A PMDD Valentine: Not All Chocolates Are Equal

For Valentine's Day, a post about chocolate (and a few other things), first written in 2009, but updated and still relevant today.

Having come freshly off a week of spending up close and personal time with my evil twin, who kicked my butt so badly the last day she was here I had to take a three-hour nap in the middle of the day, on top of getting a full night's sleep, today I feel uber-qualified to write about how it feels to experience PMDD. The thing is, now that the episode (aka her latest visit) is over, it's the last thing I want to think about.

I look around and see all that didn't get done over the week, the laundry piling up, the floors that need to be cleaned, the clutter of all I didn't feel up to coping with and simply set aside, and would much rather regain some semblance of control over my life—if only its external appearance—than write about the dark place I inhabited for eight full days and change this time around.

Why such a long visit this time? I think I know. I think it had something to do with my recent road trip: the stress of travel, the staying up later than usual, sleeping in strange environments, the change in diet, the miniscule amount of alcohol consumed, although in comparison to my usual alcohol intake, it was a big jump. Add that to the copious amounts of caffeine I consumed while on the road, the pasta-heavy fare at the conference, and I think I'm getting the picture. At home, I'm usually alcohol and caffeine free-or close to it. An occasional cup of coffee, usually one cup of caffeinated tea in the morning, if I feel the need, and chocolate only when "the cravings" come.  I hadn't had pasta or bread in weeks before the conference.

Why? All of these are bad for women with PMDD. Caffeine, alcohol, sugar, flour, hence the bread and pasta. But why am I so sensitive to their effects? I know women who practically live on caffeine and sugar, others who drink freely, others who love their bread and pasta. Is it possible they feel as miserable as I do, or more so, but deny their misery and continue to self-medicate with food and drink?

Because attempts to self-medicate is what these addictions (for lack of a better word) are. My research is showing there are very few true physical addictions in life. Most compulsions are emotionally or psychologically based. Only in rare cases is an addiction physiological.

That's not to say we can't get cravings. But cravings are cravings, temporary urges for some kind of substance to relieve our mental, emotional, or physical discomfort. Cravings are not addictions, although when you are in the throes of one, it can feel like an addiction. But as someone writing a book on dealing with addiction recently pointed out to me, "You're not going to stick a gun in someone's face for a piece of cake."

Cravings are the body's signals that some physiological need is not being met. You're low on some vital nutrient, to be exact. Your body is saying, for instance, "I'm low on magnesium," and you feel a sudden urge to eat a banana, or some almonds, maybe some oatmeal, or, yes, some chocolate.

Chocolate is one of the best known substances we crave. What confuses the issue with chocolate is not only its physical healing properties (of which there are many), but its emotional associations. We associate chocolate with feeling good. But not all chocolate is equal. Some are better for us than others. Much better. Others are almost useless, physiologically speaking. In the example above, a banana would provide as much magnesium as a 1.5 ounce chocolate candy bar, but a handful of almonds or cashews would provide almost three times as much magnesium as either the banana or candy bar.

So why do we reach for chocolate? It's as much for the emotional fix as the nutrients needed. More confusion arises when we don't know the difference between types of chocolate, due to the marketing and advertising claims of their manufacturers. Manufacturers is the key word here. Quality chocolates from true chocolatiers abound with the beneficial properties of chocolate. True dark chocolate is a rich source of flavanoids and antioxidants, with the cacao bean containing more than twice as many antioxidants the so-called superfoods like blueberries, kale, spinach, or broccoli.

It's the cheap, mass-marketed brands that—while they may contain tiny amounts of chocolate's beneficial properties—have processed most of the antioxidants and flavanoids right out of the chocolate. To derive any benefit from eating these lower quality chocolates, you need to eat way more than is healthy for you. When this happens, the negatives outweigh the positives—and you could end up outweighing all your friends.

If that's not enough, did you know that adding milk to your chocolate, or even drinking milk with your chocolate can negate its good effects?

Meanwhile you're bewildered, thinking, "Chocolate is supposed to be good for me, right? Milk is supposed to be healthy for me. Isn't that what the ads say? By eating chocolate and drinking milk, I'm doing something good for my body, right? So why do I feel so miserable?"

