irstly, what exactly is PMDD? Chances are if you searched specifically for this article, you already have it and know what it is. However, if you are a relative or family member of a person with PMDD, gone in search of a bit of advice, the lines between symptoms might be blurrier.
To illuminate, PMDD (or Premenstrual Dysphoric Disorder) is a hormonally-based illness that occurs when the body and mind are irritated by the natural hormones connected to a person’s menstrual cycle. PMDD occurs within the week before a person's menstrual cycle begins. Symptoms are generally: fatigue, irritability, bloating, breast tenderness (in less extreme cases) to depression, suicidality, or rage (in severe cases).
SSRIs and birth control can both help those with PMDD, however, they–depending on the person–do not always eliminate all symptoms. Additionally, some people affected by PMDD do not wish to take medication due to the potential side-effects.
Understandably, it can be quite difficult for a person with PMDD to continue their tertiary studies while attempting to cope with PMDD. Here are a few ways that a person can manage (without Medication)...
A Cyclical Illness
As a cyclical illness, PMDD is quite predictable in its movements. First, you must figure out through experience exactly how long PMDD occurs in you. For some, it begins ten days before their period, for others, it is only the final three days before. Recognizing the beginning symptoms of PMDD is also crucial, as it can warn you of exactly how much time you will spend ill. (General first signs of PMDD are fatigue-related, lack of motivation, etc.)
Try to monitor your cycle through a birth control app so that you can be sure when PMDD will be hitting. This will allow you to re-arrange your schedule around the days you will be feeling unwell. Arrangements you can make include:
- Informing your professors that you will be ill for the next X many days, and asking for deadline extensions
- Asking to take a quiz next week, or when you know you will be feeling better
- Texting coworkers who might be able to cover your shifts for that day
- Plan a few days of relaxation: order library books and movies ahead of time, stock up on necessities (in case you don’t feel like leaving the house), and prep a few meals so that you don’t have to cook while sick
- Call or text family members letting them know you are going through a hard time, and ask for their support
A few simple arrangements like the ones above can make quite a difference in your life, especially if you are a more severe case and find it difficult to be productive in any capacity while sick.
Plan Ahead on Assignments
On the other side of the spectrum, there are those who (instead of planning for the illness by deferring deadlines), prefer to simply knock things off their plate before the illness strikes, so that they find themselves ahead rather than behind when PMDD strikes.
Of course, this method is not viable for everyone. Some assignments command large blocs of time that simply cannot be condensed. Students may have a work life that doesn’t allow for a lot of “getting ahead in the classroom.” However, some assignments are quite simple and can be knocked out of the park right away to prevent a person from irritating an already irritable professor, or, say, the rest of the students in a group project.
- Be the first person in a group project to complete their work
- Finish an essay immediately after class, while your ideas are fresh
- Schedule a study time with a peer and complete your homework with the extra motivation of their added input
- If you have to film something, do it while you are still healthy. You don’t have to submit it immediately after you finish, and can keep it on the backburner in case you feel better later. However, with PMDD, you should always assume that you will be sicker, rather than better, in a few days.
PMDD thoughts are thoughts that only occur around the time that you experience PMDD. They are typically (okay, always) negative, and dwelling on them leads to a spiral that can send you straight into a depression if you are not careful. Often, voicing these thoughts and receiving comfort from family and friends does little to dispel them, as PMDD thoughts are persistent and susceptible to outside reason. Instead of trying to reason with your negative thoughts, which only leads to more dwelling on said thoughts, always be aware of what is a PMDD thought, and comfort yourself with the fact that you will not be preoccupied with this negative thought forever. Once the PMDD is over, you will most likely find yourself wondering why you believed any of that in the first place. It might seem weird, or feel like you’re going crazy, but this is normal. Don’t blame yourself for feeling ill when you are, in fact, ill.
A good therapist can make all of the difference in the life of a person with PMDD. In fact, there are even therapists who deal with this illness specifically! While they may be few and far between, as this is a niche disorder, they are not impossible to find–and in the age of zoom meets, shouldn’t require a lot of extra work.
Talk to your therapist about your symptoms, thoughts, and feelings. Let them know if you are struggling to maintain relationships, or if you are falling behind in your schooling. They may be able to provide a letter to your university that will allow for accommodation. Additionally, they can give you some coping tools not covered in this article that could benefit you going forward. If nothing else, a therapist is a listening ear–a person literally paid to hear your every negative thought and redirect them wherever possible. Unlike with a friend or family member, you don’t need to worry about “bumming out” or “pissing off” your therapist. They are there to listen, and to help.
