Is PMDD Real? : A Psychotherapist with PMDD Shares Her Story

Today we have a guest post from Dr. Chantal Gagnon, who has been kind enough to fill in for me while I continue my research on progestins and progesterone.  Thank you, Dr. Gagnon, and welcome!

IS PMDD Real?

THE SHORT ANSWER: Yes, it's real.

THE LONG ANSWER

PMDD can be thought of as an extreme form of PMS (Pre-Menstrual Syndrome), but with symptoms that are more severe and debilitating. PMDD symptoms can be physical, such as bloating, headaches, breast tenderness, etc., but typically the symptoms that have the greatest impact for women with PMDD are emotional and behavioral symptoms. For up to two weeks near the time of their period (but less time for some women), PMDD sufferers can experience a range of emotions and behaviors, including depression, suicidal thoughts, anxiety, tension, irritability, anger, even to the point of rage, self-loathing, mood swings and feeling overwhelmed. These symptoms can often feel severe or extreme. It's common during this period of time for women to start fights, give people "a piece of their mind" (i.e. become verbally abusive), and perceive their mates negatively. Sometimes women quit a job or end a relationship or scream like a banshee in the midst of an episode.

What causes PMDD is a sudden drop in the neurotransmitter Serotonin following a shift in hormones as a result of the menstrual cycle. The same biochemistry is implicated in PMS, but women with PMDD either are more biologically sensitive to hormonal shifts in general, or the hormonal shifts they experience are bigger. Depending on which study you look at, this disorder affects between 5% to 10% of women, and may get worse with age (30's and early 40's), possibly because stress can make symptoms worse (women report more stress during the years of raising a family and building a career).

How I Discovered I Had PMDD

My first semester as a counseling student I took a course on psychopathology (mental health disorders). The class was focused on learning and understanding the diagnoses listed in the DSM - the Diagnostic and Statistical Manual of Mental of Mental Disorders published by the American Psychiatric Association (APA). We also learned about disorders that the APA was considering adding to the next version of the DSM. PMDD was one of them. I remember thinking at the time: "This is complete BS! These psychiatrists are taking normal PMS and making it a "disorder" so that pharmaceutical companies can sell more drugs." So, for the first several years of my career, I did not believe PMDD was real. I even did a presentation in another class about how the DSM tries to create "disorders" out of normal behavior, and of course, I included PMDD in that presentation.

I was wrong. I discovered my error in judgment when I developed PMDD in myself in my 30's. I noticed that a day or two before my period, I became suddenly and severely depressed - everything in my life seemed hopeless. It was almost as if I was a different person. But the day my period started, I felt completely better. Weird, I thought. But then, the pattern continued and I became more aware of it. Sometimes my symptoms were depression-related, other times it was irritability and anger. When I got married, it got worse because I couldn't isolate myself from people during those few days of my cycle (which had been a fairly effective coping strategy in the past). My husband was always around now :) So, unfortunately for him, he got caught in the PMDD storm!

Finding Resources and Learning to Cope

So, Ken (my husband) and I began looking for answers. I had a hunch PMDD might be the issue, but I had never really believed it was a real disorder. Plus, I wanted to be mindful to not just be making excuses for my bad behavior. Around that time, we found Liana's website and blog: Living with PMDD (www.LivingWithPMDD.com). Wow, what a great resource! Through her site, a book about PMDD, and discussion board posts from other women relating their experiences with this disorder, I discovered that this was indeed what I was living. I later confirmed the diagnosis with a psychologist, and my husband and I have developed coping strategies that are effective for us, and for my particular symptoms. Needless to say, I now know that PMDD is indeed real. I'm one of the lucky ones though, because I only experience severe symptoms two to four times a year. With proper planning, improved stress management, and coping skills most months have been OK, and for the months that aren't Ken and I now know how to surf that wave, instead of getting caught in the rip current.

Every women is different, and PMDD manifests differently in different women. If you suspect (or if you know) that you have PMDD, it's important to find compassionate support people, educate your family on the disorder, and put into practice coping strategies that will work for you.

Dr. Chantal Gagnon is a licensed psychotherapist, author, and life coach in Plantation (Fort Lauderdale), Florida. To read her blog or learn about her services, visit www.LifeCounselor.net or follow her on twitter @DrChantalGagnon

Cat Stone's PMDD Crisis Guide Continues

Today is a follow up to last week's intro to Cat Stone's Crisis Guide to PMDD. Today Cat discusses several excellent ways to help yourself feel better when you are in crisis, courtesy of your PMDD. I hope everyone is able to take away at least one piece of advice that helps to ease the pain of your PMDD. Thank you, Cat, for sharing your thoughts with us.

You can find the intro to this guide either in last week's post, or at Cat's blog.

