PMS On Overdrive: What It Feels Like to Have PMDD

I was out for my birthday with my girlfriends this past spring, when my best friend told me she was cutting out a little early. Ordinarily, this would not have fazed me; I’d have given her a hug, thanked her for coming, and told her to have a good night. This, however, was not a wholly ordinary day, nor was it an ordinary reaction. This was my birthday, and this was a meltdown.

The anger boiled up inside me, and then popped, long before I had time to think through my behavior. I snapped at my BFF for choosing to leave earlier than I’d expected, and without prior warning. She tried to calm me down, but I was having none of that and told her to, “Seriously, just go” several times. After she was gone, I threw a fit and did not wish to participate the rest of the night. I wound up crying in a Starbucks with my friend Jordan over a midnight cup of decaf.

When I woke up the next morning, I got my period.

I have premenstrual dysmorphic disorder (PMDD), which is a severe form of premenstrual syndrome (PMS).

The physical symptoms can be disabling, and the condition is also marked by extreme mood swings in the seven to 10 days before your period strikes.

Although we know PMS is caused by hormone fluctuations, the exact interplay of hormones that results in symptoms is still a little bit of a mystery, says William Schweizer, M.D., a clinical associate professor in the department of obstetrics and gynecology at NYU Langone Medical Center. “Many women have premenstrual issues,” he explains. “While we really don’t know what causes it, it’s probably the progesterone component of your cycle.”

There’s a clinical definition for PMDD, where at least five of 11 symptoms outlined in the DSM-5 must be present for a diagnosis (for example: marked anger/irritability, bloating, lethargy, difficulty concentrating, and decreased interest in activities)—one of which must be a mood-related symptom. “Mood is most concerning,” Schweizer says. “If there are psychological issues, a marked increase in anger or feeling more volatile,” that’s when the regular PMS treatments really fall short. Roughly 3 to 8 percent of women are currently diagnosed with PMDD, but as many as 18 percent of women likely have premenstrual symptoms that impair their day-to-day functioning, yet forge on without diagnosis or adequate treatment.

That was me for a long time. I dealt with my extreme PMS for most of my adolescent years, before the mood swings struck in early adulthood. I finally visited my ob/gyn a couple years ago for breast tenderness, crazy bloating, and a rumbling flood of emotions in the week before my period would arrive. After going over my symptoms in full, most of which I’d been writing off for years, she diagnosed me with PMDD .

Getting an official PMDD diagnosis meant that I finally had a clinical explanation for all the crazy symptoms I’d been dealing with all these years.

My emotional moments can be embarrassing at times. Feelings well up, and it’s not at all uncommon cry over something innocuous in the days before my period. Sappy books will absolutely do me in, and I avoid tearjerker songs on the radio. (All the Me Before You ads with Ed Sheeran’s “Photograph” playing? Those suckers been doozies.) Once, I kid you not, I even spent the entire evening crying over a commercial for the Flint Water Crisis, which immediately preceded a story on the NBC Nightly News about a 100-something African-American woman who finally got to meet President Obama.

I am also irritable for no reason. Imagine the stress involved in teetering on an emotional tightrope for one week a month, hoping the line doesn’t snap or you make a misstep. Fail to inform me about a schedule change, so I don’t have time to prepare? First reaction: GAH. Second reaction: *calm down*. (I’ve learned to talk to myself.)

And of course, there are also physical symptoms, most of which you are probably pretty well-verse in. Cramps usually ravage my lower abdominal area for a day or two, but I figured out how to effectively deal with them in my teen years. As I got older, my most severe physical symptoms changed and were slightly harder to cope with—as in, I couldn’t kick them with a rotating ibuprofen and acetaminophen regimen. Some cycles, breast tenderness is my worst symptom. It sort of feels like I am carrying around lead weights in my chest, and exercise becomes “minimal impact” (if at all).

Other cycles, bloating is my most severe issue. The tummy pooch makes me want to fast for the week leading up to my period, but the savage cravings keep me reaching for cookies, candy—pretty much sweet anythings. This does not help my breakouts either, which also flare with my PMDD.

Finally, with all this havoc going on in my body, I sleep a lot during my period. There have been weeks where I’ve needed 12-plus hours a night, multiple nights in a row. I once put on tennis shoes to go for a walk, but ended up falling asleep instead. It was 6:30 P.M. I woke up once at 9 P.M., kicked my shoes off, and then slept until 7 the next morning.

