My PMDD is Under Control

For the uninitiated and new readers amongst you, PMDD is an extreme version of PMS/PMT. It can cause cyclical feelings of anxiety, depression, anger and even suicidal thoughts, as well as the physical symptoms typically associated with the menstrual cycle.

It’s been over a year since I last talked about my PMDD. When I lost wrote, I confessed that I felt like I’d become consumed by this disorder – the one thing I’d hoped to avoid above all else. However, after a rocky year or so of trials and tribulations, I finally feel like I have my PMDD under control (for the most part). Since that blog post, I have tried:

Tracking and Not Tracking Cycles

I became worried that my compulsive tracking — counting ahead based on a typical cycle and shading in the calendar when I expected to be sad or angry — was putting me on edge. I worried that I was expecting to be angry, or sad, or paranoid on X day and thus causing a self-fulfilling prophecy. I stopped tracking altogether but then ended up waking up with anxiety, or full of rage, and being unable to figure out why which just made me feel crazy (until I remembered).

I seem to have found a happy medium whereby I track my cycle start time each month and extreme symptoms in an app, but don’t cross-reference or look ahead to see where I expect to be in my cycle. This gives me a point of reference but no doom-mongering.

Consistent, Varied Exercise

I’m usually active in one way or another but I have found that I have my best months when I am both consistent in my workouts and do more than one activity, e.g. lifting and running in the same month. Months where I’ve run the furthest I find my cycle the most bearable, but then I have always found my mental health directly correlates to the amount of cardio based exercise I do.

During February and early April when I was not able to do as much as I would like (half term and Easter holidays respectively) it didn’t take long for the activity gap to hit me.

Vitamin Supplementation

I read a guest post by Beckie Takacs via the Gia Allemand Foundation (PMDD charity) in October 2017 about the supposed benefits of potassium supplementation in the treatment of PMDD. The piece struck a cord, and given my history of hyperemesis during pregnancies and probably execessive alcohol use, it wasn’t that unlikely that I had a low-level potassium deficiency. However, I got in touch with the author of the post and although mostly common sense stuff, the detailed protocol she sent me made reference to the “potential health hazards of wireless devices and smart meters” which immediately put me off; I’ve no interest in tinfoil hat science.

Nevertheless, my sister started a lower dose potassium supplement schedule and mentioned some relief of some of her pre-menstrual symptoms, so I started taking 300mg (half Takacs’ recommended dose) on an every-other-day basis, as well as magnesium, which also reportedly improves PMS. (Magnesium is also recommended for runners and those taking part in regular exercise.) My temper and anxiety/paranoia symptoms have improved since starting supplementation.

Sobriety

Last, but definitely not least: I gave up alcohol again.

After my brother’s suicide last year put me in a downwards spiral with my drinking, despite my best efforts to “be chill about it“, it wasn’t long before the casual on-off drinking became multiple triple vodka shots on a Friday night “just because”. I hit rock bottom again in mid-December and crushed by the weight of my own mental health I knew I had two choices: give in to the paranoia and anxiety and voices that told me I was shit and stupid and useless and fat and unloveable and just throw myself off a building, OR stop being a whiny dick and make the sensible decision to stop drinking.

Obviously choice A was no choice at all, so giving up it was. Just like the first time I stopped, this had an almost immediate affect on my anxiety-related symptoms.

And so here I am. I am not miraculously cured of all ills, & I can’t be sure that this isn’t all some massive coincidence, but each subsequent step against this debilitating disorder has given me back a piece of myself and some semblance of control. That’s better than nothing.

Lead photo by Hoàng Duy Lê

Identity

I was having a conversation with Gaz in bed the other day. You know the type: snuggled up in bed, pillow talk, vulnerabilities exposed, all that shit.