The Physical Realm of PMDD

This is an easy 'realm' to understand. It's the one we are most aware of. This is where PMDD is manifesting in most cases. There are many theories, from an imbalance or sensitivity to hormones, to a bug that lives in your system called H-Pylori. One thing that is common, is that it is hormonal, cyclical, and very hard to treat. Treatment is different for all women, and many have to try various medications and treatments before they find one that works.

Physical symptoms of PMDD are much like that of PMS. Bloating, painful breasts, cramps, heavy bleeding, back ache, digestive problems and insomnia, to name a few. Tiredness and lethargy is also a big problem, some days, it is hard to even get out of bed.

Weight problems can occur due to the imbalance in hormones, sporadic eating habits and lack of exercise. Acne is another troublesome physical symptom. I for one get new spots every time I ovulate or menstruate. These spots are hard, painful and more like boils. They take ages to clear up and often leave scars.

To start treating the physical symptoms (and in turn, improving your general well being) a plan of action should be devised. In it's most simple form, you should have a check-list that covers your body's basic needs. Maybe you can see it as a tool kit.

Exercise

We can actually take charge of this aspect quite easily. We can change what we eat and how much exercise we do. We have control over that. It is well known that exercise helps to relieve stress, keep the body healthy and can relieve cramps. It is easy to feel out of control when you suffer from PMDD, so by taking control over this aspect of your health, you can feel more in control of yourself in general. Sometimes, leaving the house before you blow is a good option. A brisk walk round the block will help you calm down, think, and work off some of that pent up energy. I'm sure most PMDD women go around like a coiled spring, just waiting to ping. This is energy waiting to come out. You could use it in a healthy way, or you can wait for the volcano to blow, inevitably hurting those around you with words or your own actions. Punching pillows helps... although in my house, (and I'm not proud of it) I am chief door slammer. It's the pent up energy that turns into rage. If you don't release this energy you will feel anger, you will feel rage, you will feel like fighting.

Try and incorporate some form of exercise into your daily routine. Getting outside really helps, maybe for a walk or bike ride. Join a Yoga class. This is the best way to learn to relax too, and become more sensitive to your body and what it's telling you. If nothing else, stick on your favourite album and dance and sing round the living room!

Stress

A special mention here goes to Stress. We underestimate how much stress can affect our body. Stress is not just in your head, stress affects every cell of your body. When we get stressed, our body reacts, putting a strain on our adrenal glands. In genuine situations, this reaction (known as fight or flight) can save our lives. When we are constantly stressing ourselves sick over our illness, weight, money, kids... we are abusing those reactions and leaving our bodies exhausted. Stress puts added pressure onto our hearts and can tie our stomach up in knots leading to erratic eating habits and IBS. You can overwork your adrenal glands, so they become so tired they don't function properly. This is when you health will really suffer and you will more than likely hit rock bottom. Your immune system will be lower, your 'feel good' hormones (serotonin), will be depleted and you will feel lethargic and depressed. Physical activity has been proven to help relieve stress, and should be a regular part of your tool kit.

Food and water.

The next simple tool to keeping our moods stable is eating, and drinking water. If I feel myself spiralling out of control, or I've just screamed at the kids for leaving a toy in the wrong place, I have to immediately check whether I have eaten that day. Our moods get worse if we don't eat. Obviously, try and make healthy choices, but it's better to eat than not, so if all you can manage is a piece of toast with jam, then do it. The aim is to try and keep yourself topped up with energy. Little and often is good, and will help keep your blood sugar levels stable.

Dehydration is another problem. If we aren't remembering to eat, we probably aren't drinking enough either. Tea and coffee and alcohol all dehydrates the body. Dehydration leads to mood swings, headaches and fatigue. This in turn can lead to more digestive issues such as constipation.

If we try and run on empty all day, we are setting ourselves up for a screaming rage at teatime, or a sobbing wreck at bedtime. We don't even expect our cars to go far with no fuel in the tank, but are quite happy to do it to our own bodies.

Sleep and rest.

Rest and relaxation should be the next tool in the tool kit. PMDD sufferers can have irregular sleeping patterns. Depending on what part of your cycle you are in, you may feel overwhelmed with tiredness and want to sleep all day, when at other times you cant sleep at all.

Getting plenty of sleep is essential to maintaining a stable mood. If you go to bed at 2am, and are then up for work or the school run at 7am you are going to be tired, whether you have PMDD or not, but add PMDD into that mix and you will have one very grumpy lady. You are more likely to snap, rant, cry, blow your top or worse, if you are tired. If you cant sleep, it is still important to rest your body. Try a long hot bath, meditation, or just lie down and watch a film or listen to music.

Maybe you like to read, or sew, or paint. Taking time for yourself and indulging in your favourite past time will help you relax. It is easy to deny yourself these little things, to write them off as unimportant, and say, 'how can I possibly deserve to sit here and enjoy myself when I'm such an awful person' or ' I cant take time out for myself, what about the washing up.. cooking tea... etc' If you like.. I'll give you permission! In fact, even better... I'll prescribe it!

