Living with Premenstrual Dysphoric Disorder

Have you recently heard about or been diagnosed with Premenstrual Dysphoric Disorder and are wondering what exactly that might mean? PMDD is a hormonal sensitivity that wrecks havoc in the lives of an estimated 3 to 8% of menstruating women.

It is not PMS; it is a separate disorder. It's a complicated world, and while there are certain symptoms that tend to present, each and every woman displays differently, and it may exacerbate pre-existing conditions as well. It can make the illness even stranger and scarier than it already is when one starts to compare her experiences to other women.

Questions like, "I feel worse now after my period than I did before! Is that still PMDD?" can arise and cause a great deal of confusion. It can also be unnerving when others insist that you have some other, similar illness, such as bipolar disorder, or accuse you of only making excuses for yourself. They say knowledge is power, so here are 10 things that every woman with PMDD should know:

1) PMDD is as unique as you are.

The absolute best way to gain a better understanding of the disorder is for each and every woman who suspects or has it to chart her symptoms. Because PMDD is tied, not to an imbalance of hormones, but the natural fluctuations of hormones, symptoms will present at those stages in the menstrual cycle that represent a shift in hormone production.

She will see a definite pattern than repeats itself month after month, with certain anxieties, rage, paranoia, depression, fatigue or other common symptoms showing up like clockwork at certain stages. There may still be slight variations from month to month, with some months being "not so bad" and others being total nightmares.

Some months the symptoms may last 10 days, some months only a few. Again, it is the month-to-month charting that will reveal the bigger picture, which is why charting is crucial to understanding yourself, your symptoms, and your individual needs.

2) It's not a hormone imbalance.

As already mentioned, PMDD is not the result of hormonal imbalance. So a woman who suspects something is wrong and requests that her hormones be tested may be disappointed to be told, "you're fine" by a doctor who is unfamiliar with PMDD.

PMDD is more of an allergy to the normal fluctuations of hormones. For reasons yet to be understood, though the theories are multiplying, certain women are hypersensitive to these hormonal shifts that happen to every menstruating woman. Once again, charting will prove a greater benefit to diagnosis than hormone testing. That's not to say you shouldn't have your hormone levels tested for other reasons, just that such tests won't help diagnose PMDD.

3) It is a wild ride.

The first "D" in PMDD stands for dysphoric. Dysphoria is the opposite of euphoria (feeling on top of the world). So women with PMDD are living parts of every month feeling like they are in the pits of hell. Dysphoria is defined as an unease or dissatisfaction with life.

But for a woman in the height of PMDD, dysphoria is a toxic mixture of uncontrollable self-loathing, loneliness, hopelessness, rage, anxiety, and fatigue, to name only a few common symptoms. It really is a rollercoaster of crazy mood swings and intense emotions and thoughts.

4) Relationships will be tough.

Women with PMDD tend to have a difficult time with relationships. It's not surprising given one) the fact that for about two weeks out of every month, a woman with PMDD struggles to relate and two) the disorder can create personality shifts that are less than pleasant for others to live with. That's not to say that one can't have good relationships, but they do take a different effort and understanding from all parties.

There will be people you can tell and people you can't. And of those, there will be those who are supportive and those who aren't. They'll be a little of both mixed into work, friendships, lovers, and families. Some of these people you'll have to live with, and likewise, they with you. There will be arguments sometimes over who has it harder!

5) There's no cure and nothing works for everyone.

Unfortunately, there is no cure for PMDD. There are many therapeutic approaches that run from pharmaceutical prescriptions to behavior therapy to complete dietary overhauls. The most important thing to remember is that nothing works for everyone, so don't be guilt-tripped into a treatment that doesn't feel right to you...or guilt-tripped out of one because it isn't right for someone else.

Treatment is very personal and is often an exploratory process over months or years to find things that actually help. Be open to anything, as often, some of the best help comes from unexpected places. PMDD boards and groups are a great place to discover possibilities. But as almost any other illness, what really makes a difference is taking good care of yourself by eating right, getting plenty of rest, and exercising regularly.

6) Don't make decisions at the height of symptoms.

PMDD messes with perception. Things that didn't seem all that important are vividly magnified, such as irritations and things that are normally tolerated. Paranoia runs high, and it can feel like the sky is literally caving in. This is not the time to confront people, sign contracts, end relationships, or make other major life decisions.

In fact, sometimes, it's not even a good time to make little decisions. The pressure in the mind can be screaming at you to "just do something!", but try to remember that you might not be thinking right. You may not be seeing straight. Wait a few days. See if anything changes before making a move you might come to regret.

7) Ovary removal can eliminate symptoms.

The removal of the ovaries, called an oophorectomy, is currently the only known intervention that eliminates symptoms of PMDD. Your ovaries produce hormones that control your menstrual cycle. It is a very serious step for any woman, let alone one who has yet to start a family of her own, so it isn't a solution to be taken lightly. It is also not necessarily easy to convince your medical provider that this is your best option.

8) There's help available.

Thankfully, as PMDD becomes better known and understood, if not by the medical profession, then at least by the women who have it, there are now more resources and support groups than ever. The Gia Allemand Foundation (formerly the NAPMDD) is an organization raising awareness whose website offers education, links to blogs, peer support, tools such as a symptom tracker, and information to bring to your doctor. There are also numerous private Facebook groups where women can share their stories, ask one another questions, and find compassion and a hug or two when things get really rough. And there are public pages for inspiration and information, such as PMDD Life Support.

9) It's okay to take care of you.

We live in a go-go-go world of constant action and responsibility. But when PMDD hits, you're not the same capable, confident woman you usually are. You may need to take more breaks, eat some comfort foods, sleep more, put some things or people off, and excuse yourself from having to do one more thing, no matter who you may be letting down. In fact, it's essential to make self-care your priority. The more you push and ignore your body and its needs, the more it will push back, making symptoms worse. Give yourself permission to slow down.

10) Whatever you are feeling, it will pass.

Sadly, the number of women with PMDD whose lives end in suicide is estimated to be 15%. Don't allow yourself and your precious body to become one of the statistics. The darkness that can encroach during PMDD can be very frightening and uncontrollable. Thoughts and perceptions become twisted and can lead one to believe things will never get better and to do things they wouldn't if in one's right state of mind. So remember with every last ounce of your strength that things do get better. Eventually, the hormones shift and things mellow out and the sun shines again. If you are having a hard time weathering the storm, please seek help.

PMDD is a very difficult disorder, complicated by the uniqueness with which it presents in women who are themselves unique. Remember, you're not alone. There are more than 3 million cases diagnosed every year in the US alone.