I’m 32, and was recently diagnosed with premenstrual dysphoric disorder (PMDD), though I suspect I have had it for around five years. It severely affects every area of my life.
For 10 days every month I become irritable and impatient, and have debilitating brain fog. At my worst, I am depressed, with uncontrollable crying and suicidal ideation. I go to weekly therapy sessions, take a variety of supplements, and live a healthy lifestyle – exercise, minimal alcohol, eating well, etc, but all these habits become almost impossible during my luteal phase after ovulation and I feel as though I am completely stuck.
When I am not in my luteal phase, I love life. And then it all comes crashing down: I want to leave my job, break up with my partner, ignore my friends. I struggle to share this experience with anyone or ask for help because the condition is chronically under-recognised and under-researched. Sometimes I even trick myself into thinking maybe it isn’t real. I increasingly feel I am burdening my partner as they are almost the only person I can be totally myself with.
When I am at my best, I forget I even have the condition. When my period comes, it is as if I have had a brain transplant – I am a whole new woman. And then the countdown begins until the next luteal phase. How can I live the next 20 years like this?
That’s a lot to deal with. You’re right that PMDD is chronically under-researched (like so many women’s health issues). It has existed for a long time but was only recently been classified as a disorder.
I took your problem to Dr Sophie Behrman, a psychiatrist who recently set up an NHS menopause and menstrual health clinic in Oxford. Her book Menopause, Menstrual Cycles and Mental Health comes out later this year. She told me it’s estimated that 1-3% of women get PMDD and it can happen at any time during their menstrual life. It is a mental disorder which causes severe psychological (and sometimes physical) symptoms in the luteal phase of the menstrual cycle.
Your reflection that after your period it’s like you’ve had a brain transplant is actually very astute. With PMDD, it’s not that you have an abnormal balance of hormones in your body, but how your brain reacts to them, and specifically to the falling progesterone levels before a period. The result is that people with the disorder end up feeling irritable, anxious, depressed and impulsive.
Behrman said you are already doing a lot that can help. There’s evidence that a good, wholefood diet and exercise can be really beneficial (though I know it isn’t always easy to maintain), and supplements can help. It would be irresponsible to recommend anything specific or suggest other surgical or pharmaceutical steps but, if symptoms don’t improve, go back to the person who diagnosed you and ask what might happen next. Cognitive behavioural therapy can be helpful. Behrman also mentioned the importance of peer support. You could look at the website iapmd.org for more information.
The “good” news is that you already have a diagnosis. As it’s a relatively new named disorder, lots of women have to do their homework before visiting a doctor armed with information.
I’m so pleased you have a supportive partner, but I would like to gently urge you to share your condition (for it is real) with some trusted others. It’s tiring having to educate people, but but sometimes that falls to us to do. Then they can support you – because you are worthy of support.
In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
Every week, Annalisa Barbieri addresses a personal problem sent in by a reader. If you would like advice from Annalisa, please send your problem to ask.annalisa@theguardian.com. Annalisa regrets she cannot enter into personal correspondence. Submissions are subject to our terms and conditions. The latest series of Annalisa’s podcast is available here.