Light.

Get out into natural light. The winter brings S.A.D. Seasonal Affective Disorder. If you are already sensitive to hormones, stress etc, you may find the winter becomes a hard time of the year. Low levels of light takes it's toll on energy levels and you may find yourself more depressed in the winter. If it's really severe, on top of the PMDD, you may find it hard to get up, stay awake in the daytime, or your depression and anxiety can worsen. Light boxes work well, but if you can't afford one, just make sure you get out in any sunshine (when we get it), put lights on in the house, and be kind to yourself. It is easy to assume your PMDD is getting worse in the winter, but it's more likely to be the added darkness of S.A.D.

Writing.

OK, so why would this be on the list? Because it's a physical activity. It anchors thoughts down on paper. Thoughts are like air, they flit and change. Writing things down, gets things out of you head and into the physical world. Keeping a diary, writing lists or post it notes helps you to keep track of your mind. Sometimes, making a plan on paper, is the difference to a day saved, or a day lost. Making lists will help you organise. Crossing off stuff on the list will give you a feeling of achievement. EVEN IF that list is nothing more than..

• brush teeth
• take kids to school
• wash up dishes
• go for a walk
• EAT
• have a shower

You will find you get more done by having a reminder list.

It is good to write out your feelings. If you feel weird about other people reading them, then keep a diary for yourself. If you feel you can share with other sufferers, even if it's under a false name, you should think about setting up a blog. Writing get things out of our system. The physical activity of sitting and focussing, helps us to become calmer.

Self destruction

If you suffer with PMDD you will know all about self destruction. My ability to cope with symptoms fluctuates. When I hit a low, and get ill, I forget about all the things I 'should' do. I spiral out of control and turn inwards. I become self-hating, self-destructing and down right cruel and hard on myself. Sometimes, holding onto sanity becomes too much in itself, and I let go. I free fall, I become some caught up in myself, I cant think about others. I can get really depressed and suicidal. I don't eat. I survive. I pass every hour in the day, waiting for bed, so I can try and start a fresh the next day. If I really want to hurt myself, I'll drink. Alcohol is not my friend, but I'll drink, because I hate myself, everyone must hate me, I want to hurt myself, I don't want this life, everything is wrong, why am I like this? I hate you.. and you.. why did I have kids? I'm a rubbish mother, I don't deserve them... Sound familiar? It will if you have PMDD.

Physical self destruction is something you can control. If you know you will drink yourself silly, then stay away from the bottle. If you are suicidal, then stay away from dangers, risks.. like driving for instance.

Remember that not eating or drinking, not looking after yourself, not allowing yourself rest time can all lead to a worsening of PMDD symptoms. You are in control of that. You must look after yourself. Don't allow yourself to self destruct. There is always tomorrow, the feelings will pass, and you will need your body to be there for you.

If you are feeling suicidal and have no-one to talk to, there is always the Samaritans here in UK on 08457 909090 or in the US call 1-800-SUICIDE. Or if you are a member of my Facebook group, there will always be someone around to help you through the bad days..

More Tips For Partners Dealing With PMDD

Last week’s post, while it will go a long way toward stabilizing your relationship with a woman in the throes of a PMDD episode, was barely the tip of the iceberg. So this week I thought I’d continue with some tips and information on how to cope with your partner when she’s feeling her worst.

Once again, most articles I read in researching this post were about how awful it is for the partner, who has to deal with all sorts of aberrant behavior on the part of his or her loved one. In these articles, there doesn’t seem to be much understanding or empathy for the woman actually going through the brain changes over which she has no control.

So the first thing I want to emphasize once again is empathy. Put yourself in her place, and my guess is you’ll discover you wouldn’t want to have a body and brain you have no control over for several days a month. How would you feel if your thoughts—due to a biological disconnect between your brain and your mouth—came out as something else entirely—something actually hurtful to those you love the most? How would you feel if no matter how hard you tried to eat right and/or stay in shape, your body suddenly just wouldn’t cooperate? What if it actually undermined all your best efforts by bringing on intense cravings for things you know you shouldn’t eat, cravings for things that actually make your condition worse?

How would you feel if for up to half of your life, nothing you thought or said or did made sense?

One article I read said women could be touchy—touchy!—about being labeled as a raving lunatic for a few days a month. As if the women involved had no business being so sensitive. Who wants to be called insane? Do you?

It also said very few women will admit they’re affected by PMDD. Again, would you feel comfortable telling people, “Oh, don’t mind me, my mind just goes berserk every now and then?” Would you want the strange looks that come with such a statement, would you want people steering a wide path around you because you just admitted there’s something not quite right about you?

So don’t try to be helpful (or antagonistic) by pointing out her PMDD symptoms. She’s well aware of what she is feeling. Anxious, edgy, jittery, depressed, clumsy, fat, foolish, frightened, sleepy, weepy, ravenous, disorganized, out of control…the list goes on.

