Yesterday’s visit to the reproductive endocrinologist went just fine. He evaluated symptoms, checked my labs, and levied his diagnosis: yes on PMDD, no on PCOS.
Despite my polycystic ovaries, there’s plenty of evidence of regular ovulation, and my labs don’t suggest hyperandrogenism – all my hormone levels fall within the normal range, and apparently physical symptoms don’t matter if the bloodwork adds up to normal. OK, fine.
So, if I can’t blame the monthly crazies on PCOS, then what? Apparently it’s PMDD. Yeah. Like “PMS on Crack” or however you want to describe it – yet another condition that has zero street cred and that people won’t “believe in” or will see as an excuse. While it’s really awesome that my doc happens to have done some serious research on PMDD, I wasn’t at all happy to hear the bottom line.
It’s all about stress.
In their research, all of the women in both PMDD and unaffected control groups had the same levels of progesterone and B vitamins, previously thought causal. They all experienced a drop in serotonin levels as hormones shifted, so in all the endocrinological respects, they were pretty much the same – everyone equally at risk. When the researchers turned to look at lifestyle for explanation, stress was the single triggering factor.
So that’s the #1 prescription: find ways to reduce stress.
I smiled and nodded, I listened as well as I could. But at that point, I felt more hopeless and helpless than ever. Reduce stress. I have already cut my work hours to the quick, so much so that I’m constantly wracked by guilt and shame. I’m in DBT, individual therapy, and I’m doing yoga classes. Next on my list when I finish DBT is a Mindfulness-based Stress Reduction class. All this, and I’m still way too stressed. I also have a lot of structural stress to look forward to in the next few years. The implications are huge. But I’ll get to that.
Besides reducing stress levels, there’s very little else I can do. I’m switching birth control pills to something that is supposed to have a longer release effect (the stupidly-named Yaz, sold under the stupid generic name Loryna). I’m not going the SSRI route again, so that’s completely out. The doc suggested trying ibuprofen instead of naproxen for cramps. I kinda couldn’t believe my ears, but prior experience has shown that if that was the opening suggestion, discussing the matter further was unlikely to produce more satisfactory results.
The question that won’t leave my mind is, of course, is the PMDD severe enough to be presenting as bipolar disorder? It’s funny how much that does and doesn’t matter to me at turns. Right now we’re working on acceptance in DBT, and the timing of all this is just so ironic in that respect. I’m really trying.
But now I’m mourning the loss of one last potential simple alternate explanation for my mental state. I’m mourning the addition of another Dx that brings with it few answers, but more questions. Yesterday I started crying just thinking about the repercussions for my life, my best-laid plans, and knew that I can’t really face it yet. I’ll mourn the rest of it tomorrow. After all, tomorrow is another day.
DeeDee, with all due respect. . . Your doctor is full of shit. PMDD is not “all about stress”. I would say, “Trust me, I know from experience,” but we all know that I’m a complete nut job. My mom, however, who is completely mentally healthy, and one of the calmest, most patient women ever — arguably more so before menopause (because of different roles she’s taken on at work and, oh yeah, her daughter went nuts) — used to get scary PMDD. Even my father was clued in enough to make sure and stay out of her way.
She lived most of her reproductive years as a homemaker, taking care of my sister and me. And setting aside the obvious pheromone junk that happened when my sister and then I started getting our periods, nothing, but nothing changed in that woman’s life right before her period every month to stress her out more than normal. She was calm, understanding, and patient for most of the month. And then she would snap and yell and cry, and once she even kicked a hole in one of our doors!
I say just because what they thought caused it from an endocrinology standpoint turned out to be wrong, doesn’t mean there aren’t millions of other things in our bodies that couldn’t be causing it.
Oh, and wait. Did they follow all of these women in the studies across all of their reproductive years? Because life circumstances change, stressors change, yet PMDD remains constant. I call shenanigans!
Sorry for the semi-rant. This hits home for me, obviously, but honestly I’m more upset for you. My doctors say PMDD is legit and feed me lots of pills for it. Well, okay, the pill thing is currently in flux, but you get my point.
And okay, I know you know this, but you know I have to say it to you anyway. The more you fret about trying to reduce stress, the more you’re going to stress yourself out.
As for the bipolar potentially not being bipolar, but PMDD, it’s worth investigating. I think the major factor you have to monitor — and sorry, this is another fairly obvious thing that I just have to mention — is your moods across the month. PMDD is time-limited, bipolar is anytime at all.
So now I’ve written you this long letter. . .
Anyway, sending you loves. I have to email you. That may or may not happen today, but maybe if I write it here I’ll magically accomplish it!
Thanks, dear – really. I realized my doc was giving me a rather old and tired line with what he was prescribing as course of treatment once I had a chance to start looking up PMDD and its treatments.
But in any case, assuming it’s an accurate diagnosis, and it does seem to be, it just means that we’ll control symptoms as well as possible but I’ll probably continue to have nasty mental spasms every damn month and the resultant nonfunctionality. That’s a little hard to swallow.
Yeah, I will have to see if I can figure anything out from the mood charts. The PMDD cyclic effects tend to get in the way of seeing what else is going on. But offhand, there’s plenty of variability not accounted for by monthly cycles.
Hey, don’t condemn yourself to those “nasty mental spasms” straightaway. And don’t let any doctor do it, either! When I was still on my old med regimen, I upped my meds about nine days before my period was due, and I can’t even tell you. . . I still was a little more sensitive and reactive, but most months I actually functioned wonderfully well no matter where I was in my cycle. And I was a homicidal manic/train wreck/unholy mess of a girl before I figured it out. As I am now again.
I know you’ve tried a lot of things already, and I know that you are so unbelievably tired, right now it probably almost feels preferable to live with it than try more medications, and more. . . But I promise you there is something out there to make it better for you. There is, trust me. xo
I’m hopeful that switching pills and working on whatever other strategies we can think of might help. It’s just discouraging to see SSRI’s as first line, and know that I can’t go that route.
The drospirenone in the Yaz pills has some mild anti-adrogen effects, which I expect will help with lots of little nuisances. I hope it returns my cycle to normal too, but I could be waiting months for that – extremely frustrating in itself. I’m sick of constant cramps and spotting. And I’ve seen a variety of testimonials to Yaz as a life-changing thing for some people with PMDD, so I know, it’s not hopeless. It just feels that way – not that much positive reinforcement lately, you know?
It also makes me mad/resentful/willful that my body forces me to be all uber-holier-than-though in terms of healthy lifestyle just to function at the most basic level, yet so many other people seem to be able to abuse their bodies with minimal effect. It takes so much work and time to do all the lifestyle intervention crap that everyone expects me to do – without compromising any of my other responsibilities.
But it doesn’t work that way. Realistically, I just don’t think I can do the kind of academic job I’ve been targeting if I need to be as constantly proactive about wellness management as it is beginning to appear. It’s been like a second job for a couple years now, and I can’t have a second job if I’m going to play professor.
I’m starting to try to make a more honest evaluation of my limitations and what that realistically means for my future – but oh, how it burns! And the colossal uncertainty just constantly stabs me. It’s not fun.