Most people who know me don’t even know what PMDD is. It affects up to 8% of women, but its association with menstruation has made it inappropriate to discuss in polite company. A diagnosis of PMDD requires the presence of at least five of the following symptoms during the luteal phase of the menstrual cycle, usually during the two days preceding and the first day of menstruation:
- Feelings of sadness or despair, or even thoughts of suicide
- Feelings of tension or anxiety
- Panic attacks
- Mood swings or frequent crying
- Lasting irritability or anger that affects other people
- Lack of interest in daily activities and relationships
- Trouble thinking or focusing
- Tiredness or low energy
- Food cravings or binge eating
- Trouble sleeping
- Feeling out of control
I was diagnosed during my junior year of college, while I was going through the worst period of depression in my life. At the time, I thought these symptoms were just indicative of the fact that I was a worthless human being. Then my shrink had me read a book about PMDD. The symptoms can still be debilitating (I experience all ten at varying levels) but it was incredibly helpful to be able to separate my disorder from my personality.
When I have trouble controlling my symptoms, the rest of the world sees me as petulant, indecisive, withdrawn, picky. In the dysphoric universe inside my head, decisions are looming obstacles, heavy with the weight of dozens of pros and cons and negative outcomes. Because of the sedative effects of progesterone, my energy level drops to 50-75% of that of a normal day.
Additionally, the depression caused by PMDD turns every thought into a criticism. Without constant reminders that I would not put up with those same unreasonable and hurtful criticisms from a friend, I begin to lose my sense of agency. The fatigue and the feeling that I cannot act, that my actions are meaningless, leads me to disregard normal bodily maintenance, which perpetuates my lack of self worth.
I get a lot of other fun PMS symptoms, too, like severe acne (I’m 26 for shit’s sake), and cramps that feel like a red-hot ball of lead is inside my uterus, and gross gastrointestinal issues. Those are just “regular PMS,” the scourge we’re just supposed to grin and bear as penance for our curiosity.
These are things I do not and cannot talk about. It’s perfectly fine to tell a customer that you just got over a cold, but not that you’re feeling much better now that your PMDD is letting up. It must not be mentioned even when its effects on your day-to-day life are devastating, the way mine are some months.
So when someone who has never menstruated tells me what a piece of cake it is, it shows me that they don’t make much of an effort to empathize. They tell us we’re not allowed to talk about it, then make gross dismissals of our suffering based on their own fabrications.