Even more important is that you don’t make fun of her for any of the above.

Again, if you knew people were going to ridicule you for something you have no control over, would you openly admit to having such a problem? How can any woman win the admiration and respect of the friends and family she loves and respects in such an antagonistic enviroment?

Your best bet is to save your meant-to-be-funny comments and war stories for your friends, to be shared privately, and simply act like nothing out of the ordinary is happening when the PMDD is in effect. Help to make your partner feel as accepted and normal as possible.

This does not mean you have to accept any kind of behavior she throws at you. Abuse is abuse, whether your partner means it or not. PMDD is an explanation, not an excuse, and you don’t have to accept abusive behavior under any conditions. For more on this, go to last week’s post.

Don’t spring any big surprises on her. Remember she’s doing everything she can just to cope with her everyday life, to stay on an even keel in a body emotionally tilting one way and then the other, just to get through the day without being labeled crazy. Big news, big plans, big surprises can wait for a day when she’s better equipped to handle them.

Besides, you should never trust any big decisions made while she is under the influence of her PMDD. This includes decisions she may come to regarding your relationship. If she says she wants out…do what you can to stay calm, and wait until the storm passes. If when it does she still wants out…then you have a different problem, and one that is beyond the scope of this blog.

Take it easy on social activities. If you felt like a beached whale and couldn’t seem to control what you put in your mouth, would you want to go to a party and spend it stuffing your face at the food table? A food binge can be great fun, if that’s what you want to be doing—if that’s your way of celebrating good times or good news. But if you’re watching your weight—and what woman isn’t at one point or another?—taking her food binge show on the road is the last thing she wants to be doing.

The same goes for her emotional outbursts. It’s hard enough to keep a lid on things at home. Do you really want to put her in a situation where she spends the evening either snarling at your friends and family or weeping at every little misinterpreted comment? Because during a PMDD episode, the PMDD brain will focus on the negative, and even if you didn’t say or mean anything negative at all, even if you compliment your partner, her brain is being flooded with negative thoughts and images, and eventually the dam will burst—putting a huge damper on your evening out.

And then she’ll feel miserable about it. About ruining your plans/evening/event. Whether she did or did not, and whether she admits it or not, she will blame herself for anything that goes wrong during these dark periods of time in her cycle.

So remember to track her symptoms and plan social events to avoid head-to-head conflicts with her PMDD episodes if at all possible. She’ll appreciate you all the more for your understanding.

Be understanding of her cravings. Both men and women seek comfort food when they are feeling miserable. During a PMDD episode, a woman will especially seek carbs. Doing so is a natural way to boost, for instance, the level of serotonin* in her body, and she knows this on a subconscious level. Where it gets confusing is the food and advertisement industries have done their best to convince us certain foods and drinks are healthy when they are not. So while on a very primitive level, your partner is craving something to boost any number of feel-good hormones in her body and make her feel better, what manifests is a desire to eat everything in sight in the hopes of finding that magic solution.

It’s best to have good quality carbs already on hand for when these cravings strike. I find that multi-grain toast with no-added sugar jam (not artificial sweeteners, as they can make PMDD symptoms worse), a bowl of whole or multi-grain cereal with almond or cashew milk, or a bit of good quality dark chocolate does the trick. When we consume large amounts of cheap chocolate candy (or cereal) we are looking for the same effect, but in the wrong place. The added calories from the sugar and fat that come along with the added amount of chocolate needed to reach the same feel-good hormone boost as a good quality piece of chocolate only cause our PMDD symptoms to worsen. They also cause us to gain weight.

But sometimes, the woman’s level of feel-good hormones dips so low that nothing short of a pizza will do. If that’s the case, then go for it guilt free. You might even plan pizza night around her cycle, and see if that improves things.

Take on some of her workload. Whatever you can do to help out, do it with an attitude of love, not resentment. If she asks you to help around the house, do what she asks. If she wants you to run an errand, please do the same. The slightest bit of effort to appreciate what she’s going through will go a long way toward soothing her, and is it really worth the effort to argue over whose turn it is to take out the trash?

It’s true that things that don’t usually bother her will bother her greatly when she’s having an episode. Just keep in mind who your real partner is, and go along with what she says. The sooner you do, the sooner her episode will pass.

That’s right, stress will prolong her episode, so if you want it to end sooner, the best thing you can do is to go along to get along, as long as it’s a reasonable request.

If you’re a mature adult, you know what reasonable and unreasonable is. We don’t need to go into it here.

Treat her like you appreciate her. Every woman loves to be appreciated, no matter what mood she’s in. During an episode of PMDD, with all those negative thoughts running an endless loop inside her head, your partner needs extra special care. Reassurance is always nice, but might not be believed or accepted. Understand that the negative thoughts in her brain are overwhelming the positive ones you’re trying to get across. Be patient. Be persistent. Let her know you care, and you’re there for her if she needs you. She’ll meet you more than half way if she possibly can.

