7 Things You Should Really Know About PMDD
It's not mere PMS
Context note: There will be discussion of death, suicidality, body image, derealization, and other health concerns related to PMDD. Please read with caution.
There exists this myth about anyone who experiences menstruation. You know the one. There are many, but the biggest one is about how one's behavior changes. Basically, anyone bleeding or having their hormones shift suddenly turns into a monster, to be avoided at all costs. Worse, there's the assumption that any time a person perceived as a woman is angry, it must be because they're menstruating.
It's a huge problem for many reasons. First off, not everyone who menstruates is an afab person or a woman. Not everyone who is a woman menstruates. And of course, people can be angry regardless of where their hormone levels are. In fact, for the most part, menstruation or hormonal shifts don't completely change someone's personality, and men also have hormone shifts and things, you know.
However, I do believe that I know exactly where this myth of the monster woman on her period comes from. I believe I know why some folks thought isolating such a person was necessary or reasonable. Hell, I might even know why the werewolf myth ties them to the moon.
There exists a serious medical condition that can actually threaten the lives of people of any or no gender who menstruate or have cyclical hormonal shifts. It's called PreMenstrual Dysphoric Disorder, and it very nearly killed me nearly 12 times a year since I was 12.
Thus, the very first thing you should know is that
1. PMDD Can Induce Suicidality
Now, I've never had a pleasant or simple life. I experienced many traumatic events and generally find myself at the bottom of the barrel. However, when I finally realized I had PMDD, I looked back on my life and came to a horrifying conclusion:
The times when I thought I would be better off dead, the times I was down enough to try to end my life, nearly all coincided with my menstrual cycle. That week or two before I'd finally bleed, I would be a total mess, forgetting everything good in my life, and I'd feel as if there was no hope.
Being able to link my attempts with the shift in my hormones allowed me to better plan for it, to battle it, and to avoid it. Saying it's a life or death situation is no exaggeration.
It is literally dangerous for me to have a period because
2. Having PMDD Means I'm Basically Allergic to My Own Hormones
So what exactly is PMDD, anyway? Many people, and even doctors, refer to it as just severe PMS. The DSM even lists it as a subcategory of depression now. But the thing about PreMenstrual Dysphoric Disorder is that it is a physiological reaction to one's own hormones, not merely a psychiatric or mood disorder.
During the luteal phase, as the hormones shift in order to eventually trigger the sloughing of the uterine lining (if one is present), the body responds differently than most on a cellular level.
Instead of just the usual bloating, soreness, and emotional sensitivity, there is a vicious train reaction - that shakes one's entire sense of self - rooted in an abnormal response to even a regular level of reproductive hormones.
There's some disagreement over whether the allergy/reaction is to high levels of estrogen or progesterone, but I know in my own experience that higher levels of progesterone make me feel calm and wonderful (I have lower natural levels of progesterone due to several other conditions I have) while any level of estrogen - even the lowest - makes me feel...like a monster.
Whichever hormone or hormonal interaction it is for you or someone you know, it hacks into the emotional center of the brain and decreases the levels of serotonin you have to work with, turning the sensitivity up from five to 100. Everything becomes more intense. Many of the people who live with PMDD agree that the main two emotions one feels while in the fog are rage and paranoia. Panic attacks abound and even spilled milk will have you flying into Sailor Saturn mode.
This actually leads me into another lesser known yet equally life-wrecking symptom of PMDD:
3. PMDD Can Make You Feel Like You're Not Even Real
While the rage and paranoia can pose their own huge problems in one's life (which I'll detail in the section below titled "The Impacts of PMDD on Your Life and Job"), not knowing who you are or who you can trust also have devastating consequences.
PMDD can manifest the experiences of depersonalization and derealization, which are subsets of dissociation. Yes, as in that thing that is usually caused by or a symptom of some sort of trauma.
Depersonalization within PMDD usually looks like merely bearing witness to your body, thoughts, and actions becoming those of someone else.
Derealization goes as follows: Those you love and trust cannot possibly actually return the favor and are secretly plotting your downfall. Your memories distort and you begin to wonder if you've fallen into another universe. You recognize things and people, but they, or you, seem to have shifted to the left or something.
You know your life in some aspects and you know what things are, but they feel distanced. You are suddenly an alien in another universe. Everything is fake.
It's a hell of an experience and terrifying to live through. But please don't forget that
4. PMDD Has Other Physical Symptoms
On top of all this, there are other physical symptoms that PMDD induces on the poor person subjected to this horror. No, people with PMDD have to also deal with breast pain, headaches, heart palpitations, severe fatigue, acne, muscle spasms, dizziness, gastrointestinal issues, more painful periods, bloating, and more for an average of 10 days. Sometimes it can last longer if your cycle is irregular, but it always occurs before you menstruate.
Usually, the symptoms ease as soon as the blood comes. In a literal rush of relief, the haze lifts and we can only stare in shame and shock as we being to realize the far-reaching effects of our hormones turning our bodies into a battleground.
