Premenstrual Dysphoric Disorder–Not Your Mama’s PMS


Unless, of course, your mom has PMDD.

About every four weeks, my world falls apart. We’re talking everything is suddenly too dark and too heavy for me to bear. Usually, I cry a lot. I latch onto the emotions of sad songs and movies. Often, I believe that no one actually likes me; sometimes I don’t like them either. Either way, I am convinced I am completely alone in the world. Nighttime is miserable because I don’t sleep well and the physical darkness makes my mind’s perceived darkness seem all the more real and oppressive. I have almost zero tolerance for any sort of stress. Everything is just too hard. And too much.

When this hits during a fairly well and stable phase, I can manage. I mean, relatively speaking. I still struggle to get out of bed in the morning and to find a reason to keep pushing on, but I do it anyway.

When this hits and I’m already in crisis, then things get really ugly.

My husband and I started noticing that, in addition to and separate from the cycles my mental illness goes through, my moods cycle with my menstrual cycle. Super fun. And it probably seems like I have no problems with being open about all things awkward and uncomfortable, but I really don’t like discussing anything involving the word “menstrual.” Eventually though, I realized it was not going away and it was creating some really scary moments for me, so I brought it up to my doctor.

My openness was rewarded with yet another diagnosis. Yay! PMDD—Premenstrual Dysphoric Disorder. What is it? Well, it’s a very severe form of PMS. For me, it begins about 7-10 days before my period actually starts. It occurs about 2 weeks after ovulation. It involves the unpleasant physical symptoms associated with PMS, but the mental and emotional symptoms are far more significant. Web MD has a good list:

  • Mood swings
  • Depressed mood or feelings of hopelessness
  • Marked anger, increased interpersonal conflicts
  • Tension and anxiety
  • Irritability
  • Decreased interest in usual activities
  • Difficulty concentrating
  • Fatigue
  • Change in appetite
  • Feeling out of control or overwhelmed
  • Sleep problems
  • Physical problems, such as bloating, breast tenderness, swelling, headaches, joint or muscle pain.

If this looks like something you might be suffering from, go see your doctor for an official diagnosis. There are prescriptions, including antidepressants or hormone treatments (e.g. birth control pills), that can help reduce these symptoms. Exercise also helps decrease symptoms for me—at least temporarily. But when you feel like you are literally carrying the weight of the world and it is going to inevitably crush you—even temporary relief is totally worth it. Plus, it gets me out of bed in the morning.

This article recommends calcium, vitamin B-6, magnesium, and L-tryptophan. I was already supplementing with most of these before I got diagnosed, so my doctor and I didn’t discuss these as potential helps with PMDD. The article also recommends reducing caffeine, avoiding alcohol, and smoking cessation. I find caffeine induces anxiety for me regardless of where I’m at in my menstrual cycle, so I avoid it all of the time. I never drink or smoke, so again this isn’t something I can speak to personally.

I think one of the most critical pieces to coping with PMDD is awareness. Knowledge truly is power! If you don’t already, begin tracking your cycle. Track when potential PMDD symptoms start and when your period starts. If your cycles aren’t very consistent, you can buy an ovulation kit to track when you ovulate. This will give you a better idea of when your symptoms will start—about a week after ovulation. My husband helps track mine. That way, when I get blindsided by the PMDD symptoms, but forget that it’s coming from PMDD, he can help remind me that this is probably what’s causing me to feel so awful.

Since I can’t tolerate most medications or hormone treatments, awareness is sometimes the only thing that helps me survive an episode of PMDD. I can tell myself that even though my mind is 100% convinced that I cannot handle life and that things will never get better, it is a lie. I can look at the calendar and see that within two weeks (typically symptoms end when menstruation begins, but sometimes they linger for the first 2-3 days), the sun will come out again and I will see things more clearly. Life may not seem worth living in the moment, but I know that if I just hold on until then, things will seem more bearable and life more worthwhile. So, if this is something you can relate to, talk to your doctor about a potential diagnosis and take comfort in the fact that there are things you can do to help mitigate your suffering!