Fending Off Depression and Rage
With PMDD can come alienating symptoms such as unexplainable rage and depression. While many who experience these symptoms believe that they are an inevitable symptom of their illness, just as many have also found relief through distraction–as it severs a negative line of thought and redirects it to something more interesting, for example, a movie, or a spa day.
- If you are well enough, visiting a cafe, a cinema, going for a walk, or even just getting out of the dorms can help tremendously
- Schedule something in the future, give yourself something to look forward to
- Rent or buy a new book, watch a new film, or (if your family can stand you) spend time with your family
- Cook or doordash yourself one of your favorite foods
The Disability Dilemma
It’s not That Bad...
To be or not to be? That is the question indeed. Whether ‘tis nobler in the mind to suffer…or to take arms and end suffering.
PMDD is by many metrics, a disability. However, there are certain stigmas that come with getting disability aid from your university. For example, because PMDD is so niche, there is likely no procedure in place to help with it. Additionally, disability has a habit of following you wherever you go, potentially impacting your housing, insurance, and even career.
My purpose in mentioning this is not to deter you from seeking help. Many women with PMDD have symptoms so severe (such as suicidality and rage) that they simply cannot manage without accommodation. There is nothing wrong with this. However, even in severe cases, through the tactics above or through medication, you may be able to reduce the severity of your symptoms to the extent that PMDD no longer disables you. In that scenario, it may be better to keep your diagnosis between you, your closest family and friends, and your doctor.
One thing to keep in mind, whether or not you seek accommodation from your university, is that it is indeed “that bad.” PMDD has very serious symptoms, and should never be taken lightly, by yourself or others. Just because you are not seeking treatment through medication or accommodation does not mean that you are “well,” or that the other people in your life who know about your illness have permission to drag you every which way while you are sick. Learn to set boundaries by telling others that, no, you are sick today, and will be doing X instead.
PMDD’s Impact on Jobs
It would be dishonest..or perhaps at least withholding to write an article about PMDD without mentioning its impact on a person’s career. Of course, rage, irritability, depression, and scattered thoughts are going to have an impact on a person’s workplace life. PMDD is a perfect storm of negative emotional symptoms that can, at times, make it impossible for a person to slog through the day-to-day of their job. Women have lost their jobs because of episodes. They have quit suddenly out of the blue, not considering the later consequences.
This article by Refinery21 does an excellent job of sharing the stories of women with PMDD and how it has impacted their relationships to their work.
If you are unclear about your rights as a person with PMDD, review this PDF for employers, detailing ways to accommodate those with PMDD. It may give you an idea of what is reasonable to ask for when seeking out accommodation.
What to Do
There is no clear-cut solution to “the work problem” of PMDD. Some offices may recognize your illness, others might look at you funny for even mentioning issues relating to menstruation. Quite a bit of it is up to chance, actually. Maybe you have a supportive boss, maybe you have an abusive one. Maybe your career is more lax, allowing you to set your own hours and take time off, maybe it isn’t.
If you can work from home, great! If you can’t, and don’t feel like using up all of your sick days, do what you must to feel better and try not to take on any more work those days than is necessary. Set a pick-me-up schedule, so that you have something positive on the horizon to look forward to while you work. If you’re feeling up to it, be spontaneous! Bring donuts into the office (which should cheer both you and your coworkers up, while leaving a positive impression on the boss), or sing in the car. Anything to interrupt your routine. PMDD’s depressive thoughts thrive on the monotony of routine.
NOTE: While disclosing your disorder may cause career issues, it is a relative certainty that your PMDD will flare up at some point whether you disclose it to your boss or not. It is up to each individual to determine whether or not to say something about their PMDD, but chances are that it will impact your career whether or not you decide to speak up about it.
It’s frankly tragic that an illness shared by so many has relatively little coverage in the media, or even recognition in the medical world. Menstruation has historically been deemed a “sensitive topic” in Western culture, which only serves to provide more barriers to those suffering with PMDD. It can be hard to open up, however, with the help of therapy, potential medications like SSRIs and birth control, and a clear understanding of your illness and how it impacts you, you can find a way to continue to push through to the finish line. As PMDD lessens over the years, eventually ending completely in your 30’s, or with menopause, it, assuredly, does end.