Because all the chocolate in the world isn't going to solve your problems, honey, and while I may crave it like mad at times, neither is it going to make my PMDD go away. For all its mood-enhancing abilities, even the finest Belgian chocolate won't "cure" dysphoria.

Dysphoric is the opposite of euphoric. Euphoric means happy, dysphoric means depressed. As in depression. But only pre-menstrually, which I suppose can be considered a blessing.

In some atypical cases, however, the dysphoria can come AFTER a woman begins her period. Lucky me, I'm atypical. Mine usually starts on Day 3, if it's going to come. It doesn't always come. Which is what drives me batty, trying to keep on top of what I need to do—or to avoid—to keep it from returning.

I lead too full and rich a life to keep being knocked flat by this unwelcome change in my body. It makes me feel like I'm constantly behind—on everything.

As women, we all know "it will never get done," but to have something come along and steal a full week or more out of your month, something that no matter what you do or don't do seems to be totally beyond your control...it's more than frustrating. It's crazymaking.

I'm here to tell you you're not crazy. I'm here to tell you there are scientifically proven physiological reasons for why you crave the things you do—like carbs—and what happens to your body as a result of that. I'm here to tell you there's help, and hope, but it's far from easy, living in a body that seems to have a will of its own at times, and a manufacturing and marketing culture that promotes unhealthy foods as healthy because of their base ingredients, while completely ignoring the toxic effects of their processing processes.

That said, the first step is to forgive yourself for falling short of your own expectations, and to understand that what is happening to you is as involuntary a response as an allergic reaction. You cannot control it. You can try to soften it, to be sure, by living a universally healthy lifestyle (once you understand what that truly is) but you cannot control it.

Nor can you deny it and simply plow through it, as most women do. We have commitments, responsibilities, schedules, and deadlines. We have people counting on us to be there for them.

But first, we have to learn how to be there for ourselves. My book PMDD and Relationships, addresses this topic in detail. I can hit on a subject here and there in a blog post, but the book...the book covers it all, from start to finish. And if you are a partner here looking for information about PMDD and how to live with the woman you love: PMDD: A Handbook for Partners is for you. Click on the book covers in the sidebar for more information.

So be good to yourself today, and every day, and when it comes to chocolate—insist on the good stuff. 

Because you are most definitely worth it.

Happy Valentine's Day, all!

Remember: When it comes to chocolate, the darker, the better.  You might have to work your way up to it (I'm now at 70% cacao), as it can taste bitter at first.  But the darker it is, the better it is for you (and your blood pressure!).  And don't drink milk with it because that interferes with your body's ability to absorb the antioxidants in the chocolate and therefore dims its beneficial/healing effects.

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.   More information on PMDD can also be found on Liana's Facebook page, Living with PMDD.

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. 

PMDD Quote of the Week

~During an episode of PMDD everything is magnified 100 times and everything in life sucks...but to those around us life stays the same.  That's the insane part of PMDD.  Everything in your life is the exact same as it was the day before, or even an hour before, but suddenly, in your mind, it's all gone to shit.~

PMDD Quote of the Week

Women with PMDD want to feel normal,  We don't want to admit there's something going on in our brain that isn't right.  Something that even the medical professionals can't agree on, much less define.  We can find a thousand excuses for why we are so clumsy at times, or so ravenous, or irritable, edgy, disoriented, anxious, or weepy.  We deny and deny and deny there is anything wrong with us, or that we are in any way acting strangely, because to admit that we are doing so means we will have to stop and deal with it somehow, and how can you deal with something that defies description?

Sometimes it's a battle you just don't want to fight. 

From my books, PMDD and Relationships and PMDD: A Handbook for Partners  

PMDD: A Handbook for Partners

At the request of my readers, I have written a PMDD book especially for partners of women with PMDD:

PMDD: A Handbook for Partners  

Does your wife or girlfriendʼs personality change drastically every month? Like clockwork? Youʼre far from alone. It could be Pre-Menstrual Dysphoric Disorder, or PMDD, a debilitating hormonal disorder which affects 3 - 8% of women in their fertile years, including many using birth control. PMDD is what makes it seem like sheʼs gone Dr. Jekyll and Mr. Hyde on you once, sometimes twice a month. Sometimes even for half of each month or more.

