• Expert By Experience

A Mental Illness That Affects Me Because I Have Periods

Written by Natasha Abramson

“One of the things that I find really hard is making people who are very close to me understand what I'm going through, they often don't know what will make me feel better. And, I don't blame them. Neither do I.”

24-year old Kritika Narula, from Delhi, India, didn’t know something was wrong until she started seeing a therapist. In her quote she was referring to PMDD. PMDD is a disorder which is not very well known yet. Premenstrual dysphoric disorder (PMDD) is a condition which can affect any woman who menstruates. PMDD can also affect trans-men.

Medically speaking Premenstrual dysphoric disorder (PMDD) is defined as -

"Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome (PMS), which can cause many emotional and physical symptoms every month during the week or two before you start your period. It is sometimes referred to as 'severe PMS.
While many people who are able to have periods may experience some mild symptoms of PMS, if you have PMDD these symptoms are much worse and can have a serious impact on your life. Experiencing PMDD can make it difficult to work, socialise and have healthy relationships. In some cases, it can also lead to suicidal thoughts".

“When I first felt something was wrong, I blamed it on my history of anxiety and depression. I noticed that I would get odd heart palpitations - where my heart was beating really fast but I didn’t think I was having an actual panic attack. I just felt something was happening to me. I dismissed it as a new symptom of my anxiety. So to deal with what I thought was another level of anxiety, I started seeing a CBT therapist,” explained Kritika.

PMDD is a menstrual mood disorder. It means that when a woman’s (or trans man’s) hormones fluctuate during their menstrual cycle, the body has a severe reaction to this and exhibits symptoms similar to depression, anxiety and other mental illnesses. The disorder is considered cyclic because a sufferer often feels relief once their period comes or at some point during their cycle. However, in a few weeks with the pattern continuing on as normal they feel very unwell. The thing about PMDD is the severity of the mental symptoms.

If people within the support system don’t understand then those who experience the disorder are constantly educating others - which can lead to the further emotional toll on the sufferer.

Some people may trivialise the disorder and may not understand the emotional toll it takes on the sufferer . As a result of which sufferers are often left feeling isolated and alone. Kritika described this as a “roadblock” to her recovery. Overcoming how other people view her illness.

Not only is this illness not well known or understood by the general public - it isn’t common knowledge with the target demographic either. Many women and trans-men do not know about PMDD and tend to go through years and even as long as a decade without being diagnosed. However, inside they know that something is wrong.

To make matters worse, getting a diagnosis can be difficult. Your doctor may not be aware of PMDD. Equally, the disorder can look like other mental illnesses such as bipolar disorder.

However, getting the correct diagnosis is important as this will help lead to finding effective treatment and coping strategies.

“My diagnosis didn’t come from a doctor whom I’d visited for my fatigue which is one of my symptoms nor did it come from a gynaecologist. But for six months I had noticed these symptoms before the diagnosis from my CBT therapist. After the diagnosis, I started keeping track of how I was feeling.”

PMDD should not be confused with PMS. Symptoms of PMS are described as being less severe than PMDD. The effects of PMDD on its sufferers can cause them to feel so bad they can feel suicidal. PMDD’s mental and physical symptoms stop sufferers from living their lives. PMS although important in its own right, trivialises PMDD when used to describe the sufferer’s experience. However, the term severe PMS can be used to describe PMDD according to Mind and the National Association of Premenstrual Syndrome.

Mind, the mental health charity, recommends that anyone who suspects their bad mental health days are in relation to their menstrual cycle should do the following:

Keep track of your symptoms. This is made easier by the many period tracking apps now available online. The more information the better. This includes tracking physical symptoms as well as mental symptoms. It is recommended that the symptoms are tracked for at least two months. Bear in mind the symptoms can vary from person to person. Bring your collected information to your appointment with your GP.

Prepare yourself by taking the NICE guidelines to your appointment with your GP. This will help bring the attention of the disorder to the doctor’s attention. Be open to the fact that your doctor may not know what the disorder is. Don’t let that stop you from finding someone who will listen to you.

Discuss the most distressing symptoms first to your doctor. Doing this will immediately bring to their attention the severity of the problem. Tell them what treatments and adjustments to your lifestyle you have made in an effort to alleviate your symptoms.

Mind recommends using self-care to help alleviate the symptoms of PMDD. This includes physical self-care such as your diet and exercise and emotional self-care like avoiding burnout.

“The things I do to make myself feel better and to manage my symptoms include regular exercise, guilt-free eating but with portion control, regular 8 hours of sleep, and adjusting my day according to how I feel. So, if I’m feeling mentally or physically low, I will schedule my work around that,” said Kritika.

The right treatment may not be the first treatment you try but there are a variety of options that women and trans-men can try to alleviate the symptoms of PMDD.

Living with PMDD might take your life on a different course. Kritika felt that in order to work she would freelance. Freelancing allows her to schedule her work around any strong symptoms she felt during her bad mental health days.

“Setting boundaries when it comes to not just other people and what they are expecting, but also what I expect of myself,” said Kritika.

“I am in control of my day. So, that helps a lot. This means that I can have some days that are lighter than the others. And, the days that I'm feeling better I get multiple things done. Whereas the days that I don't feel so much physically or mentally able to, I give myself a break. One of the things that I really have learned along the process is giving myself the time to adjust and to not be hard on myself on days that I'm not able to work.”

But Kritika does feel there is a downside to this.

“I feel displaced in society’s social structure,” she added.

Because Kritika feels she cannot work full-time she feels she does not live up to society’s standards. Standards that are felt very strongly in the South-Asian community which is why at one point she was prone to pushing herself to burnout. Now, she listens to her body when it is ready for rest.

Kritika did note there was a difference in cultures when she talked about how she was feeling. She found it easier to be open in the UK about her mental health but in India she felt she came up against a lot of resistance from the gynaecologist and doctors she met when trying to figure out she was dealing with before discovering PMDD.