If she doesn’t, it’s because she can’t, or doesn’t understand enough about what’s happening to stop the train of negative thoughts in her mind. It’s not because she doesn’t want to, or doesn’t love you. It’s not about you at all. So remember that, and try not to take the things she says and does personally. In a few days time, the woman you love will return, and when she does, it would be a good time to discuss what may have gone wrong during her most recent episode.

A lot of women will want to forget what happened, pretend it didn’t happen at all, and that’s quite normal, but not the best way to deal with it. Talking it out with your partner when she’s feeling herself is the best way to prevent unwanted behaviors and situations in the future.

The bible says it best : Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres. ~ 1 Corinthians 13

All a woman with PMDD is looking for is the same thing everyone wants—love and acceptance.

The more you accept, the less you’ll have to. What we resist persists. So don’t fight your partner’s PMDD. Go with it, roll with it--and watch the waves grow smaller over time. 

For more information, check out my book, specifically written for partners of women with PMDD. 

*Serotonin is only ONE of several feel-good hormones in our body.  The serotonin-deficiency theory highly touted as the answer to PMDD has never been proven, but has been marketed heavily to women with PMDD.  More on this in another post.

PMDD and Maple Syrup

Okay, time to check in again. One of the things I make a point of here is to be as honest with you as I possibly can. But my information is only as good as what I have personally experienced, so I can’t—and won’t--recommend things I haven’t tried. I’m just as eager—and sometimes just as desperate—as the next woman to find a way to feel well all the time, but I’m not one to just throw things out there to see if they stick. I’ve chased enough dream cures for PMDD in my forty years to know I don’t want to send any of you down the same road of futility and despair.

Because every time one of these so-called “miracle cures” fails to take away our PMDD, we tend to blame ourselves, and not the product we just spent another $20, $50, or $100 on. The problem must be with us, right?---not the stuff in the pretty package with all the glowing testimonials of how it worked for other women.

Wrong. The only problem here is you fell prey to hope.

That said, the only thing I know for sure is a woman with PMDD needs to pay careful attention to what she eats and drinks, and needs to listen to the signals her body sends her about whatever she is putting into her body, be it food, drink, supplements, creams, hormones, or medication of any sort. It’s only through this total body awareness that we’ll be able to get a handle on our PMDD.

Our bodies are amazing, and communicate with us constantly. Think aches, pains, tingles, queasiness, sleepiness, nervousness, whatever. Unfortunately, we’ve been conditioned to ignore these distress signals from bodies, and therefore our health and well-being, as long as we are able to get done all the things we need to do. It’s this ignoring of our bodies that leaves us wide open to using and abusing them in ways that invariably come back to haunt us, via cravings and weight gain, irritability and mood swings, and susceptibility to illnesses of all sorts, both physical and mental.

So the number one thing you need to do is take the time to get to know your body, what nourishes and sustains it, and what sends it, and therefore you and your life, out of kilter.

Last week I thought it was the cottage cheese bringing me down. I’ve since figured out that it was--and it wasn’t. It wasn’t bringing me down in the way I thought it was. As most women with PMDD, I need a certain level of carbs to be functional. Carbs are the precursor to making serotonin, which is a hormone a woman with PMDD lacks during certain times of the month.

There aren’t a lot of carbs in cottage cheese :). So after coming off the fast, which was a cleansing fast, and not one I would recommend for everybody (which is why I’m not openly promoting it here), I was (and still am) determined to watch my calories. Not count them—never again will I count calories—but I am determined in general to stick to a reasonable level of healthy fuel for my body intake.

Full fat cottage cheese is 30% fat—that’s what makes it so tasty. But by eating the cottage cheese, I was putting something in my body that wasn’t going to help improve my mood. What I should have been eating was something that would provide some healthy carbs to fuel my serotonin production.

In short, I substituted fat for carbs. And while it satisfied my hunger and the pleasure/reward area of my brain, it did nothing to improve my mood, or sense of mental clarity and well being. The key, in my case, is to keep a steady supply of carbs in my system, so my body has enough resources to make the level of serotonin I need to stay happy and focused. There are a few ways to do this. One, by eating some dense, healthy carbs—like oatmeal, or multi-grain toast with no sugar added preserves, or even bananas, grapes, apples, or oranges. (But you have to be careful about eating too much fruit if you have problems with insulin resistance.)

Another way to boost your serotonin levels is by exercising moderately. Too much exercise, and you deplete your body’s stores of carbs, therefore defeating the whole purpose. So a nice, moderate, 2-mile walk really helps. Maybe a some kind of dance (Zumba is great for this) or Pilates class. But if you don’t have time for that, even 10-20 minutes of walking or light aerobic exercise will help—just enough to get your heart rate up and break a light sweat.