Inspired by the most-read posts in the blog Living on a Prayer, Living with PMDD, this book is for the partners of women with PMDD. Inside you will find insights as to what is going on in her mind during her seemingly inexplicable bouts of confusion, irritability, anger, rage, fear, anxiety, sadness and/or despair, what contributes to her state of emotional chaos, and tips on how to cope with and care for the woman you love during these, her most vulnerable days of the month.

Thereʼs no need for you to ride the rollercoaster of PMDD like you do. There are ways to help her manage her PMDD. Let this book help you to do just that, and find peace in the midst of the wildly careening emotions that PMDD brings into your relationship and life.

On sale now for Kindle at Amazon.  Introductory price of $4.99.  Available in print from Amazon as well for $9.99.  More than 200 pages of information and understanding about what itʼs like to be caught up in the unpredictability of a relationship with a woman who has PMDD, and what you can do about it.

PMDD Quote of the Week

~Knowing it's PMDD doesn't make it any less real or terrifying.~

Readers Speak Out: Advice for Partners of Women with PMDD

Today I uncovered another gem of wisdom from a reader on how to approach your partner's PMDD.  Rather than leaving it buried in the comments section of another post, I've decided to feature it here:

I just found this blog searching for something to help my husband know what to do with me. I feel better now, but I fear I'll regress and we'll struggle again as a family. I have PMDD. I say DO NOT bring it up when she is at her worst. She is completely irrational and doesn't want to answer stupid questions or talk about how she is feeling. [In that moment] it seems so obvious to her that you should know how she is doing. Don't bring it up on a date or otherwise special time between you two. It is better to ruin a good day or week to get her help, than to keep living like how you are and end up divorced.

First, you need to get your wife medical help. When you have an opportunity to talk—not in public—ask her if she's ever had PMS. She may not have realized her moods are associated with her cycle. You're either going to get a "Yes, dumb***" answer or a "No, not really, I don't think so."

Depending on how that goes, tell her you've done some research, you think her moods might be associated to her cycle, or, if she knows she has PMS, that it might be something more serious. Tell her about PMDD. Read her the symptoms. Ask her if this is how she feels sometimes. Feel bad for her, say you're sorry she has to endure that every month. Let her know there is help available.

I know it sounds insane. I know you shouldn't have to put up with it. I also know how well I'm doing now and wonder how much better last year could have been for my marriage if my husband would have reacted to me differently. If he could have said, "How are you doing? Not well? Let's get you to the doctor," instead of "You're so mean and I don’t have to put up with this." I think I would have felt better. I was already on an antidepressant. It wasn't working.

What I need to feel better is a new prescription and a husband who will back off when I'm irritable and take care of the kids. When I have a bad day, I need him to think, "She's mad, hmm, let's look at the calendar, yep, she's pre-menstrual, I'm going to leave her alone, not mention PMS, and take care of the kids until she feels better."

It might be a few hours, it might be a few days, but it won't be a few weeks like it was last year when he was mad at me for having a bad day; then I felt worse, then there was a fear he'd leave me. I get it, I wanted to leave me, too, but women with PMDD, I'll speak for myself at least, need to feel wanted and loved and worth it to help.

So that is my advice, stranger. Ruin a good day to get her the medical help she needs. Say, "I took next Thursday off work, would you like me to take you to the doctor?" If you have kids, arrange babysitting. It's so hard for moms to find an hour to go to the doctor, especially if she doesn't feel she's worth helping. Even if it's not PMDD she has, make sure she gets bloodwork done. They should be testing her thyroid to make sure there aren't issues there.

Either way, good luck, and from the wife's perspective, thank you husbands who stick it out and deal with us. Some of these marriages seem beyond repair, but husbands can do so much to help. Think of how she is doing and what you can do to help, even if that means just leaving her alone for a bit. She’s not rejecting you. She feels like s***. Unless she comes to you, your touch will be repulsive. It’s not personal, it’s just how she feels. Know that she cannot help how she feels when she is pre-menstrual. For me, I feel angry, tired, sad, and irritable so I am distant to try to protect the ones I love most (from me).

Perhaps your wife [doesn't] care so much if she is mean, but I care. I bet deep down she cares too because she loved you enough to marry you and doesn’t want to be mean to you. You don't have to understand it, you won't ever. You just have to love her through it. Hopefully she's worth it to you.