Ten months ago, I started taking a birth control pill. After being on the pill for two months, I wrote this article about my experience with PMDD. At the end of it, I said that I would report back. In this piece, I will be sharing my experiences and thoughts about how the pill has affected my periods and PMDD over the recent months.
What is PMDD?
As a refresher, PMDD is short for Premenstrual Dysphoric Disorder. The most common symptoms are depression, irritability, irrational anger, moodiness, insomnia, paranoia, and panic. Sometimes physical symptoms occur as well. Examples are severe cramps, extra fluid retention, vision changes, and infections. Only about six percent of menstruating people have PMDD. Therefore, not much research exists. However, PMDD can be a debilitating problem. Although the symptoms above sound like the symptoms of any period, PMDD can make them feel much more severe. From suicidal ideation to fainting, PMDD can make periods- and life- tough to manage.
Research on PMDD
Due to limited research, PMDD can often be misdiagnosed as bipolar disorder. The cause of PMDD is still unknown. Research suggests that “it may be an abnormal reaction to normal hormone changes that happen with each menstrual cycle” (Premenstrual Dysphoric Disorder (PMDD)). One theory is that this hormone change negatively affects serotonin levels. A decrease in serotonin is a very probable reason for the adverse mental and physical effects of PMDD.
How PMDD is disruptive
My first article, “Premenstrual Dysphoric Disorder: PMDDiaries #1” delves deeper into my experiences with PMDD prior to being diagnosed. To summarize, PMDD was very disruptive to my life because the symptoms do not only occur during the time span of having your period. The symptoms can begin days, or even weeks before you get your period. For me, I would experience extreme mood swings and depression about a week before my period. I would feel lethargic and find it difficult to do much but sleep. A few days before I got my period, I would not be able to sleep for days and would experience a burst of energy. A burst of energy sounds like a positive thing. But it tended to manifest as restless anxiety, paranoia, impulsivity, and foggy thoughts from lack of sleep.
Overall, I would feel what the PMDD community refers to as “brain fog.” During these periods of brain fog, I struggled to concentrate, and separate reality from my dreams or anxious thoughts. When that line of rational thinking starts to blur, it can be difficult to make the best decisions and to take care of yourself.
On top of that, once my period actually started, my cramps were unbearable. I threw up often and passed out. I was uncomfortable in any position, and constantly felt stabbing pains and overbearing nausea. When I first got my period, I used Tylenol to ease my cramps. When even four Extra Strength Tylenol couldn’t soothe the pain, I tried Advil, Ibuprofen, Aleve, and Midol. Over the years, I basically developed an immunity to all. Hot packs, and certain teas and foods, alleviated the pain slightly, but the mix of this much physical pain with an unclear, fatigued mind was too much.
My PMDD timeline
I would be very fatigued and depressed the week before my period. It was disruptive to my productivity in school or work. It also meant a week or more went by every month where my living space fell into disrepair. Lethargic and feeling bad about myself, I ate and did little. The pain during my period meant I missed more school and personal events. I was always slipping behind, and I would spend the rest of the month catching up. It was exhausting. Every month, I had to reorganize my life. After my period, I would spread myself thin, catching up on work I missed and social connections. I had to keep readjusting to having a healthy routine. Having to rebuild those habits every few weeks, missing exercise, socializing, hobbies, and just getting sun, then trying to make up for the missed weeks, feels more and more impossible each month.
Ultimately, I felt like my months were slipping away. I was either in pain or sleeping my days away, then scrambling to get my days back in order. Always on edge, I felt like I was losing control of my decisions and missing out on life. I felt like I had no power over this pain, over my emotions. All I could do was try to ride it out, every time, forever. Thinking about that itself sometimes made me feel like everything was pointless. It even scared me at times, when I felt like I couldn’t think clearly. The anxiety made me feel so irrational. PMDD can cause suicidal ideation and impulsive behavior. Sometimes, my brain would feel so fuzzy, I couldn’t think through my anxious, paranoid thoughts, affecting my mood or behavior. It made me irritable and overly emotional.
Diagnosis of PMDD
Because I have other diagnosed mental health problems, I was told that the above problems just were part of those. Doctors would tell me that periods are just painful for all people who menstruate, and there isn’t much to do. Only years later, after more research came out, did my new doctor give me an explanation. She said that though all periods are rough in general, if they are in the extreme range, you potentially have PMS, PMDD, PCOS, endometriosis, adenomyosis, PID, or fibroids. It is a misconception that periods need to be so insufferable.
I had the copper IUD for a long time and I was happy with a non-hormonal contraceptive. I also felt like my mental health was genuinely getting better, and that my psych meds were working. Gradually, I realized that these extreme depressions and pain only happened around my period. I was able to separate the symptoms of this from my other mental health problems. This helped my doctor diagnose me with PMDD. She recommended that I switch to the hormonal birth control pill. She said that the pill would regulate my periods and decrease the pain, which itself would improve many other symptoms. Sometimes the pain is so blinding, you can’t think straight! The hormonal pills also help regulate your hormones so they don’t swing so out of whack during periods.