A third alternative is to take some 5-HTP. I have two kinds here…one with 37 grams per capsule, and one with 100 grams per capsule. That way I can take whatever I need, based on whether I feel like I need a big boost in mood and focus or a small one. However, it is not recommended that you take 5-HTP if you are already taking any MAOI drugs or SSRI anti-depressants. The main reason being that they accomplish the same purpose so you could easily overdose by taking both. For more information on Serotonin Syndrome, go here.

An alternative to 5-HTP is to take a SSRI-type antidepressant—but only while you are feeling symptomatic. There’s no need to take any kind of drug every single day, day in and day out, for something that troubles you only part of the month. SSRIs have been proven to help with symptoms of PMDD in 60% of the women who take them. You won’t know if you’re one of the 60% unless you try. But what they don’t tell you is that for PMDD, you only need to take them when you are feeling symptomatic. It’s just easier to prescribe one for you to take all the time, and when it starts to fail, up the dosage (and all the unpleasant side effects). It’s like we can’t be trusted to know when we need a boost and when we don’t.

But while an anti-depressant takes a few weeks to kick in for those who are truly depressed, if you have PMDD, a SSRI can somehow affect the part of your brain that boosts your serotonin level within hours. So yes, I have a 10 mg prescription handy for those days when nothing else seems to work. But those days are few and far between, Thank God (in six months I’ve taken them three times, for 2-3 days each time), and I much prefer to use the natural methods of treatment available.

Other options are to increase your intake of Vitamin D, or to simply get more sleep. I realize that this last one is the least simple of the options available, but sometimes nothing less will do. For it's when we sleep that our body has a chance to re-set itself, and put everything back into balance if it can.

I did mention that while on the cleansing fast, I had no symptoms of PMDD. My guess is this was due to the maple syrup component of the fast, which kept a slow, steady supply of carbs circulating through my body and brain all day long. One serving of maple syrup contains 53 grams of sugar, 10 more grams than a can of regular soda. But all sugars are not alike. Sodas not only don’t add anything to your body but calories, they actually rob your of vitality and nutrition, and leave you dehydrated, to boot.

But since I was using organic Grade B maple syrup, I was getting all of the nutritional benefits (Grade B organic maple syrup is filled with all sorts of vitamins and minerals), without any negative side effects. However, at one point I was running out of Grade B syrup, and since the Whole Foods store was on the other side of town, I went to the grocery store instead to find a replacement to get me through the weekend.

No dice. All I could find was 100% pure Grade A maple syrup (not organic). One serving of that, and I had an immediate headache and was sick to my stomach. I went to the internet to find out why, and learned that non-organic Grade A maple syrup is sometimes processed with formaldehyde.

My body was letting me know I was not giving it something that was good and healthy. Back to the Whole Foods store I went, and the problem immediately went away.

So now I sweeten my tea with a little Grade B organic syrup, and it does wonders to keep the healthy carbs flowing.

Finding a Doctor to Help You With Your PMDD

Update:  March 2018...I have been getting a lot of requests for names of naturopathic doctors lately...I refer everyone to the American Association of Naturopathic Physicians.  A good nurse practitioner in your area can also be of great help.  I realize these links are for Americans, but perhaps you can find a similar organization in your country.  I wish you all the best and let me know how you make out!  In the meantime, here is my original post, written just over two years ago:

Someone had asked if I’d ever looked into saliva hormone testing, and the answer is yes. Once, last summer and fall. This post will be long, but I hope it will be of some help and consolation to those who are meeting dead end after dead end in your own search for relief from your PMDD.

Imagine my joy last summer when I opened my local paper to find a special supplement for women, and discovered, after all my years of searching, that my town had a genuine hormone specialist.

Or at least that’s what the ad said. My experience, unfortunately, didn’t bear that claim out.

My first visit to this woman was a resounding disappointment. I’d waited until I was in the throes of an episode to call for an appointment, so that she could see for herself what I was dealing with, but was told I’d have to wait several weeks for an appointment.

Once I finally got there, symptom-free, the upshot was she wasn’t at all familiar with PMDD, had no idea what I was talking about, and when I tried to describe it to her, how I am perfectly fine and happy most days of the month, but then there is that one week that everything goes awry emotionally, in conjunction with my menstrual cycles, she just looked at me and asked, “Have you talked with a psychiatrist about this?”

Yes, I said, I have, but it’s not a psychological problem, it’s a hormonal imbalance in the brain (ergo why I am here) due to a dip in serotonin (aka a mood-elevating hormone) on those days, that causes the D part of PMDD, or depression.

“Depression!” she says, her eyes practically lighting up. “Then what you need are anti-depressants.” No, I repeat, because it doesn’t happen but a few days a month. The rest of the month I am fine. Healthy, happy, whole, and sane.

I explain the situation to her again. She decides I must be in denial, puts Depression down as my diagnosis (which I discover after I go online to find out what the diagnostic codes she has written on my receipt and lab test requests mean) and hands me a home saliva hormone testing kit.

