About a week before my last period started, I felt the chemicals in my body change. It was a weekend afternoon and my 5-year-old twins were helping me take ornaments off of the Christmas tree. They were carefully placing their contributions at my feet, and I was wrapping the ornaments in tissue paper or placing them back into their original boxes. It was going surprisingly well, and I was feeling good.
As I sat on the couch, though, I felt all those good feelings slowly drain from my body while dread and sadness replaced them. Oh no. Here it comes again. I leaned back and knew another cycle of Premenstrual Dysphoric Disorder (PMDD) had started. The shift felt like a cloud moving in front of the sun on an otherwise clear day. I was covered in shadow. I was suddenly in the sun’s blind spot again.
Each month, I cycle between fairly consistent, stable emotions and the darkest, angriest moods I have ever experienced. Those 7-10 days of each month are the PMDD blind spot.
The Mayo Clinic defines PMDD this way: “Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling extension of premenstrual syndrome (PMS). Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships.”
According to MedicineNet, PMDD affects 3-8% of menstruating people. Symptoms include: depression; severe mood swings; anger and irritability; severe breast tenderness, cramping and bloating; change in sleep patterns; inability to focus; tension; anxiety; and suicidal thoughts.
PMDD is an absolute nightmare and is triggered by the hormone changes in the body following ovulation. After ovulation and before menstruation, levels of serotonin—which is a chemical in our body responsible for balancing our moods—drop. This is what can cause PMS fatigue and irritability. It’s also what causes a complete change in personality for others who have PMDD.
A friend of mine, Natalie, describes her PMDD like this: “PMDD turns me into a completely irrational, nasty, intolerant person I do not even recognize and would absolutely never associate with. I have zero control over my behaviors because of the havoc my hormones are wreaking inside my body.”
Another friend, Crystal, said, “I go from being pretty content, to Googling divorce attorneys–it’s that much of a shift every month. I want to make big, irrational decisions during PMDD. I can’t trust my own brain.”
I understand this now, but until I made the connection between my moods and my period, I didn’t know what was wrong with me.
On a random Tuesday a few months ago, I sat at my desk and cried. Not weepy, I-am-going-to-get-my-period-soon, totally justified hormonal cry, but hours of uncontrollable tears. I was so incredibly sad and hopeless. My brain was telling me awful things: I am a fraud. I will always feel this way. I will always go through these cycles of depression and negativity. I am so tired of this. If I wasn’t alive, my friends and family wouldn’t have to deal with this. I am no good. I am a burden.
I have obsessive-compulsive disorder, anxiety, and bouts of depression. I am also a sober alcoholic who was been clean for about 18 months. As a nonbinary person, I struggle with body dysphoria too. I am no stranger to uncomfortable feelings or dark moods, but this was different. I fought through it with people reminding me that my brain was lying to me. The chemicals surging through my body were out of my control. I needed to be kind to myself. I needed to be okay with just surviving. And that is what it feels like: having PMDD feels like an exhausting battle to just make it through the day.
A few days after my period started and my mood stabilized, I started talking to friends who had mentioned they deal with PMDD each month. I did some research and talked to my therapist.
Because the serotonin levels in my brain are already low, I learned that my underlying depression and anxiety make PMDD worse. So does the fact that I am an alcoholic. There is still the chicken vs. egg debate when it comes to alcohol addiction and PMDD. Is my brain predisposed to PMDD in part because its chemical design is low of serotonin? Does this design also lead me to anxiety, depression, and self-medicating for both via booze to get the feel good effects of dopamine, the chemical which surges through my brain when I drink, telling me to keep drinking to feel good? Or did my alcohol abuse create a brain more prone to PMDD?
The answer is likely yes to all of this.
A study reported in Neurotransmitter Review found this: “Serotonin plays an important role in mediating alcohol’s effects on the brain. Alcohol exposure alters several aspects of serotonergic signal transmission in the brain. For example, alcohol modulates the serotonin levels in the synapses and modifies the activities of specific serotonin receptor proteins. Abnormal serotonin levels within synapses may contribute to the development of alcohol abuse, because some studies have found that the levels of chemical markers representing serotonin levels in the brain are reduced in alcoholic humans and chronically alcohol-consuming animals.”
The report also showed that serotonin interacts with dopamine during alcohol use. “An alcohol-induced increase in 5-HT3 [serotonin] receptor activity would enhance dopamine release in these brain regions, thereby contributing to alcohol’s rewarding effects.”
I don’t drink anymore, but my brain is still healing. I don’t know what it will take for it to be “normal,” but I’m not really looking for that. I am just glad that I finally made the connection between the worst depression, anger, and anxiety I have ever experienced and my menstrual cycle.
Treating PMDD can look like a lot of things. Some people take SSRIs (Selective Serotonin Reuptake Inhibitor) either every day or during the time between ovulation and menstruation. SSRIs don’t increase serotonin in the brain, but they help the body use the levels more effectively. Others find relief with antidepressants, hormone therapy through birth control, exercise, diet changes, and/or stress management and environmental changes.
Another friend, Michael, said this: “One empowering thing I’ve done for myself is to accept PMDD as part of my life. Now I chart my cycle diligently, warn my husband when PMDD is about to strike, and remind myself that ‘this too shall pass.’”
I will be honest; I don’t really want to accept PMDD as part of my life. It sucks. I hate losing days to not feeling good. I hate knowing that every few weeks will be fucking miserable. I hate the constant routine of being knocked down and having to find ways to crawl back up. Yet, I feel better talking to people about it. I am glad my therapist knows. And I am relieved that I am starting to understand PMDD; it helps to know I can’t magically alter the chemicals in my brain, despite in my darkest moments thinking my mood is something I can control.
I am already taking an SSRI and mood stabilizer for anxiety and depression, so adjusting doses may be an option. I also am experiencing some temporary environmental stress, so with time, I hope my PMDD improves. And I do the things I can control to stay well. I stay sober, fit, and productive. Finding wellness looks different for everyone, but I’m actively choosing to do things I know will benefit my mental health. I also remind myself that I am not alone.
If any of this sounds familiar to you, please talk to someone. Reach out to a friend, your doctor, or therapist. PMDD is scary AF at times. Please don’t suffer through it alone.