PMDD and Perimenopause - a match made in heaven*
*No, really. It's amazing.
Warning: contains blood🩸
I’m talking to my patient when I feel it: something inside me has given way. It feels like something was stuck, the pressure built, and suddenly it’s come free and is pouring out of me. I glance down to make sure that I’m wearing dark pants, which thankfully I am. Wearing light-coloured pants has become a high risk gamble these days, and I’ve never been much of a gambler. I finish with my patient as quickly as I can and then beeline to the bathroom. Sure enough, my long-awaited period has arrived, with bells on. I speed-dial my husband and ask him to bring me a fresh pair of undies to work, STAT. “I bled through my underwear,” I tell him, still amazed that this happened. This is a first in my 30 years of having a period.
My periods used to be as regular as clockwork. Every 28 days I would get up for my morning pee, and there it would be, having politely waited all night until a receptacle was there to catch it. I didn’t have accidents, didn’t have unexpected visits from Aunt Flo, and I knew precisely how many sanitary products I would need for the 5 days it would last - never longer, never shorter. That changed about two years ago when perimenopause knocked on my door. These days it’s a guessing game, with the length, frequency, and heaviness of my cycle varying wildly. There have been a few cycles so bloody that even Dexter, the blood spatter expert and serial killer, would feel queasy.
Perimenopause also brought some other questionable gifts: absentmindedness and forgetfulness; pimples that are fighting for space with the thick, black, single hairs that are sprouting faster and faster on my chin; having difficulty reading the fine print on anything, which means reading glasses and bifocals are in my immediate future; and a sudden, noticable drop in skin elasticity that makes my whole face crease into folds like an accordion when I smile.
However, I take all these inconveniences gratefully and with a smile for the truly tremendous gift perimenopause also brought: she’s taken the sting out of PMDD, premenstrual dysphoric disorder, the medical condition that used to make my life hell. On day 21 of every cycle all hell would break loose, unleashing a tornado of misery in my life and the lives of my nearest and dearest.
PMDD is a much more severe form of the often joked about PMS, premenstrual syndrome. PMS shouldn’t be treated so dismissively either, because mood swings, fatigue, insomnia, headaches, cravings, bloating, joint and muscle pain, and breast tenderness are no laughing matter. It could be argued that it would be taken much more seriously if it would affect 100% of the population, not just 50%. I sometimes imagine men having to go through periods, and how they would brag to and compete with each other about whose period was the bloodiest. No whispering about it behind closed doors, pretending to the world that nothing was wrong; it would be talked about loudly and proudly, sanitary products would be available for free everywhere, and saying “I’m PMS-ing” would be accepted as the legitimate medical syndrome it is instead of being ridiculed.
While PMS is no picnic, PMDD is much, much worse. It’s like an evil force that takes over your body, mind, and soul, taking all the control away from you. You are helplessly at its mercy, and let me tell you, PMDD is a cruel taskmaster.
The worst for me was the anger. A massive wave of rage and fury would engulf me, replacing all reason and levelheadedness with anger, even hatred. I was furious with everything and everyone, but most of all with the people I love. PMDD was like the devil on my shoulder, filling my head with toxic lies that were disguised as truths. The devil would convince me that I had it all wrong before, that my husband didn’t actually love me and wanted the best for me; that people weren’t good and decent; that my life wasn’t a good life. It felt like I was seeing the ugly, horrible truth for the first time, that the world really was a dumpsterfire, and what was the point of going on?
That’s when depression would enter the stage. How can you not get depressed when you think you’ve just seen your life for what it truly is, and it’s all terrible? Depression brought her friend hopelessness along, and if you don’t have hope, you have nothing.
PMDD has a terrible power. It ruins careers and wrecks job prospects. It makes people smash their art, tear up their writings, sabotage their ambitions. But maybe worst of all, it destroys partnerships, friendships, bonds with siblings and parents. How could it not when its power to convince you that the people in your life are shit is so great? PMDD tells you that you’re better off alone, or better yet - that you’re better off dead. After all, if you’re friendless and partnerless, why wouldn’t you want to shuffle off this mortal coil?
I’ve shown you the dark, now let’s move on to the light. Yes, there is light! I wouldn’t leave you hanging in hopelessness and despair.
All those terrible symptoms I just described above? They come with an expiration date. As soon as your period arrives the symptoms disappear, washed away by the blood, if you will. It feels like waking up from a bad dream (or a bad hangover), and suddenly you can’t remember what all the fuss was about. Of course your husband loves you! Your friends aren’t selfish bitches! Life is actually pretty damn great!
The trick is to recognize PMDD for what it is when the symptoms arrive, and to remember that she is lying to you. Easier said than done, I know; but with practice it becomes doable, at least some of the time.
The other good news? I don’t know if you noticed, but I used past tense when I described my experience. As in, the worst for me was the anger, not is. Because thanks to perimenopause, my beautiful, amazing, life-saving friend, PMDD and I aren’t close anymore. It’s like they’re cancelling each other out, mood-wise, and isn’t that the best news ever?!
The mood swings I’ve heard so much about that often accompany perimenopause haven’t shown up for me. On the contrary, the catastrophic mood swings I had thanks to PMDD are also fading more and more into the background!
While I’m firmly in perimenopause, I’ve also made several other lifestyle changes that probably contributed to my much improved relationship with PMDD:
Regular therapy
Becoming alcohol-free (773 days today)
Moving my body daily
Focusing on my breath and meditation
Making rest a priority
Leaning into my authenticity
Nurturing my creative side
Checking in with myself (how do I feel? what is bothering me? what do I need?)
It’s impossible to say what helped the most; I suspect it’s a combination of all of the above.
I hope this letter brings you a ray of hope, especially if you’re a woman suffering from PMDD, or someone who’s worried about perimenopause and menopause.
It’s a change for sure; but it’s not a bad change. Our society wants us to fear aging and the bodily changes that come with it, but we don’t have to.
I choose to observe the changes that are happening with compassionate curiosity instead of judgment; as something fascinating instead of something that I need to despair over. And best of all: it has brought me the gift of reprieve (maybe a permanent one?) from PMDD.
Perimenopause - you’re alright.
❤️ Miriam
What is your experience with perimenopause, menopause, or PMDD? Share in the comments!
Totally agree with you ❤️