Is it PMDD or Pre Menstrual Exacerbation?

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

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

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

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

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

Imagine that.  Is it a coincidence or what?

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

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

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

Acne                      

Allergies

Arthritis

Asthma

Bipolar Disorder

Blood Sugar Problems

Chronic Fatigue Syndrome

Depression

Dysthmic Disorder

Eating Disorders

Endometriosis

Fibromyalgia

Headaches

Hypoglycemia

Insulin Resistance

Irritable Bowel Syndrome

Joint Pain

Lupus

Migraines

Panic Disorder

Peri-menopause

Personality Disorders

Seizure Disorders

Somatoform Disorders

Thyroid Disorders

A Special Word About Bipolar Disorder

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

            Manic Episodes

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

Euphoria

Extreme optimism

Inflated self-esteem

Poor judgment

Rapid speech

Racing thoughts

Aggressive behavior

Agitation

Increased physical activity

Risky behavior

Spending sprees

Increased drive to perform or achieve goals

Increased sexual drive

Decreased need for sleep

Tendency to be easily distracted

Inability to concentrate

Drug abuse

An Additional Word About Major Depressive Disorder

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

How MDD predisposes women toward PMDD and vice versa

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

PMDD and Dysthmic Disorder

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

Peri-menopause and Menopause  --  Confusion City

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

Depression

Tension, Anxiety

Lability

Irritability, Anger

Foggy Thinking

Lethargy, Fatigue

Overeating and Food Cravings

Hypersomnia or Insomnia

Physical Aches and Pains

Bloating and Weight Gain

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

 

The Bottom Line  --  PMDD Makes Everything Worse

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

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

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

PMDD and Learning to "Just say No"

Okay, I promised ways to de-stress your life in this post, which is exactly what took me this long to write it.  I looked through my files for what would be good advice, and found all the stuff we already know:   avoid alcohol and smoking and sugar and caffeine, drink lots of water, exercise, eat more vegetables and get lots of rest. 

Boring.  Nobody wants to do that.  Or to be told to do that --- yet again. 

Nope, we'd rather look for that magic formula, that silver bullet, that holy grail of a cure for our PMDD. 

And while we're looking, we don't want to have to give up our crutches. 

We also don't want to have to make any changes in our lives.  Change is hard.  It's messy.  It's unsettling.  It makes us feel all confused and chaotic inside, and we already feel confused and chaotic enough, thank you.

But change is the only thing that's going to work for you, ladies, because what you're doing now obviously isn't working, or you wouldn't be here.

I don't say that to insult you.  I say that to give you a starting point.  The first step to change is to admit that something isn't working. 

So, what in your life isn't working? 

Take some time to think about it, and yes, the answer "Nothing in my life is working" is an acceptable answer.  It happens to more of us than you'd think.  Everybody's just so busy running around pretending that their life is working because it looks like everyone else's life (everyone who matters to us, that is) is "working" but ours, and God forbid we should be perceived as imperfect or somehow less-than. 

Well guess what?  Nobody out here has all the answers.  Including me.  Especially me. 

But...if I had to limit myself to one pearl of wisdom regarding de-stressing your life, it would be this: 

Stop looking for the answer outside yourself. 

You're not going to find it in a pill, a supplement, or cream.  The best you're going to be able to do with those is manage your condition - maybe.  True healing comes from within.  You know what you have to do, and you know that only you can do it --  be it something you know you need to give up to feel better, or something you know you need to add to your life to do the same. 

Here are some ways to start, off the top of my head:

Don't do anything you don't want to do.  Period. (If you have children under the age of 18, you need to see to their needs -- that's needs, not wants -- such as food, shelter, clothing, love, and safety.  But beyond that, you don't owe anybody anything.)

Say goodbye to guilt.  Refuse to let yourself be ruled by it.  If someone is manipulating you through guilt, put an end to it once and for all.  You don't deserve to live your life that way.

If you don't want to go to that family/church/community/social function that stresses you out so much, don't go.  You are a grownup and are allowed to make your own choices.  You don't have to apologize or explain yourself, either.

If you don't like the way someone is treating you, either stand up for yourself or leave.  Nobody is going to rescue you.  People will only treat you as badly as you let them treat you.

If you're in an abusive situation, get help.  Staying is not healthy for you, or your kids.  If your friends and family won't listen, there are strangers who will.  It's not like it used to be.  There are resources all around to help you.  I'm not saying it's easy...it will never be easy...but there are a lot more people willing to help than you think.  But no one will help you if you don't take any steps to help yourself.

If you need counseling and think you can't afford it, look harder.  There are those who offer programs and services on a sliding scale.

These statements may seem harsh, but are all true.  Most of our stress comes from letting other people manipulate us via guilt and shame. So find a way to deal with that and "just say no" to those who try -- and that includes yourself.

"Well if I don't (insert something to go to or do here) I'll look bad (to the committee, my family, the teachers, the other parents, my friends, the neighbors, my co-workers.)"

If you find yourself saying that...Don't Go. 

If you find yourself saying, "If I don't (do this), I'll let (someone I love) down," then give it some thought.  If it's someone whose opinion you truly care about, then give it some thought.

Looking out for yourself and getting rid of guilt will not turn you into a person without morals.  You will still know wrong from right.  And when the time comes to make decisions about how to spend your precious time -- how to spend the moments of your life -- you will be guided by your heart, not your guilt.  Once you start living from the heart, you will automatically start taking care of yourself, because you will love yourself.  You can't love anybody else until you love yourself.  Oh, you can take care of them and do for them and cater to them, but you can't truly LOVE them until you love yourself -- and you can't love yourself if you're beating yourself up, or letting others beat you up, mentally, physically, or emotionally.

We PMDD women know about beating ourselves up.  We're pros at it.

It's time that stopped.  I don't care what you've done, or what you think you have done.  If God can forgive you, you don't need to worry about anyone else.  Doing so places them above God.  This includes you.  If you can't forgive yourself for something, you're making yourself bigger than God.  Think about it. 

Now, once you've gotten rid of the junk in your life, be it spiritual, mental, emotional, or physical, you have some breathing room to concentrate on the positive.

See if you can get through a day, just one, without complaining.  Okay, try five minutes :).  What you focus on is what you get.   If you focus on the negative in your life, you'll only get more of it.  Try it.  Start paying attention.  Negative events spiral.  The good news is so do positive ones. 

But they spiral upward.

So try being positive for a change.  Re-frame your so-called failures into successes.  I made it until noon without bursting into tears.  That's a positive.  I didn't scream at anyone for two hours today.  That's a positive.  I took a nap and was good to myself.  That's a positive.  I walked for half an hour.  That's a positive.  I got (some job) done.  That's a positive.  I didn't eat any sugar today.  That's a positive. 

If the opposite happens, that's okay.  But find something positive to hang onto as you crawl your way out of that pit.

Focus on what's good in your life, not what's bad.  What's bad is on its way out the door anyway.  You're making room for good and positive people and things to come in and replace them.  It's the best way to de-stress your life.  Fill it with people and activities that nourish you instead of deplete you.  Things that uplift you instead of drag you down.  Things that bring you life instead of drain you of it.

Go ahead, make a list.  Make a list about what you like about your life and what you don't.  Find something small you can do to get rid of a negative.  Just doing this alone makes your life a little more positive.  Double the benefit by adding something small to your day that's positive.

Do this one day at a time, one moment at a time. 

It's all any of us has. 

And remember, even if you're taking baby steps -- you're moving in the right direction.