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Premenstrual Dysphoric Disorder (PMDD) can be a debilitating disorder. It is chronic, meaning it is more or less happening continuously. The constant and repetitive cycles of pain, fatigue, anxiety, and depression can be overwhelming. The average menstruator will have about 450 periods in their lifetime. That is a lot of cyclical suffering!
The main criteria separating garden-variety PMS from PMDD is the degree to which the symptoms create difficulty or dysfunction in these three specific areas of life: home, school/work, and relationships. Personally, I think that there is also one more very important area to be considered, so stay tuned to the end to find out! You can either watch the video or read the blog post below.
Home Life
PMDD can make your home life very difficult. The one place where you should be able to feel safe, calm, and relaxed can become the only place where it's safe to let your (very large and overwhelming) emotions out. However, those that you life with tend to misunderstand why this is happening and think that their loved one is lashing out and picking fights on purpose. I would wager a guess that PMDD is responsible for causing deep rifts or even ruining many family relationships and marriages.
Family Relationships
PMDD can be hard to deal with when your family doesn't understand what is going on with you. In fact, up to 90% of PMDD sufferers are undiagnosed, meaning most don't even know what's going on with themselves! You and your family may not understand why you are moody or upset at times. This can create an environment ripe for misunderstandings and arguments.
Personally, my relationships with my parents and sister were fraught through my teenage years and early twenties, when my PMDD first began. My family thought that I was just a typical angsty teenager, taking my anger out on them. I would use up all of my energy trying to keep it together at school or work, and finally break down at home. In reality, home was my only safe place to let my emotions out and finally feel them.
Many people with PMDD feel misunderstood by their loved ones, but don't have an explanation for the way they are feeling. Learning more about PMDD, educating family members, and asking for accommodations such as extra space or patience can make all the difference in this type of situation.
Extended Family
My relationships with extended family have also suffered as I have, at times, found it hard to make it to family events such as holidays, birthdays, baby showers, weddings, and the like. Sometimes your social meter is just too drained to go, and if you force yourself to, you come across as cold and moody. Amidst the ups and downs of PMDD, it's hard to care for yourself, nevermind remembering birthdays, gifts, cards, and everyone else's business. You may love your family, but it's hard to keep up with the crowd. It may also be difficult to watch siblings and cousins your age surpass you in life milestones because they are not hindered by a debilitating disorder. Although you're happy for them, this can be painful and hard on self-esteem.
Partner Relationships
Similarly, my relationship with my partner has also suffered over the years. Although he is now very understanding, it has taken a lot of research, communication, and personal experience with the ups and downs for us to reach the place we are today. I often felt afraid that he would leave me due to my bouts of depression and anxiety. My libido has suffered on an off throughout the years as well, which has also added strain on the relationship at times. Not only can the menstrual cycle can affect libido, but medications for PMDD are also known to decrease it as well. I often hear that PMDD has a negative impact on partner relationships, and that being left behind is one of the most worrying factors for sufferers. The same tips I mentioned above for direct family members can be useful here.
Children?
As PMDD has affected my everyday life so deeply, and as it may also increase the chances of having severe postpartum depression (PPD), I have also delayed having children. It's possible that PMDD may be the primary reason that I decide not to have kids at all. It's an agonizing decision and it also affects my relationships with my partner, family, and friends. It may also deprive me of a relationship with my possible children, but ultimately I know that I need to make choices in my best interest to support my mental and physical health.
That being said, many PMDD Warriors do have children and there is no doubt that they love and care for them. But parenting with PMDD can be a big challenge. At certain times, patience can wane, tempers can flare, and it can be hard to meet all of the high expectations parents hold themselves and other parents to. It can be hard to make time for self-care when you're burnt out from caring for others. You may end up feeling guilty or feeling like a bad parent for not living up to these expectations.
Being honest with your children about how you're feeling is okay. Kids aren't always happy and fun, either. You can show them that it's okay to ask for space and rest when you need it, and encourage them to do the same. It's okay to struggle with your mental health and model self-care to your kids! You can also ask your partner, family, friends, or a babysitter to take on more family duties when you need space.
Housekeeping
The final area that PMDD has affected my home life has been housekeeping. It is really difficult to keep the house clean when half of the time you're depressed, fatigued, and overwhelmed. I tend to clean on a monthly schedule instead of weekly. My partner does his fair share, but we always seem to fall behind. Although some mess and clutter is our normal, it's embarrassing to have others over unexpectedly. It also makes me feel worse about myself when I visit others' homes that are better maintained.
Sometimes you need to readjust your expectations of yourself when it comes to things like housekeeping. As long as your environment is safe, comfortable, and works for you, it's okay. And if you don't want to invite others over, then you need to enforce your boundaries and suggest an alternate meeting place. Let go of the guilt!
