Over the years, several analogies and euphemisms for painful periods have popped up: “shark week” (because the uterus apparently looks like an angry hammerhead shark), “hell week”, and my favourite, “Lucifer’s waterfall”.
Menstruation isn’t a pleasant experience for many. Menstruators usually dread their period and the time right before which comes with Premenstrual Syndrome (PMS). This can bring with it unwelcome guests in the form of fatigue, nausea, moodiness, acne and anxiety.
But for me, those symptoms also include anger outbursts, anxiety attacks, irritability, depression, suicidal ideation and severe mood changes. And they kickstart a full two weeks before the crimson tide even arrives.
I have Premenstrual Dysphoric Disorder (PMDD), which means the days before my period make me want to die. No, literally. Every month, for two weeks, I feel like someone is forcibly holding my head underwater while I’m struggling to breathe. It’s like a ticking time bomb that can go off any second, and I’ve left dozens of loved ones as casualties of my anger outbursts over the years. When my period arrives, I feel like my head is finally out of the water and I can feel the oxygen reentering my lungs.
I first noticed how miserable the two weeks before my period made me feel when I was 18. I began tracking my cycle on a period-tracker app and noticed my symptoms flared up during the luteal phase, when PMS usually occurs. I brushed it off initially. “It’s just PMS, I should suck it up,” I’d tell myself. But it was exhausting.
It did not help that PMS is ridiculed and made fun of in the mainstream media and society alike. “That time of the month” or “oh, she has her period” have become such running jokes that it’s easy to dismiss a woman who may be angry, in pain, upset or anxious. This trivialisation especially hurts women who have something serious going on.
It was as recently as 2019 that the World Health Organization (WHO) added PMDD to its international classification of diseases. According to a Harvard report, 15 percent of people who suffer from PMDD have tried to attempt suicide. According to a study, women with PMDD are 70 percent more likely to experience suicidal ideation. Globally, five to eight percent of menstruating women have PMDD.
PMDD sufferers could also be more prone to anxiety. “Women with PMDD demonstrate greater activity in the amygdala, a collection of cells in the brain, in response to negative stimuli compared to healthy controls – a feature often seen in women with high levels of anxiety,” Deborah Lee, a sexual and reproductive health specialist from Dr Fox Pharmacy, tells VICE. “These findings seem to correlate with increased levels of the progesterone hormone.”
In my search for answers for why I felt the way I did before each period, I went to a renowned gynaecologist in my city, a couple of years ago. I was diagnosed with “severe PMS”. My doctor put me on vitamins and asked me to have a good diet and exercise regularly. But I was doing all those things already; I used to work out nearly everyday and had a fairly healthy diet for a 19-year-old university student. Where was I going wrong?
In several countries including India where I live, several medical communities don’t see PMDD as an actual condition. Some of them don’t even know it exists. When I told my gynaecologist that I suspect I have PMDD, she quietly nodded and mumbled something about looking it up later on.
I wasn’t the only one who was dismissed by a gynaecologist.
Namrata Menon, a Mumbai-based content creator and videographer, first noticed symptoms of PMDD in 2017. “My gynaecologist told me it’s a part of being a woman and menstruating, and it was frustrating that the doctors had no answers,” she tells VICE. “I ran from pillar to post in 2017 looking for answers but to no avail. I think this incident made me lose trust in doctors in a way.” Menon also creates content through Reels and memes on her Instagram for PMDD awareness. “I think my urge to tell the world about PMDD came from seeing the lack of conversations around it. We cannot exclude PMDD when we talk about menstrual health.”
Like some medical disorders, there is no test to evaluate PMDD. No blood tests, scans, or sonography reports can indicate if the menstruator deals with PMDD.
“I think that further marginalises menstruators who suspect they are dealing with PMDD,” says Rucha Joshi, a psychiatrist based in the city of Thane in India. “Tracking one’s symptoms and period cycle is the first step to understand if they have PMDD. Journaling and making a record of their mood changes is also helpful.”
Joshi is one of the few psychiatrists who view PMDD as a real disorder. “It’s unfortunate that most of the medical community is unaware about it despite it being classified as a DSM-5 disorder.” Joshi recommends managing PMDD through lifestyle changes first, and then moving on to pharmaceutical approaches, like taking antidepressants like selective serotonin reuptake inhibitors (SSRIs) under the guidance of a psychiatrist to manage mood changes. “With therapy and SSRIs, patients completely recover if treated adequately over a period of time,” she adds.
