Chapter 33: PMDD

During my first year of law school, I would cry every day on my way to class for no real reason. It happened all week once a month. I went to my primary care physician and I was diagnosed with premenstrual dysphoric disorder (PMDD). It's basically and extreme version of PMS that interferes with your daily life. There are no indications that it's related to endometriosis, but since I am in the middle of a particularly bad spell, I figured it's a good time to talk about this important aspect of women's health.

Symptoms of PMDD usually appear a week or two before your period and stop a few days into the bleeding. Symptoms include anxiety, depression, fatigue, tension and anger, irritability, cramps, difficulty concentrating, headaches, joint and muscle pain, and mood swings. If you experience 5-7 of these symptoms during the PMS time period, you probably have PMDD.

This week I have all of these symptoms. I don't bleed anymore due to taking the pill continuously, so it's more difficult to keep track of. My anxiety is through the roof and I'm convinced that I have covid even though logically I know that I don't (coughing is from allergies and chest tightness is from the anxiety and goes away after I take a Xanax). I'm also pretty convinced that all of my loved ones hate me and that I will die alone. Logically, I know that it's the hormones, but honestly, it's hard to remember it during cycles like this.

What made this cycle so bad? Well, the general unrest in the world due to the covid pandemic is probably a good start. I live in the US, and our President is useless, so it's hard to not feel hopeless and scared. I have medical anxiety anyway, so a pandemic is basically worst case scenario for me. I was around more people this past weekend than I have been for all the pandemic, so I'm sure that fueled my anxiety. I regret that we weren't as careful as we should have been. I'm also reading a book about The Oregon Trail and there is currently a cholera outbreak (of course). It sounds silly, but when the thing you use to escape also feeds into your fears about the pandemic, it does a great job of helping fuel your anxiety.

In the more physical symptom side of things- I slept for 12 hours last night and could have probably slept for 3 more if I didn't force myself out of bed. My boobs are swollen and sore, my back hurts, my legs hurt and I just polished off a huge bowl of ice cream and would love nothing more than to eat an entire pizza, a block of cheese, mac and cheese, and drink a glass of Hershey's syrup. And then have a taco or 9 for dessert. I will refrain, but the desire is definitely there. Oh, plus Double Stuff Oreos. Always Double Stuff Oreos.

So how is PMDD treated? The main way is antidepressants, specifically selective serotonin reuptake inhibitors like Zoloft (my SSRI of choice)., Prozac, Paxil, Lexapro, Celexa, etc and their generic counterparts. SSRIs treat depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that carry signals between brain nerve cells (neurons). SSRIs block the reabsorption (reuptake) of serotonin into neurons. This makes more serotonin available to improve transmission of messages between neurons. SSRIs are called selective because they mainly affect serotonin, not other neurotransmitters. SSRIs can treat moderate to severe depression and anxiety disorders, making it a great way to combat the two most debilitating parts of my PMDD.

Initially I started only taking a small dose of Zoloft during my 2 PMS weeks, but now I'm taking it all of the time. It helps keeps everything much more consistently okay. It's something I used to be ashamed of, but I think mental health is important and something that needs to be addressed more often. I'll dedicate a whole post to mental health complications that are often associated with endometriosis in the future..

So, all of this to say this- If you feel like PMS is ruining your life, get help. It shouldn't be. I know it's hard to ask for help when you feel so crappy, but it is worth it. I feel 100 times better than I used to. This bad PMDD flare is an anomaly, but it used to be the norm.

If you feel like you need to talk to someone, call the National Suicide Prevention Hotline at 1-800-273-8255.