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The slow fog of PMDD

Friday, 28 April 2023 Emma

Emma explains the impact premenstrual dysphoric disorder can have on her life and how she is learning to manage it.

April is PMD (Premenstrual Disorder) Awareness month, so I wanted to give you an insight into what PMDD (Premenstrual Dysphoric Disorder) can be like and share a bit about the condition.

If you know me
You likely see the me I enjoy being
Feel lucky to be
Excited about ideas, about what you’re doing, what we can do together
Ready to listen, to smile, to laugh.

10-14 days into my menstrual cycle it’s as if my battery breaks
The ground beneath me drops
Feelings of dread, self-loathing, hopelessness seep in
Intrusive thoughts of self-harm on a loop
A brick wall between me and the things I did a day earlier without thinking
- get up, shower, dress, log on, text, talk, tidy, cook –

This is what you don’t see.

If I can go out, I move in a slow fog
Around people, I grip my partner's hand or arm to keep me safe, connected, away from spiralling flights of fear
Best case scenario I’m numb, so tired, I give up and just sleep.

The day after my cycle ends, when a new one begins, all this vanishes
I stand on solid ground
I’m happy, life feels lighter
The sun comes out, and I smile.

I didn’t know until recently that these mental health dips were linked to my hormones and menstrual cycle. Who knew? Growing up in the 90s, part of our feminism was denying any difference between men and women. Periods were embarrassing, PMS a weakness and a joke to be used against us.

I discovered PMDD in my late 30s. I describe it as severe PMS to explain how it affects me cyclically and link it to something people know about. For it to be PMDD the mental and emotional symptoms impact your daily living. I used an app to track this before getting the diagnosis. If symptoms disappear with your period (more or less) it may be PMDD; if you have an ongoing condition but it’s worse in your PMS phase it could be PME (Premenstrual Exacerbation). You can suppress your period bleed through contraception and still ovulate, so still have a premenstrual disorder.

“I’m trying to accept and live with PMDD as a chronic condition. There is no quick fix. But it’s also not out of my control.”

If you have a menstrual cycle and don’t track it - I highly recommend you do! Many of us have different energies, needs, interests at different points in our cycle, depending on what our hormones are doing and how we react to them. We can use that data to make life better. There are lots of apps you can try out, or simply note what day you’re on (day 1 is the first day you bleed/finish PMS symptoms) and how you feel in your diary or calendar.

With PMDD, there are ways to manage it, including HRT (hormone replacement therapy), antidepressants, counselling and complementary therapies, as well as finding ways to do the lifestyle things – nutrition, exercise, de-stress – that can improve many health conditions. You can even have a chemical or surgical menopause, not something anyone goes into lightly. For me, at the moment, I’m trying to accept and live with PMDD as a chronic condition. There is no quick fix. But it’s also not out of my control. Those negative symptoms from day 10-14 of my cycle? Now, I take a body identical progestogen (HRT) when they start and the next day I feel much more myself again.

What works fluctuates and that’s hard, but it teaches me to tune into my body and try and honour what I need. And that’s an important lesson to keep learning.

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