she doesn't fit some erroneous profile that was originally established on a very small base of women. And if, like me, your hormones are in flux anyway due to perimenopause, you might indeed be a bit all over the symptom map!

With 11 days to go...The first thing I notice is an almost instant loss of my sense of humor. It was there one second, gone the next. My husband noticed it since we had been laughing for days prior. It isn't that things have ceased being humorous so much as that I have stopped being able to find humor in them. Even my face feels like it has forgotten how to move upward into a smile. The next thing I finally notice is growing fatigue. In fact, I'd slept 12 hours for two nights in three days. This is an absurdly long amount for me to sleep. I didn't even wake to relieve my bladder which is a common occurrence during a night of much less sleep. I gave into this need for sleep instead of fighting it off, and I think it did me a world of good. I also notice my body feeling colder. I wear a sweater and my hands ache with cold even though the temperature isn't that different from weeks prior. Then there's the hunger. I'd probably be eating all day long if I could. The menu? Salty chips, roasted nuts, dark chocolate, and butter on all manner of cakey-bready things. Unfortunately, the baker where we used to get our organic sourdough stopped taking orders, so I'm left with unfulfilled pangs and cravings for hot buttered toast or French toast. When it comes to food, I know I can't give into every craving anyway. I'd be the size of a buffalo. So, I balance things as best I can eating oat crackers and high-quality chocolate along with the grapefruit and parsley juice and salad and fruit. For the weeks leading up to this time, I was making banana shakes using almond milk, including the spices turmeric, cardamom, and cinnamon...each known to alleviate various PMDD symptoms like depression. I've also started taking magnesium which is supposed to help with symptoms. We'll see if I notice anything.

With 6 or 7 days to go...I felt like I was doing better this time around contrasted with last month. Is it the spices? The magnesium? Luck? I've noticed that, generally, I have good months and bad months. This makes the whole concept of PMDD even harder to understand and, for some, to believe. And yet, other women express the same experience. Some say every third period is the worst. I seem to have three on, three off...way off. Will this be a good month? Weepiness has set in and my legs are starting to feel like two leaden logs, so maybe it is too soon to tell. (Note from Liana: this good month/bad month pattern has been explained by whether or not the woman is ovulating.  If  you ovulate, you will experience PMDD symptoms.  As we enter perimenopause, we have fewer and fewer ovulations.  No ovulation = no symptoms.)

5 days and my mind is off and racing. I can't stop over-analyzing, over-thinking, and over-compensating. Some who know me might say I'm always like that. Okay, so, imagine that ramped up by 10. I've become afraid of the world, and what were merely challenges have become insurmountable obstacles. My husband is doing his best to distract me and also to listen to me without himself becoming depressed and defeated. Somehow, I've managed to regain my sense of humor, and this is really saving the day. Squirrel! 

4-2 days: Could I actually get through this month without losing it completely? I've had three social obligations in the last three days, and though as an introvert I'm feeling the drain, it isn't debilitating. The fact that I could even be social just a few days before my period is somewhat of a miracle.

1 day to go and everything I thought I'd managed to escape this cycle has come down full-force. The internal pressure I feel...how to describe it...has increased dramatically, making me very antsy...agitated. I feel like a combustible material. Pour the wrong remark over me and I will blow up.

So what happened next? I was attempting to control an out-of-hand ant problem (yes, ironic...me being antsy and all). My husband was pressuring me to leave for grocery shopping because the stores would close soon. He wasn't helping or taking part in what I saw as a near-disaster. Yes, I realize ants are not a near-disaster, but PMDD magnifies everything by about 1000. Couldn't he see what I was dealing with? I became furious.

So my husband asks, "Why are you acting like an asshole?"

Wrong move. That was it. The end of marital bliss. I may well have been an asshole, but I didn't need anyone pointing it out to me, thank you very much. I tore the shopping list in two, gave him his half and wished him luck. Despite wanting to call a truce in the market, I couldn't bring myself to do it because of the way he was now behaving...like an asshole.

The thing is, if I act like a big-enough asshole, then eventually, so does my husband. And then, we're lost. We're lost for an hour, a day, a week...hard to tell. But I know I can't engage with him AT ALL if he's also going to be a two-year old. And then I hate him because he doesn't have a "hormotional" excuse and could be making all this so much easier for us both.  (emphasis added)

Why couldn't he just have grabbed me, hugged me, and told me the ants were a little problem and that if I could just walk away I would feel better? Herein lies the greatest PMDD difficulty for me and countless others. Our behavior becomes exceedingly difficult if not impossible to control. (Liana adds: and once we have reached that tipping point, we are literally unable to go back, to retreat, to regain control.  All our efforts to soften our PMDD symptoms (meditation, herbs, vitamins, exercise, rest, nutrition, mantras, art or music therapy) are done in an effort to not reach that tipping point.  Because once we have, all is lost for that day or that PMDD episode. This is what most people do not understand.  We can't stop, once the emotional cascade begins.)

We're not doing it to be difficult. We're not doing it because we like throwing tantrums. We don't even get any pleasure out of it. Well, maybe some do. I don't. Mostly, I see a madwoman taking over my body and wonder how on earth to reach her, calm her, and love her. It is no easier for our significant others who try desperately to understand us as we're suddenly shooting daggers at them when five minutes ago they could do no wrong.

My husband and I talk about this stuff when we can. When I'm back to my old self again and after he's recovered, we talk about this funny thing called PMDD. We strategize and decide we can handle it. We make-up and go about our lives...laughing, loving, sometimes bugging each other, but getting over it. But then, when it rolls around again, it seems neither one of us remembers what to do. It's a common amnesia.

When I can, I will do another symptom play by play post. In the meantime, have you noticed similar symptoms in your own or a loved one's life?

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.