After many months of suffering and torment careful observation and research, I have reached the conclusion that the reason that I spend two weeks of every month transported to whole new block of Crazy Town is an extreme reaction to the fluctuation of ovulation hormones during the luteal phase of my menstrual cycle.
Menstrual Cycle
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Premenstrual Dysphoric Disorder, them docs call it. Kind of über-PMS, you dig? Except not really:
The day of my period and for about 13 days afterward, everything is great. I’m calm, happy, full of energy.
Around day 14, I start to notice a little edginess, nothing major. I may have trouble focusing in class.
By day 17 I am actively censoring my bitchy thoughts, but I am still able to function, despite the fact that I am anxious to the point where I am having somatic symptoms (tachycardia, dry mouth, nausea), and I am exhausted all the time but I can’t sleep more than 3 or 4 hours a night.
The last week I am a complete wreck. I’m late for everything because I start driving and then I can’t remember where I am going. Or I’ll start to nod off in traffic and have to pull over. I am more clumsy than a teenage boy (I actually fell up the stairs at least 4 times this week, twice on the same steps in front of the same receptionist…on two different days).
Excuse me, which circle of Hell is this?
I feel hopeless and helpless, and then I feel nothing at all. I don’t care about school or work or anything and the best I can hope for is that I remember that I will care in a few days and so I keep plodding along trying not to flunk out or get fired.
I feel ugly and stupid and unlovable and terrified that I will lose everything for about 48 horrible hours, then my period comes, and it’s like a switch goes off, or on, and I am perfectly fine for a few more weeks.
Now, it’s true that any diagnosis of PMDD is complicated by my bipolar disorder, but I have been stable on medication for years. My affective symptoms completely remit during that nice happy follicular phase. No irritability (other than my normal bitchy personality, that is), no apathy, lethargy, confusion, memory problems, anxiety, clumsiness, suicidal ideation, or depression. Then, POW!, that fcuking egg is released and I am one hot mess for the rest of my cycle. Add to that a side order of joint pain, muscle aches and a vessel-bursting migraine or three. Yummy!
There is some debate over whether PMDD should be classified as a mental disorder at all. Critics claim it stigmatizes women, and it raises all sorts of fascinating issues about the social constructs of mental illness, none of which I will get into. Not that it’s not interesting; I couldn’t go there now if I wanted. Cognitive problems are another major symptom for me, and as someone who puts much of her self-worth into her intellectual ability, it’s scary thing.
I tried adding a dose of bupropion (Wellbutrin) to my med cocktail for the two weeks between ovulation and menses, but other than that whole yucky trip thing, there was little effect. Certainly no symptom relief. The second line treatment is alprazolam (Xanax, an anti-anxiety drug) with the same luteal-phase dosing. I’m crossing my fingers that this one will work, because it’s the last treatment with a relatively benign side effect profile. The next step would be something like Danazol (an endometriosis drug), which would stop ovulation altogether.
Well, that’s one way I would get to be the boy, I guess…
references:
American Family Physician: Diagnosis and Treatment of Premenstrual Dysphoric Disorder
Canadian Journal of Human Sexuality: Does PMDD belong in the DSM? challenging the medicalization of women’s bodies
Pharmacy Times: The Pharmacist’s Role in Breaking the Cycle of PMDD