To manage her symptoms, Menon takes pills prescribed by her psychiatrist. “I’ve made some lifestyle changes too, like taking on less work before hell week and eating healthier, which have helped greatly. I finally feel in control of my PMDD and not as overwhelmed as before.”
But psychiatric interventions are not a one-size-fits-all glove. Misdiagnosis by psychiatrists can even lead to PMDD symptoms worsening. “I think I was 16 when I first noticed how bad things would get a week or two before my period,” says 21-year-old Atishi Mukhopadhyay from the city of Pune in India. Mukhopadhyay found out about PMDD while looking up “extreme PMS” on Google. “The search results immediately showed PMDD and for the first time in ages, I felt seen.”
Mukhopadhyay reached out for psychiatric help before she had a clear idea of her PMDD. But she was misdiagnosed. She says, “My psychiatrist wrongly diagnosed me with bipolar disorder. She then put me on a bunch of pills that made things worse.” Mukhopadhyay’s symptoms, which include lethargy, depression, anxiety and mood swings, then became much worse. On some days, she would sleep all day.
For some, child birth could also lead to PMDD. Caroline Church, author of I Blame The Hormones, noticed she had psychotic episodes during her luteal phase after the birth of her second child in 2010. “Every healthcare provider I reached out to seemed dismissive of my symptoms,” she tells me over email. “I was dealing with chronic fatigue and fibromyalgia which was making me lose my mind. Finding out that PMDD was real validated my entire experience which led to me seeking help and finally writing a book on PMDD.”
Coping mechanisms can differ for everyone. For me, it was forcing myself to take up more work and go out more. I felt like shit all the time, but at least I was able to force myself out of bed and meet deadlines even when I felt like I was dying inside. “I turned to weed for some time as a coping mechanism,” Mukhopadhyay said. “I realised during last year’s lockdown that I didn’t want to develop a dependency so I switched to music.” Mukhopadhyay found catharsis in piano and yoga. The hours spent playing the piano or doing asanas were the only time when she didn’t have intrusive thoughts in her head.
For me though, overworking myself through the pandemic or looking at cute pictures of dogs no longer worked as a coping mechanism. I needed more answers and as unrealistic as it sounds, a cure. Last year, on a whim, I looked up PMDD memes on Instagram and came across the obviously titled @pmddmemes. I could relate to every single meme.
I found some comfort in memes, but then I found Facebook support groups for PMDD. The International Association for Premenstrual Disorders (IAPMD) has a support group on Facebook where people across the world discuss their symptoms and coping mechanisms. Why hadn’t I thought of looking up support groups on Facebook when a Facebook group exists for literally everything, including roleplaying Baby Boomers?
One of the graphics on the support group says, “PMDD is like being in an abusive relationship with yourself.” I couldn’t agree more, and after endlessly discussing and explaining what PMDD is to everyone I know, I finally felt seen. BeyondBlood is another non-for-profit organisation from India working towards PMDD advocacy online, and is a partner with IAPMD.
“These groups finally made sense about why my ex had those severe mood swings and anger outbursts,” Atticus Green, from Okhalama, U.S., tells me. I met Green on a support group he had joined to help his then-girlfriend with PMDD. Green later met his wife and noticed she had similar symptoms too. “I asked her to look up PMDD and bring it up with her therapist. She had a lightbulb moment. We later set up consultations with specialists and a gynaecologist to help her manage the symptoms. It’s a work in progress but this realisation has made both of us more understanding towards each other’s expectations and needs.”
Several people I spoke with reported gaslighting themselves when they first started analysing their symptoms. I remember doing it to myself too. I would constantly blame my symptoms on the stress at university or work, or how shitty my then boyfriend was. It took me nearly a year to see that what was going on with me wasn’t normal.
Of course, the conversations around PMDD have a long way to go. Trans and non-binary people have rarely ever been mentioned in discourses and research on PMDD, which in turn invisibilises them even more. The month of April is also marked out as PMDD Awareness Month. Support groups hope that this month can be used for advocacy and awareness campaigns on PMDD and how common it is. Over 75 percent of menstruating women report experiencing PMS and yet, premenstrual disorders are understudied in comparison to erectile dysfunction.
Several menstruators choose to have hysterectomies or cancel their period to avoid PMDD. The good news for me is PMDD disappears after menopause. For now though, I have several hell weeks to go through before I say goodbye to PMDD.
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