And this deep, meaningful conversation — the sort of conversation I can only truthfully have with my fucking wonderful husband — made me suddenly realise that over the past year or two I’ve become so wrapped up in treating or not treating, coddling or ignoring, planning in or avoiding my symptoms of PMDD that it has become my identity.

In my desperation to not become defined by this Thing that I cannot fix, I have literally let it define me. Let it control me. Let it stop me taking risks and let it stop me pushing harder.

Having not so long ago risen up against foes and demons of my past and thrown myself into the deep end of discovering ‘me’, I have gone and let a new demon wash me away. My fear of drowning in the abyss of hormones and treatments and not-treatments and symptoms and anxiety and SHIT has distracted me from the greater goal of constantly learning and constantly redefining who I am and who I can be.

Of course, this epiphany doesn’t come with answers. Knowing I’ve wrapped myself up in knots trying to avoid something whilst simultaneously using it as the very rope that binds me doesn’t magically fix all my problems. Introspection has only ever got me so far, and acknowledging that won’t make it go away.

The funny thing though, rather than ignoring it and hoping it goes away I think the real solution is to acknowledge it, embrace it, and fucking kick some ass anyway.

Easier said than done though, right?

Crack on

I started writing a blog post about anxiety yesterday, and perhaps ironically my own was so strong that I ended up deleting it.

I spent most of yesterday hiding: hiding from the world, hiding from myself. I was supposed to be going for a run… with a half marathon fast approaching it would be silly not to. And yet despite getting out of bed and putting on my gear I just could not bring myself to leave the house. I spent half of the day trying to distract myself from Dark Thoughts that can only mean my period is fast approaching. I ended up having a long hot bath, a hot chocolate and finished reading Amy Liptrot’s The Outrun (more on that another day though)

By the time Gaz got home, despite having talked myself out of going to taekwon-do, he talked me back into it and so I got changed, and we set off. As we approached the community center, I glanced in through the windows and saw something I did not want to see: our principal instructor was taking class.

Now, I have a lot of respect for this guy. He’s obviously passionate about taekwon-do, he’s very good at what he does and he has clearly worked very hard to get to the grade he’s at. But he scares the shit out of me. Absolutely terrifies me. If he said jump, I wouldn’t just be asking ‘how high’, I’d be asking ‘how high, Sir?’; I’d be asking if he wanted fries with that, Sir, and whether or not there was anything else I could help with… Sir.

(And I say that as someone with an abject — and obviously completely inappropriate — disregard for people of authority.)

So usually this makes me nervous, and a bit wobbly on my feet, but I crack on. Because that’s what you do, isn’t it? Crack on. Unfortunately yesterday I forgot how to “crack on”. Perhaps exacerbated by missing a few lessons, but almost certainly because a day of Dark Thoughts had left me without the reserves to fight the demons. So I started to shake, and my heart rate quickened, and my breathing became shallow. I tried to control it, but it wouldn’t go away and so I started to panic. Tears welled up in my eyes and I had no choice but to flee.

It’s the first time I’ve been unable to bring it under control in public and that scares me more than anything else. I don’t care about crying or making an arse of myself, I don’t care about people knowing that I have these issues with anxiety or that sometimes shit overwhelms me, but I do care about losing control. Losing control is not an option. I need to be able to just “crack on”.

An Insight into PMDD aka Today I’m Crazy Because…

Today is day 12 of my cycle, so over the next few days I will be at peak hormone anxiety-ridden mess. To put this into perspective, this is how it’s affected my day so far:

  • I turned down the opportunity to work for a local agency today because I couldn’t face people. My usual day rate is £400, so this isn’t just like turning down the last slice of pizza.
  • I took a phone call from a client, arranged a meeting for tomorrow AM, spent a couple of hours after that panicking that they wouldn’t be happy with the quality of my work (despite being my longest standing client of some 11+ years) and proceeded to hide from a follow up phone call.
  • Noticed another client on twitter chatting to a tangentially related business and convinced myself that they were going to ‘leave me’ for a better alternative. Had a panic attack. Cried.
  • I ate an entire tub of pringles because I had an overwhelming carby salty craving and then convinced myself I was going to be fat forever thanks to my poor diet choices and the meds I recently gave up.
  • Masturbated. 6 times. Thanks, ovulatory libido increase.
  • Got angry at Gaz because he didn’t reply to a text message this afternoon (despite the fact that he is, you know, working) and convinced myself it’s because he doesn’t love me, and goes to work to get away from me. Cried.
  • Had a small glass of prosecco because it was the only thing I could think of that would calm down the anxiety enough for me to function this afternoon. Convinced myself I am an alcoholic that’s going to die of massive liver failure. Cried.
  • Realised I hadn’t thought of suicide ‘properly’ since coming off the meds. Thought about suicide. Cried.
  • Pondered what I did to deserve life throwing so much shit at me (completely ignoring all the pretty cool experiences and stuff I get to do). Cried.

I am unproductive and unpredictable, up and down and anxious. I see no worth in myself or my creations and can’t understand why people like me, let alone love me.

& I’m already having doubts about my choice to drop the meds, instead of increasing the dosage.

I guess I should hurry up and investigate that rabbit hole.

Progesterone, PMDD and a rabbit hole

(Please note this post is more so that I can refer back to important links and notes later on, rather than for you guys. I won’t be offended if you’re not interested or find the whole thing a little TMI…)

I’m currently pre-menstrual and, as with all periods (pun) of pre-menses symptoms, I have sore boobs, massive mood issues and something I’ve never given much thought to before: I have small fluid-filled lumps on my hands. After consulting Dr Google, I have learned that cyclical skin issues such as mine are often related to progesterone intolerance/allergies. Given my previous issues with progesterone (after taking the mini pill, 2014 and Depo Provera side effects, 2008) this wasn’t a surprise.

What was a surprise, however, is that progesterone intolerance and PMDD can be closely linked. Leading me down a rabbit hole of hormone related articles and gynaecological fun facts, I’ve discovered a couple of learned leading gynaecologists (Professor John Studd, Mr Nick Panay) who specialise in PMDD who have experience treating it with hormone therapy: battling the side effects with more of what the body tolerates and less of what it doesn’t.

I’ve also discovered and ended up knee-deep in blog posts by a lady who had a hysterectomy to relieve her PMDD after hormone therapy following a private consult with one of the aforementioned specialists.

My curiousity is piqued. I know that the combined pill does offer small improvement to my symptoms (which lends support to the idea of hormone therapy being of use) as does weight lifting (which is known for its testosterone boost) but I had no idea that all of my issues were specifically linked in with progesterone problems. I don’t particularly want to take pills every day for the rest of my life, hence being sterilised, but neither do I want to put up with mood swings, anxiety, depression, pain and suicidal thoughts that leave me unable to function for three quarters of a month.

I have a lot of reading to do, I think…

Giving in

I went to the doctors a couple of weeks ago and got my referral for sterilisation as mentioned back in January. The doctor tried to give me non-permanent long term contraceptive options but was obviously content that I had done my research and knew what I wanted as he consented to the referral. I can only hope that it continues to be as simple a process when I see the gynae specialist (must make that appointment).

While I was at the doctors we talked again about the debilitating effect the suspected PMDD has on my life: that I am basically inable to function for 2 out of every 4 weeks. I “gave in” and accepted his recommendation of trying fluoxetine (prozac) which has been shown to be effective in several studies, e.g.:

The marked increase in the number of well-designed placebo-controlled studies in the past decade has established several selective serotonin reuptake– inhibiting antidepressants as effective first-line treatments for this disorder. Both continuous dosing and intermittent luteal dosing strategies lead to rapid improvement in symptoms and functioning.

ncbi.nlm.nih.gov/pmc/articles/PMC353031

I say “gave in”, because that’s what it feels like I am doing. Feels like I’m letting it win. Having spent a lifetime stubbornly battling my problems by myself, this feels like a step backwards. Of course it’s not giving in: it’s fighting back. It’s accepting that there are ways to combat the issues I have without driving myself crazy shouldering it alone, or making excuses for myself and my inability to cope.