The pill and PMDD
Now I have been on the pill for ten months and I do see a difference. Some parts are confusing, and I’m still figuring it out. For example, most months on the pill, I got my period, but it came late. That can be frustrating because you don’t know if the pill is working or not! This month, I didn’t really get a period at all, but that is apparently normal. The months I had periods on the pill were significantly better than before. Yes, it was still uncomfortable, yes, I still experienced some cramps and some moodiness. But it felt like a “normal” period. I might be a bit cranky or have a few cramps, but I don’t feel so powerless over my emotions. I might need to take extra rest, as anyone should on their period. But I am still able to be mostly productive, happy, and consistent.
Where I’m at now
I’m still kind of in the experiment stage, since I’m figuring out how periods really work with this particular pill. Overall though, I feel so much better and I’m happy I made this decision. I have so much more energy and my head feels clearer. Even on bad days, my ability to use my coping mechanisms, distract myself, or talk myself through disruptive thoughts is much better because I’m not clouded with exhaustion and pain. It is incredible how much the simple things matter: being able to sleep well, having an appetite, having the energy to exercise, maintain a good routine, and socialize. Even smaller things, like just getting some air and sunlight are so hard with PMDD. But it makes a world of difference.
These things in hindsight sound so easy. But when you can’t get up because pain and depression are weighing you down, these things fall to the wayside. The pain and negative self-image made it hard for me to eat, which only worsens any health problem. Hormonal imbalances cause intense bouts of self-doubt, anxiety, and paranoia. It feels like it’s not worth it to take care of yourself. It feels too hard and that can lead to relying on “easier,” but potentially bad habits. That cycle is easy to get stuck in. I felt bad for a long time because I thought I was just being lazy or careless. Sometimes when I think back, I still get that feeling because now I feel much better and memories fade. But it really helps to know that I was doing my best while dealing with a very real problem.
The power of hormones
Hormonal problems are no joke. They can really ruin your physical and mental health. Since they’re something I can’t see, I minimize it in my head sometimes. It’s hard to imagine that these invisible things are disrupting my thinking and body so much. When you don’t even know if you can trust yourself, it’s scary. It’s hard to remember that you’re not a bad person. It’s a chemical problem. It needs care and patience and rest, like any other health problem. The fact that it occurs on some weeks, and doesn’t on others, does not help. That inconsistency really throws you off and makes it hard to remember what reality and feeling like “your normal self” is. It feels similar to coming to terms with learning you have any other mental health disorder. Having PMDD sometimes feels like a flaw in me.
I’ve even had the thought, “what if the organic, natural me, is a bad person or broken, and that’s why I need the medication. I can only be a productive member of society and people will only like me when I take this.” That kind of thinking gave me a sort of impostor syndrome type of feeling. I felt like Jekyll and Mr. Hyde. During these times, I remind myself of who I am and what I am like even without medication when I’m not having a period or hormonal problem.
I’m learning to be less hard on myself. I’ve had bouts of irrational behavior or thoughts from PMDD that make me feel so bad when I reflect on them. But I also know that I am not a bad person. I am working on fixing the symptoms. I am fully capable of taking care of myself. And I know that I can enjoy life and take rest as needed. I remind myself that it is not a weakness to have a hormonal problem. It doesn’t make me a different person. Regulating my hormones will only improve the quality of my life.
So far, taking the pill has been a good experience. I mentioned some confusion that I am having above. I am going to continue taking the pill and see what happens. The pill has helped, as has simply having a name to the problem. After knowing what I had, I have been able to talk to others who have PMDD. That has made me feel less like PMDD is a fault. I met people who experienced the same terrifying feelings of imbalance, whether it was PMDD or another hormonal issue. It helped so much to know that others have felt that intense loss of control and lack of motivation, simply due to hormonal imbalance! I know now that it doesn’t mean you don’t have enough discipline or strength. It’s you against your biology.
At the beginning of this article, I mentioned that vision change is a symptom of PMDD. I have talked to people with PMDD who have had hallucinations when their hormones caused such intense anxiety and paranoia. Knowing this also helped me feel like it wasn’t a weakness that sometimes I felt like I couldn’t think straight, say the right thing, or was looking at things wrong. I just had hormones that were going all over the place and there is something I can do about it.
Other than the pill, I’ve been practicing a lot of mindfulness. Staying grounded and in the present is the best skill I can have to fight against the mental symptoms of PMDD. Practicing just sitting still and letting thoughts go by, but not suck me in, is something I also am learning to do to keep my mind strong against fearful thoughts. Having a good routine, drinking water, exercising and keeping a clean space all help me declutter my mind. But doing all of this is so much easier and less daunting when supplemented by the pill for me.
I do hope more research will be done on PMDD and other menstruation-related problems. PMDD and other hormonal problems can feel very isolating and scary because there isn’t as much information about them. Until then, stay posted for PMDDiaries #3! It will be a year of being on the pill soon. I will reflect on the degree and consistency of emotional balance, reduction in physical pain, and regularity of periods.
“Premenstrual Dysphoric Disorder (PMDD).” Premenstrual Dysphoric Disorder (PMDD) Facebook, Johns Hopkins