For nearly half of every month during menarche, you suddenly don't know who you are and your body is in pain-panic mode. So you can only imagine
5. The Impacts of PMDD on Your Life and Job
Unlike many invisible illnesses, your coworkers, lovers, family, friends, and perfect strangers will definitely notice something is going on with you. Impulse control flies out the window and you cut people down to size with your tongue (or hands, if you are not verbal). You find yourself yelling at your boss or strangers, bursting into tears of pure fear at the touch of loved ones, and believing with every part of you that your life isn't worth living.
Your performance suffers, your relationships suffer, your health suffers. In order to get ahead of it, you might have to take up to two weeks off work every single month or so and avoid human contact. But in isolation, there's no one to counter your dark thoughts or help stop you from doing something reckless or dangerous.
Few workplaces will put up with missing so much time or outbursts on the job. Even trying to plan around it is of no avail, because - and I know how odd this is - PMDD creeps up on you every single time. It comes on with no warning, and until we start bleeding we don't have the capacity to understand why everything is suddenly so difficult and so different.
It is exceedingly hard to keep jobs and relationships while dealing with PMDD. Yet for some reason, some of them having to do with the myths around menarche,
6. PMDD Isn't Viewed as a Disability, But It Should Be
PMDD is not officially considered a disability, or at least won't be considered one by the Social Security Administration on its own or without a really compassionate team and all the luck in the universe. Most doctors aren't well-educated on the disorder, and with health disparities across race and economic status there exist many barriers for getting diagnosed and then even more for receiving knowledgeable help.
Leaving aside the other effects of PMDD, there is one that should clearly impart the severity of this condition and serve as impetus to improve and create more resources for those who live with it:
At least 5-10% of people who experience menstruation also experience PMDD, and of them, at least 30% attempt suicide. As the tenth leading cause of death among women and menstruators worldwide, suicide must be taken seriously.
Even when we know we have PMDD, the black hole of that hell week can push anyone over the edge and blur our memories. There is often no light, and only time can help us...if we can just get through. Too many of us don't.
If you think that this is a simple fix of tampering with our hormones, I've got news for you:
7. There Is No Cure, and Treatments Have Their Own Problems
As with most reproductive issues not related to penises, PMDD isn't high on the list for research. And even though there are several theories as to its cause, like every other invisible illness of the chronic type, there is no sight of a cure.
If you happen to find doctors that believe you and are familiar enough with PMDD to help you then you can formulate a treatment plan. The main treatments for PMDD are antidepressants and hormone treatments. Antidepressants come with a long, terrible list of side effects...and so do hormone treatments.
Antidepressants can also have some of the most awful withdrawal periods, and with fluctuating access to healthcare and restrictions on medications, too many people will experience several, if not dozens, of withdrawals. And as you may know, withdrawals and antidepressants can also make things worse...and result in suicidality.
So, it's a really small band-aid on an enormous exploding star.
Moving on to hormonal treatments, these tend to come with their own problems. First of all, they can actually end up exacerbating your symptoms. There are kinds that are much more likely to do this, namely the ones that include estrogen and/or progesterone - even those with low levels of either. This is on top of all the other potential health issues surrounding using hormonal birth control and the fact that some people have other health issues that are contraindicated with use of birth control.
Additionally, if you do manage to finally find a kind of birth control or hormonal therapy that eases PMDD symptoms, some of them induce menopause. And if you don't know, menopause includes some of the same symptoms as PMDD, including depression.
Meaning even when your body would have naturally started menopause, you're not safe from PMDD's effect.
So we're back where we started.
By now, you may be wondering,
So...What's The Point and What Do We Do From Here?
Is there a light at the end of the tunnel for those with PMDD and the people who care for them or work with them? Why does knowing all this matter?
If you take action, knowledge can become wisdom. Someone out there is reading this and thinking, "Thank goodness! It's not just me. I'm not alone. There's nothing wrong with me. I have a disorder. This makes total sense." That person will start researching, will stop by IAPMD and Me v PMDD, will make changes that bring their life more into alignment.
People that love, work with, or know these people will say, "So there is a reason my beloved turns into a werewolf each month! No wonder they're having such a difficult time. I wonder how I can make things easier for them." They will begin to understand, will advocate for those they care for, will build skills necessary to help their PMDD person.
Doctors and institutions will be like, "We should conduct more research. Let's try this. This is a serious issue affecting so many lives. How can we make things more accessible?" These folks will listen more closely to those with PMDD, will learn all they can about it, will find more effective treatments.
At least, this is all very possible.
The next time you come across someone who seems irrationally angry, examine and dismiss your first instinct and remember many people are facing down demons you've never even heard of.
The next time your highly successful self shuts down due to a panic attack in the middle of a perfectly normal workday, examine your past few days and remember that this will pass and that you've survived worse.
The next time someone comes into your office and tells you that their menstrual cycle is trying to kill them, examine your assumptions and take a closer look.
There may not be big, sweeping changes. But being just a little more informed can make a life-altering difference in someone's life. Especially if they're considering ending it.