Send this in and call me to schedule an appointment to discuss the results, she says, practically shoving me out the door. Oh, and that will be $100. Next!

The thing is, I have to wait until I have another episode of PMDD to take the test, because I want to do the test while the PMDD is happening, and an episode has just passed, so it takes another month for me to even do the test.

In the interim, since it is clear that the true focus of this woman's practice is elsewhere, as in botox injections and chemical peels (both of which are truly hazardous to your hormones), and the hormone testing is apparently just some sort of sideline, I call all around town to find someone else to help me sort out my unruly hormones.

No deal. Only she and one other doctor in town are doing this kind of hormonal testing and the other one was a man and couldn't see me for at least three months.

So I do the test. I knew it was a mistake the minute I dropped the samples off at the UPS shipping post. The instructions had been so specific about keeping the saliva samples in the freezer and mailing them off THE NEXT MORNING. You could go with UPS or the postal service, but I knew the US mail didn’t go out before three around here anyway, so I opted for UPS.

I walk in with my little test kit, and the woman says, “Fine, just leave it on the counter.”

“When do they pick up?” I ask. “Oh, sometime this afternoon.”

In the meanwhile, my little kit sits out in the open on the counter of a store that has its front doors wide open to the fall sunshine. How could the samples not be corrupted?

I ask this of the doctor when I see her three weeks later, and she looks at me like I’ve grown two heads. “I don’t know,” she says. “It’s not a problem.”

Well, I see it as a problem, because my test results turned out to be totally unexpected and off the charts in some areas, and she can’t explain why. She just kept looking at the results, and circling them, and saying nothing more than, “Well, that’s what it is. As you can see, its…high.”
She drew in some upward arrows for effect.

It turns out, that according to the test results, instead of a deficiency in my hormones, I have an excess in some areas. This causes a problem for the doctor, because apparently the standard procedure is, she tells me I am low in this, this, and that, and then tells me I am in luck, as she has just the supplements I need on hand.

Be very wary of any kind of testing that comes complete with (their own) name brand products as the solution to your problems.

Fortunately, however, she was out of the one thing I was deficient in, Vitamin D. I told her that was okay, I’d manage to get some on my own (from a company I know and trust).

In the meantime, I ask the doctor, “How do you get rid of excess hormones?” She looks at me. “I don’t know.”

Well, I know the answer exists, because I read it somewhere, but I don’t remember where, because it was just something I'd read and had no idea I’d be needing.

“I’ll call the lab and see what’s going on with these results,” she says. “Why don’t you make an appointment for next week to come back and find out what they said?”

This time I looked at her. “Why don’t you just call me and tell me what they said?”

She agrees to do so. So I ask her what could possibly cause my hormone levels to be so high. I know the answer. I want to see if she does. After all, I’m the one paying her to tell me what the problem is. She fumbles badly until I give her a clue, then she takes off with it, all the while, asking, “You know what I mean?”

Yes, Doctor. I know what you mean. I also know that you’re winging it here and it shows.

In the end, she decides I need more testing, and bounds out of the room to figure out what test I need.

"Why do I need to take a different test?" I ask. "Because this one is better than the other one," she says, which leads me to wonder why she didn't give me the better test $500 ago.

No matter. No way am I doing this saliva test thing again, which several doctors in my research books have found to be unreliable. They recommend blood serum tests instead.

I ask her if there aren’t any blood serum tests I can take to get a better picture of what’s going on. “Why?” she asks. “It won’t do any good.”

This is the exact quote I have read over and over again in my books about women seeking help for hormonal issues, being shut down by their doctors who either have been trained to say or truly believe blood hormone tests aren’t reliable.

But how can the home-collected saliva tests be? It’s impossible. At least when you have samples taken at a lab, be they blood, urine, or saliva, they keep them refrigerated, and transport them in refrigerated containers. God only knows where my samples sat during the five days it took to get to the lab. I sent my samples off the morning of the 25th. They weren’t tested until the 29th.

To find out more about the subject, I went to what was billed as a seminar on saliva hormone testing, sponsored by a local pharmacy. A compounding pharmacy, one that can create individual prescriptions for women with hormonal imbalances, once the testing kits show where they are deficient. The room was filled with about forty women, all middle-aged.

The presentation was completely on target and informative. The information was correct. But it was a marketing presentation all the same. Go to your doctor, ask for these kits, get your hormones tested, then come back to us for a consult and we will mix up the perfect prescription for you.

Sounds like a dream come true to women who can’t sleep, can’t lose weight, are either bitchy or want to cry all the time or both at the same time, have hot flashes, headaches, backaches, swelling, cramping, bloating, joint pain and are either losing their hair or growing a moustache, just to name a few symptoms. And don’t forget, we’re all exhausted, and not interested in sex.

But they warn you the testing is imperfect, and it may take a few tests to get your prescription right, and you will need to be tested every three months thereafter to make sure the hormones they are giving you are the right ones for you.

