MORE THAN JUST PMS

Posted: August 3, 2016

It's important for people of all genders, those who were born biologically male included, to understand premenstrual syndrome (PMS) and pre-menstrual dysphoric disorder (PMDD), as it can explain seemingly confusing sudden changes in people with:

mood disorders
food-related struggles
chronic illness
physical pain
anxiety

This is also particularly true in highly sensitive people (HSPs), as sensitivity increases significantly for people with PMDD at this point in the menstrual cycle. If you believe you or a loved one has PMDD, you may need professional help in processing and coping with this challenge. It can be very hard to determine which of your difficulties are connected to PMS or PMDD vs. personality- or relationship-based without a more neutral third party's perspective.

(In an effort to include biologically female individuals with all gender identities - agender, male-identified, female-identified, etc., I use the pronouns "their" and "them" throughout this article to describe anyone with a menstrual cycle.)

PMS occurs for most biologically female individuals old enough to reproduce. It consists of a series of unpleasant physical and emotional symptoms that occur for a few days between ovulation and the beginning of menstruation. People usually begin to feel relief from these symptoms during the first couple days of their period. The changes are related to hormone shifts during this time, specifically a drop in estrogen and progesterone levels. The Mayo Clinic describes the following mild to moderate symptoms as typical of PMS:

bloating, water retention, and related weight gain
headaches
irritability
increased appetite and cravings
anxiety
depression
acne
fatigue
joint and muscle pain
insomnia
social isolation
uncontrollable crying

On the other hand, pre-menstrual dysphoric disorder (PMDD) is basically PMS on steroids! Dysphoria is another term for a moderate-level sense of uneasiness, discontentment, and general low mood.

PMDD usually involves severe versions of the above symptoms, in addition to much more extreme relational and emotional experiences. People with PMDD are completely bowled over by their PMS. PMDD is likely the way PMS manifests in biologically female highly sensitive people. On top of the usual PMS symptoms, which are generally not-fun-yet-manageable, they also struggle with PMS-related:

major conflict and disruptions in relationships
self-harm, such as cutting or feeling suicidal
panic attacks
debilitating fatigue
incredibly painful cramps

There isn't a lot of helpful information available on exactly why some people get PMDD vs. "only" PMS, but according to the National Center for Biotechnology Information website, approximately 3-8% of biological female people of reproductive age have PMDD.

Be prepared

Keeping track of your menstrual cycle is incredibly revealing for most people with PMDD because

You can gain insight into the reasons you may suddenly feel terrible without any obvious life changes.
Tracking your cycle provides you with an opportunity to plan for the next one (whether counting down the days yourself or your app shows you ahead of time). This allows you to add some extra self-care or downtime when you need it.
You'll see connections between your eating habits, weight, mood, and productivity levels at different points in your cycle.
Your doctor will have valuable information regarding timing, intensity, and severity of your physical cycles and distress. This data will help them make more educated decisions about your treatment.

Using an app on a smartphone or computer is a terrific way to get started. Or you can just mark it on a written calendar if you prefer. These apps allow you to track changes in mood, appetite, energy, weight, and more. Some reputable* apps to try are:

Clue
iCycleBeads
Spot On

I have most of my biologically female clients track this and I hear the following repeated time after time: "You mean I'm not actually crazy?" Even if your cycle is not regular, tracking your changes helps you to build mindfulness (non-judgmental self-awareness) along the way.

It's such a joy to see that transition, to watch someone move from feeling completely out of control and confused to understanding why they feel slammed with a tidal wave of turmoil every few weeks.

What helps?

There are many ways one can cope with PMDD. If you are in a relationship of any kind with someone who suffers from this ailment, do your best to:

Give them as much leeway as possible during this time of the month. It's not easy to remember the role hormones play in conflict, but try to keep it in mind as much as you can. Remember that they may feel better when these few days pass and wait it out.
Discuss with your loved one the ways they would like to be reminded or talked to if you believe their PMDD is contributing to conflict or self-loathing. Set up a plan to address this struggle at a time when they're feeling better, NOT the few days before menses begin.
Spend a few hours apart if one or both of you are feeling irritable. It's ok to ask for space and a lot of people want to be alone when they're menstruating, anyway.
Find out if they need extra reassurance or affection during this period and give it to them. It's just as important to openly let them know what you need, too!

If you suffer with PMDD, try this:

Using your chosen tracking system, track the worst days of the month for a couple of months and use this data to anticipate the approximate dates that might be difficult next time. Talk with your loved ones before you start feeling bad, reminding them that you will likely be more vulnerable or sensitive.
Decide what you need (space, affection, reassurance, quiet time) from yourself and safe, loving others and ask for it.
Take extra space from people who don't feel safe.
Use this time as an opportunity to practice self-compassion. Allow yourself extra rest and flexibility. If you can, wait to work on important or stressful projects after the worst few days is over.
Talk to your healthcare professional about medical treatments -- herbal, pharmaceutical, homeopathic or otherwise -- that can alleviate the symptoms. There are many false claims out there, so make sure to consult with an expert on this topic.

PMS/PMDD is not:

PMS is an explanation for an often disorienting series of internal states, not an excuse for bad behavior. It does not to give permission for people with PMS or PMDD to lash out and ignore others' feelings or to stay home from work for a whole week every month.

Nor is PMS or PMDD a reason to discount someone's feelings. Even though their mood changes might be more intense than normal, your loved one's thoughts and feelings are still important. Never tell someone they're only acting a certain way because of the "time of the month" or any variation thereof. I promise you will regret it and it will damage your relationship.

Become friends with your menstrual cycle

That might seem like a weird suggestion, but notice your reaction before and after reading the following article from LONERWOLF, "a community of people who thinks differently and lives differently." I highly recommend it to anyone mentally fighting with or resenting their menstrual cycle.

Their take on the topic views the menstrual cycle as a natural part of a biologically female person's life. They recommend embracing your period as a way to understand and honor your body's needs, respecting nuanced physical transitions each month. Did you relax at all after hearing it framed that way? Doesn't it feel nicer to see it as a remarkable feat accomplished by the female reproductive system, something sacred to honor?

You don't need to do it alone

Many people with PMDD need professional help, as it manifests in harmful behaviors and relationship problems. If you or a loved one are seeking help with this struggle, reach out today. You can contact me here or send a message using the "I'm Ready" button at the top of this page.

*I do not have a vested interest in any of these apps, and simply recommend them based on my own experience with them and recommendations from others who have.