School/Work Life
Expectation vs Reality
I think the impact of PMDD on school and work life is severely underestimated. Although it would be nice to tailor important events around your cycle, it's just not possible in an institutional, organization, or corporate setting. There are always seems to be meetings, deadlines, and networking events when you're was feeling at your worst.
Our work systems are centered around a male worldview where a static level of ability is expected to be maintained all the time, whereas someone with a menstrual cycle has peaks and valleys of ability. Menstruators may be passed over for promotions because, although we are able to complete the same amount of work in total, others would appear more productive regularly, and it often seems like we are 'slacking off' at times, despite trying desperately hard.
No matter where I worked, I would have additional difficulties due to PMDD:
In customer service jobs, I would find myself regularly grumpy and find to difficult to be patient and cheery with customers.
In labour based jobs, I was often fatigued and in pain, reducing my ability to complete hard work consistently.
In corporate jobs, I'd be expected to be productive all the time, when in reality, I would be underproductive half the time, and over productive the rest of the time, leading to burnout.
Missing Work
There would be absenteeism on days where I just could not force myself out of bed, and when I asked for accommodations, since I couldn't explain what was going on with me. It's difficult to explain to your superiors (particularly male ones) that you can't get your work done in a conventional way because of your period - it just sounds nonsensical in a work environment. I'd generally end up burning out of jobs and leaving, hopping around seasonal jobs, and even getting fired.
Entrepreneurship
Although I had dreams of starting my own business, the ups and downs proved to be too much to manage. Me anxiety and depression would get the better of me. My lack of self-esteem and faith in myself, combined with my many self-perceived failures, led me to unemployment, which stalled my career and greatly impacted my income.
Finances & Access to Treatment
PMDD has greatly affected my ability to provide for myself, which in turn, limits my ability to access proper treatments. I have spent literally thousands of dollars on doctors, therapists, medications, and supplements. I am fortunate enough to be supported by family with great benefit and insurance plans, but I carry guilt about this and often wonder where I would be if I had had to support myself through the years. PMDD can wreak havoc on someone financially, and economic status can be a massive barrier to access to care and treatment. It's a vicious and terrible cycle that I don't wish on anyone.
Social Life
Friendships
PMDD can have impacts on relationships with friends as well. I would often reach out to friends in my good phases and make plans, only to be feeling terrible by the time the date rolls around. This leads to a lot of uncomfortable hangouts or cancelled plans, labelling you as the "flaky" friend, and often resulting in the trickle of invites coming to a halt. The constant overwhelm also makes it difficult to remember to pick up and send birthday cards, gifts, and thank you notes. PMDD makes you an unreliable friend at the time when you also need friends the most. The one bright side is that it makes you an extremely empathetic friend and the person people may turn to for a listening ear.
Social Events
I've had plenty of times where I am expected to be happiest when I was feeling at my worst. I've experienced PMDD episodes on (many, if not most) vacations, birthdays, holidays, nights out, weddings, you name it. I even experienced a PMDD episode during my own wedding, so that I could be free and clear to enjoy my honeymoon (I had my period for the first half, but at least I wasn't grumpy!). It can be hard to put on a happy face and enjoy yourself when you're suffering, and most people simply don't understand what you're going through.
Not Often Considered:
Self-Esteem
Feeling Like A Failure
The constant peaks and valleys and dissonance between expectation and reality in all areas of life can be really hard on self-esteem. The lack of effective treatments can cause a rollercoaster of high hopes and deep disappointments, leading to a sense of hopelessness. You like you are constantly letting the others around you down. You end up missing deadlines, missing work, missing events with family and friends. The unpredictability of emotions and ability to function make it difficult to be able to trust yourself. You begin to see yourself as a failure.
Lifestyle Difficulties
Building healthy lifestyle routines, especially concerning hygiene, diet, and exercise, can be very difficult for someone who is experiencing constant ups and downs, compounded by low self-esteem. Maintaining a healthy lifestyle can feel impossible. Luckily, it is possible to build your life around your cycle - but you also have to be okay with living outside of the norm and letting go of social expectations, which can be really difficult.
Coming Up...
Over the next few weeks, I'll be discussing the specific phases of the PMDD menstrual cycle and giving you some insight as to how you can tailor your life to better fit your cycle.
But for now, please let me know what you thought of this post, and let me know in the comments how PMDD has affected YOUR life! Are your experiences similar, or different? I'd love to hear from you.
You can sign up to receive 4 FREE yoga classes for each phase of your cycle + a guided meditation for PMDD by clicking here.