I’m currently trialling intermittent luteal dosing (second half of my cycle) to see if that helps. The side effects (nausea, loss of appetite, trouble sleeping) are hard going but I feel like they’re starting to pass. I do feel quite zombie-like at the moment, literally spending hours feeling absolutely nothing, but I also have seen a marked improvement in rage responses over the past couple of days. I hope this is *it*, and not a fluke…

Living with PMDD (or why I’m regularly crazy)

I’ve only mentioned once (briefly) before that my doctor thinks I have PMDD. It’s mostly because I’m in denial: I’m a “fixer” and if I have an Actual Thing (with capital letters) then I can’t just fix it. I can take things to help — e.g. the doc wants me on low dose prozac — but I’m probably stuck with it until I go through the menopause. Maybe? I have no idea.

I started experiencing feelings of extreme anger after I had Oliver. I think I may have had post natal depression, or his birth triggered some sort of hormone thing, or something… I don’t know what exactly, but that’s when it all began. (I’m so glad I blog so that I can pinpoint this stuff, you know?)

Counselling helped me to deal with some issues in my life which did seem to help placate some of ANGRY ME’s worst tantrums, so I thought my problems were all ‘mental’. I thought more counselling would fix it, but it didn’t.

I thought I could fix it by changing my diet, changing my pill, changing my exercise levels, changing how much I drink, changing how many people I see, changing my boyfriend, changing my job — changing anything and everything I could to be “normal” again. Blaming anything and everything I can because doing so prevents me from having to accept the reality.

But no matter how much I change, no matter how much I blame, it’s still there. Anxious and emotional during “ovulation” and then easily annoyed, touchy and irrational before menstruation. These happen like clockwork, despite taking the pill. It also happens irrelevant of how many packs I take; I will get angry pre-menstrually in my cycle, even when taking 2 or 3 packs back-to-back so not actually bleeding. (It also happens if I don’t take the pill, so it’s not to blame.)

Some months, I get more ‘normal’ PMS: I get a bit emo for few days, then later on a bit grumpy. Some physical symptoms, nothing major.

Some months, like through August and September, I descend into blackness. Getting out of bed is a massive chore. Dealing with life is overwhelming, frustrating, too much to cope with. I become intolerant of my children, I get paranoid that Gaz is going to leave me, I doubt the friendship of people close. I become reliant on ego-stroking, intimacy and affection just to give me the reassurance I need to get through a day, but the little bubble of love is fragile and doesn’t last: for example, despite thriving on intimacy I have (more than once) broken down during sex because of something ridiculous that I’ve suddenly felt or noticed, or assumed about Gaz’s mood.

And while we’re on the subject of sex: my libido (during both ovulation and pre-menstruation) shoots through the roof. Ho ho ho, Jem wants to get it on. Sounds like an amazing side effect. Except not so much, because I can become literally insatiable: like having an itch that that you can’t quite reach. On one occasion I spent four hours in bed masturbating to try and give me the relief I needed, only to end up more frustrated and more angry because it wasn’t working. I couldn’t satisfy the craving.

As well as the mental symptoms, I get the headaches, tender breasts and cramping (varying from minor to extreme).

I have on, more than one occasion, thought about suicide. Not from a planning to do it or a working out the fastest way point of view, purely on a logical basis: if I did X, then I would no longer feel Y. I would never use it as an answer to my problems; having lost my brother to suicide, I couldn’t put my family and specifically my children through that pain, but that is exactly how low and worthless I’ve felt… that my continuing existence is purely for the benefit of not causing others pain.

