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.