They do not mention the cost, nor that it is not covered by insurance, nor that there are only two doctors in town who subscribe to this method of testing, and one of them is a woman who apparently doesn’t know the first thing about interpreting the results. All she knows is how to hand you a kit and say, “Call me for an appointment to get the results.”

This is the same woman who after speaking with me for 15 minutes, strongly suggested I go on anti-depressants as the solution to my hormonal problems, which I refused, because 1) I'm not depressed, and 2) countless case studies show that taking anti-depressants only makes your PMDD symptoms worse.

Hormonal imbalances are so individual, because each woman’s physical make up and life stressors are so different, that prescribing one pill to take care of them is like asking every woman to wear a one-size-fits-all-tent dress.

This time, after seeing the supposedly high levels of my hormones, in particular my serotonin level, which is what the SSRI anti-depressant would supposedly boost, the doctor did a complete 180 degree turn-around. As I was leaving, I asked her, just to make sure, “Now, you don’t recommend the anti-depressants any more, correct?” And she looked at me. “Well, you’re the one who said you wanted to go natural, right? You can’t do that if you’re on anti-depressants.”

A few weeks later I got a call from her office, informing me that the supplements for my depression that my test results indicated I needed were in and I could come in and pick them up.

I said, "I'm sorry, but I'm not depressed, and at this point I have lost all confidence in your office's ability to help me with my hormonal problem, so I won't be picking up any supplements."

I received a call from the doctor the next day, placing the blame on the receptionist, who obviously had "misunderstood my situation."

Professionalism at its finest. Blame someone else. The receptionist hadn't misunderstood anything. Not when I knew the doctor herself had diagnosed me with depression.

I then asked the doctor if she had called the testing company (as she had said she would when I was in her office) to find out why my results were so abnormally off the charts, and she said that no, she hadn't, because, well, "The results are the results."

And besides, she said, "I didn't give you all the results anyway."

"You didn't?" I asked, stunned.

"Well, no," she said impatiently, "because you wouldn't be able to handle all the information at once." These things take time, she insisted. It takes more than a couple of visits to sort everything out.

Needless to say, I never returned.

April 2012 Update:  I recognized the "hormone specialist" I wrote about above in the check out line at our local whole foods co-op.  The clerk was chatting about a television show she had watched the night before and the doctor asked, "Does it have to do with money?  Because I only know about things that make money."

Everybody laughed.

But I knew she was telling the truth.

After my useless encounter with her, I went to an endocrinologist, for whom I had to wait several more months to see. She was a lovely woman, well-informed, empathetic and understanding, since she herself happened to be going through menopause.

However, she was not a fan of bio-identical hormones. We talked a while, and then, comfortably leaning back in her chair she said, "As a medically-trained doctor, I can only give you advice based on the information that has been clinically proven. Your choices are anti-depressants, birth control pills, or hormone replacement therapy."

(The HRT she was talking about, however, was the conjugated estrogen therapy proven to cause several potentially fatal side effects by the Women's Health Initiative Study. (More on this in another post, since this one is already so long).)

"But as a woman," she added, then leaned forward and looked me in the eye, "When you find the answer, call me." She held up her hand to her ear to mimic using the phone.

This are only two examples of how frustrating it can be to find answers for your PMDD. Some doctors claim to have the answers but don't, some can only speak to what they have been taught, others are willing to help, but don't know what to do.

Meanwhile, month after month rolls around, and we suffer.

I managed to talk her into doing some blood tests for my estrogen and progesterone levels. "I'll order the tests," she said, "but what are you going to do with the results?"

"I don't know yet," I said, "but I'll figure something out."

In the end it turned out the tests she ordered for me weren't quite what I needed, but I didn't know it at the time. I've since learned more on the subject, and after more than a year's worth of PMDD episodes later, I managed to get my primary physician to request the serum blood tests that I needed, per the instructions on page 385 in Dr. Elizabeth Vliet's book, It's My Ovaries, Stupid!  We then started a bioidentical hormone regimen that finally saved my sanity. 

Yes, in the end I was able to work with my primary care practitioner, who, per the instructions in Dr. Vliet's book, prescribed bioidentical hormones for me in the form of an estradiol patch (the right dosage for me was .075mg/day, but you can start at .0375 mg and go up to 2.0 mg), and 200 mg of prometrium (progesterone capsules), which I still take daily.  For seven years, this bioidentical combination was a huge help with both my symptoms of perimenopause, and my PMDD. (March 2018: I have now reached menopause and reluctantly no longer use the patch.) 

Other effective things I found to help ease my PMDD were all lifestyle changes - diet, exercise, self-awareness, self-care when an episode descended, and vitamin supplementation.  For a list of what I took then and/or now take daily, please email me at info(at)livingwithpmdd(dot)com. I do not provide it here, because I am constantly fine-tuning my efforts to be well.

And that is all I want for you.  To be well.