On/off crying, low self esteem, indecisiveness, feelings of little or no worth, a deep sadness despite everything being ‘good’ in my world, complete brain fog rendering me unable to concentrate or do anything constructive, uncontrollable anger manifesting in shouting or physical aggression (towards objects not people), passive aggressive behaviours and a lot of feeling useless because I know why these moods are happening and can’t just “snap out” of it. And then like a switch is flicked, I am back to ‘normal’ me for a couple of weeks before the next dip.

One of the hardest parts about accepting that I probably have PMDD, apart from all that fun stuff I’ve already mentioned, is coming to terms with the idea that my hormones are to blame. I am sure most women have had to deal with the PMS stereotype in their lives: that they’re pissed off about something because it’s “that time of the month”. To basically embody that stereotype in a very real way makes me feel vulnerable. It makes me feel like anyone can dismiss me because of “that time of the month”. I feel worthless enough when I’m down, the last thing I need is to have my intelligence, my right to have an opinion, my right to exist questioned because it’s “that time of the month”.

After a prolonged down, yesterday was an OK day. Today I’m ‘normal’ again. I might have a few days, maybe a week before the next dip: it could be a nasty one, or I might not even notice it. One thing’s for sure… it’s definitely not my hormones. I can’t have PMDD. Because that would mean I can’t fix it, and I can fix everything.

Making Baby v2?

If you’re following me on twitter or facepoop you’ve probably seen my recent posts about my new nephew, baby Jack. “Unfortunately” this has thrown an already very broody me into the deep end of omg-another-baby thoughts.

My original plan was to wait until Isabel hit 2 as a minimum. This is a) because I want to meet the WHO recommendations for breastfeeding as a minimum (and many kids wean when mama is pregnant) and b) because the idea of herding two kids under 2 fills me with nightmares.

In addition to those two minor factors, there’s one major thing playing on my mind… hyperemesis.

For new readers, or those forgetful sorts, I suffered from hyperemesis gravidarum during my pregnancy with Isabel. From week 6 until the day I gave birth, I vomited. I would vomit anything up to 8-10 times a day. Bear in mind that one ‘severe hyperemesis’ symptom is described as losing 5% of your pre-pregnancy body weight… well, just to give you an inkling of the kind of effect this had on my body: I lost 21% (and 3 dress sizes in the process).

It’s funny really, when I was pregnant in 2009, someone left this comment on Karl’s blog:

Jem is going to be fat. Muahaha.

Irony was, I was anything but; the day I gave birth, my pre-pregnancy jeans not only FIT but were falling off.

Hyperemesis suffers commonly suffer with each pregnancy, and generally it gets worse each time. The very thought terrifies me to my core. Constant reflux, bright red face from broken blood vessels because of the force of the vomit-retch-vomit cycle, complete inability to eat anything with any semblance of taste. Gah, I don’t know how I got through it, just thinking back right now.

And if I survive the constant stream of bile rapidly exiting my mouth, I get to deal with the incessant questions and suggestions from people: “have you tried ginger?” / “wear sea sickness bands” / “eat before you get out of bed” / “overdose on vitamin b12” / “eat X food at X o’clock whilst hanging upside down” … you get the picture.

And if I get through that, and assuming Isabel DOESN’T wean during pregnancy, I have to balance the weight loss and my nutritional/physical needs with hers. Plenty of mamas nurse through HG but not all of them lose over 40lbs in weight.

But of course, all of this is irrelevant at the minute. Why? Because I’m scheduled for gallbladder removal surgery on November 21st. The removal of on organ which, aside from one attack, has been problem free my entire life. Which isn’t bothering me now. Which might not bother me again. (Can you tell I’m not convinced about this?)

And what about potty training during pregnancy? Co-sleeping with 2? Tandom nursing? Isabel getting jealous? Juggling 2 while I’m on maternity leave? Affording childcare for 2 when I’m not? Work? My next course module in October?

Sigh.