My diagnosis also opened me up to treatments that I wouldn’t have considered when I just thought I had bad PMS and no choice but to suck it up and pray the Advil would work.

Since fluctuations in progesterone levels seem to be behind many PMS and PMDD symptoms, managing the hormone can often help reduce them.

Initially my doctor put me on the combination progesterone-estrogen birth control pill Yaz, which is extremely helpful for some women with PMDD, says Schweizer.

I did a one-month go-round with Yaz when I was first diagnosed, my second time on the Pill in my life. Sadly, my body just doesn’t seem to respond well to any changes to my hormone levels—even if those changes are designed to help. My PMDD got significantly worse, to the point where I was bedridden for a couple days. So, I stopped. Schweizer confirms that Yaz, though specifically used to treat PMDD, is not for everyone—but he stresses that even when it does work, it’s not an instant fix, so you should give it some time. “I often tell women to wait several cycles, and we’ll try things one at a time,” he says. “It may take that long for your body to adjust, and to figure out what works for you.” That one month I was on the Pill was more than enough for me—I didn’t want to wait any longer. I was completely miserable, 24 hours a day.

That was two years ago, and to be honest, I haven’t done much to make my PMDD better. I manage several health conditions in my fibromyalgia constellation—fibro, IBS, interstitial cystitis, to name a few—so sometimes the PMDD falls by the wayside while I focus my healing attentions on my other chronic health issues.

There are OTC supplements known to help with PMS and PMDD—but doctors don't recommend trying just anything you find on the shelves.

I asked Schweizer if he ever recommends supplements or natural fixes for PMDD—I take enough meds already; I’d love alternatives. He told me about several, though he stressed that it’s important to check with your doctor before starting any new regimen because of potential side-effects or interactions with other meds you’re taking. Chasteberry extract may reduce estrogen levels and increase that all-important progesterone. He also says evening primrose oil really does wonders for breast tenderness.

Other supplements include dandelion leaf for bloating, as well as calcium, magnesium, vitamin B6, and vitamin E to help reduce other PMS-related symptoms. Schweizer also likes to try diuretics for people who deal with extreme bloating—not OTC, so if you’re a sufferer, ask your gyno—and even light therapy for those with particularly tough-to-manage symptoms.

What’s most important, he said, is to make sure I’m incredibly in tune with my cycle’s arrival. Back just a few years ago, you had to use a calendar, but now they make tracker apps like CluePeriod Tracker, and Monthly Gift (which includes a cute symptom forecaster, like a weather app but for cramps and mood swings). Being totally aware of when my period is coming and when my symptoms are at their worst gives me the chance to get ahead of their overwhelming strike. About two days to three days before my symptoms typically begin, I start taking two NSAIDs in the morning and two before bed. Schweizer says this primes the body to handle the extra pain, and I have found that it does help me roll easier into the start of my period.

Antidepressants are an option for women with severe PMDD-related mood issues.

Schweizer says that in cases in which there’s a mood issue working alongside physical symptoms, he will commonly prescribe a drug to handle that increased anxiety, depression or anger. He’s had great results with selective serotonin reuptake inhibitors (SSRI) like Zoloft and Prozac. Sometimes, with PMDD, he will take the typical dose a doctor might prescribe to a woman with another condition, such as clinical depression, and halve it. “Like with Prozac, I’ll often have a patient take just 10 milligrams in the second half of the cycle,” Schweizer says.

I've learned a lot about PMDD, but basically I'm a model of what not to do if you have it.

Though I’m still trying to figure out the best course of action for me, I have learned one piece of wisdom that I’d like to pass along to other PMDD sufferers: Don’t, like me, just assume that there is nothing out there for you if the Pill didn’t work.

There are lots of options. If you have PMS or PMDD that impacts your life pretty significantly: Go to your ob/gyn. “I don’t like the shotgun approach,” Schweizer says of my one-and-done method. “I always say, ‘Let’s try something for two months, and if it doesn’t help, we’ll try something else.” Usually, everything sorts itself out in a matter of months, he says, and then you’ll have yourself a go-to monthly routine to kick those annoying symptoms that are plagues upon womanhood.

As for me and my PMDD, I’ve added a few supplements into my routine that have substantially helped the physical symptoms—vitamins B6, B12 and magnesium—which, in turn, help me keep my emotions in check. (When you feel better physically, you feel better emotionally.) And hopefully, by fall, I’ll be substantiallymore chill about all this pre-period nonsense.