Co-Existing with PMDD

I didn’t notice the pattern until about a year into the pandemic. There were a ton of other reasons that explained how I was feeling. I already had a diagnosis of complex post-traumatic stress disorder (CPTSD) to explain away the feelings of anxiety and depression. Also, who didn’t have difficulty concentrating and falling asleep during lockdown? But there was one problem I couldn’t quite figure out:

Why did I have this almost compulsive desire to self-destruct every two weeks?

Whether it was through excess drinking, bringing conflict into my relationships, or seriously considering bizarre career changes, some inner demon in me seemed to take over half of the month before I magically returned to normal. As you can imagine, these behaviors aren’t ideal for sustaining a career, running a business, or keeping personal relationships intact. I initially thought I had ADHD or bipolar disorder. However, it turns out my menstrual cycle is to blame.

Welcome to the wild, wild world of premenstrual dysphoric disorder (PMDD).

What is PMDD?

The International Association for Premenstrual Disorders (IAPMD) describes PMDD as a “cyclical, hormone-based mood disorder” that occurs when a person’s brain has a “severe negative reaction” to normal changes in progesterone and estrogen that occur during the menstrual cycle. In practice, this means people with PMDD feel pretty healthy during the follicular phase (1-14 days before their periods) and like all hell has broken loose during the luteal phase (15-28 days before their periods). Then, everything returns to normal once our periods show up. It’s about as fun as it sounds.

Since there are no blood, saliva, or imaging tests for PMDD (because of course there aren’t), those who suspect they have the disorder track their symptoms for two months to see if they follow the pattern I described above. At least one of the following symptoms must appear during the luteal phase:

• Irritability and anger
• Mood changes
• Increased likelihood of conflict with other people
• Depression
• Anxiety

Other symptoms can include brain fog, fatigue, feeling overwhelmed or out of control, weight gain, impulsivity, and sleep problems. Also, people with PMDD are at higher risk for suicidal ideation and suicidal behavior. A 2022 study in BMC Psychiatry showed that 72% of participants with PMDD experienced suicidal thoughts, 40% had a suicide plan, and 34% made an active attempt to end their lives.

I hope you see that PMDD isn’t just a bad case of PMS. It’s a disorder that can seriously damage people’s lives and the lives of those around them. Still, we have to participate in society like everyone else, even though society is barely willing to talk about periods, let alone the physical and emotional symptoms that can come along with them.

Living and working with PMDD

After learning about PMDD and tracking my cycle, I realized I had almost every single symptom during my luteal phase, and nearly all of them disappeared once my period arrived. I also learned that I was at higher risk for PMDD due to a history of emotional abuse and neglect, which helped the diagnosis make sense. Still, I received the diagnosis with a mix of relief and anxiety. How was I supposed to manage the challenges of having relational trauma, battle my inner luteal demon two weeks per month, and run a business at the same time? Who has that kind of time?

Since there is no cure for PMDD or CPTSD, I’ve had to make some changes in my professional and personal life to make it all work. In addition to therapy and medication, here are the steps I’ve taken to manage my life and business with these disorders.

Frontloading

Frontloading is a new thing I’m trying, and it seems to be working out so far. I use a blank monthly desk calendar to assign myself work-related tasks based on my cycle. Tasks that involve a lot of thinking and concentration, like blogging or writing proposals, are assigned to the follicular phase of my cycle. Tasks that require a little less brainpower, like desk research or quick website updates, get assigned to the luteal phase.

Of course, I don’t always have control over all my deadlines. Work is due when it’s due, and I always prioritize keeping big projects on track. But for the tasks I have more control over, it’s been a real game changer to think about them in accordance with my body’s calendar instead of a standard calendar.

Spooning wisely

In the chronic illness community, sometimes people will talk about being low on “spoons.” A spoon is essentially a measure of energy. For instance, if you spent most of your spoons on getting your kids ready for school, commuting, and running two meetings by noon, chances are you’ll barely have enough energy to make it through the rest of the day.

I’ve got about half as many spoons during luteal compared to my follicular phase, so I try to use them wisely. I know that I tend to have more energy in the mornings, so if I have to have meetings, I schedule them before noon as often as possible. Since my spoons are generally gone after 2 PM, I’ll try to reserve that time for quieter, more low-key tasks. Again, I can’t do this all the time, but it’s another example of working with my body’s calendar instead of forcing it to align with everyone else’s schedule.

Weightlifting

About two years ago, I joined a powerlifting gym. At that point, I had never touched a barbell, but I was inspired to give it a shot after watching an episode of Queer Eye that followed a trans powerlifter. Now, I can squat 200bs and deadlift 265lbs (my bench press is sad, so we will not be discussing it here!).

Exercise is recommended for PMDD management, though there is not a ton of evidence supporting this claim. And to be honest with you, I have no idea if weightlifting is helping alleviate my symptoms. What I can tell you, though, is that lifting heavy weights even when you’re feeling awful is a great ego boost. And during luteal, when my self-esteem is in the garbage, I will take any ego boost I can get!

Rest

Rest has been an essential part of accepting that PMDD is going to be a part of my life for the foreseeable future. I used to power through at work in my younger years, even if I was nodding off at my desk. I didn’t want my colleagues to see me as less capable or less committed, even though it was becoming physically challenging for me to show up every day.

Now, at 40 years old and with more flexibility in my schedule, I can schedule time to take breaks or even close my eyes for 30 minutes if needed. I still have a lot of room for improvement on this front. However, I am much better at acknowledging and accepting my changing capacity than I used to be.

There are many privileges wrapped up in being able to work for myself and having this kind of control over my time. Still, I’ve had to learn how to work with my PMDD instead of trying to fight it all the time. When I don’t listen to my body and push myself too hard, I’m setting myself up to fall apart. It’s in my best interest, and in the interest of those around me, to take care of myself as best as I can, no matter what it throws my way.