u/Phew-ThatWasClose

Obligatory disclaimer – since apparently this is necessary now. Most women with PMDD are not Ragers. Most women with PMDD are not Abusers. PMDD doesn’t cause abuse. But PMDD can open the door, and here we are.

There is a second negative review of the book, this one written by a human. If I can follow the logic the basic premise seems to be you’re not allowed to say anything negative about your abuser if she also has PMDD because someone else with PMDD will think you are accusing them of being an abuser and then commit suicide.

It’s pretty twisted and I’m fairly confident it’s the same woman who once accused us, as a group, of forcing (her word) women with PMDD to not talk about anything substantive during luteal. At least I hope it’s the same woman – otherwise there’s two of them. But to be clear nobody is forcing anybody to do anything. Including – nobody is forcing partners to engage in conversations they don’t want to engage in. She can talk all she wants, but you don’t have to be there.

To be honest there are more than two. At this point I count at least seven, but I would estimate more like twenty. A small but vocal minority of women with PMDD hate the whole idea of a book centered on partners because it doesn’t talk about how awful PMDD is for her. They’ve hurled all kinds of accusations like the book overgeneralizes, stigmatizes, speaks in absolutes, portrays all women with PMDD in the same negative light, etc. Furthermore it’s not balanced, doesn’t take the science into account, gets the science wrong, is too blamey, pushes for accountability while also infantalizing the women by having the man manage the condition … just a lot of bad faith and emotional reasoning.

I won’t go into why all those accusations are off base because you can just read the book for yourself. It’s free. But I do want to touch on one thing … It’s worse for her.

So what? Is that really going to be the cornerstone of your position? That’s where you want to plant your flag? It sucks for everybody! But you want to claim the high ground because it’s slightly worse for you? Two things can both be true. My pain doesn’t decrease when you belittle it. If anything that’s part of the problem. We’re both in pain but only one of us is trying to do something about it.

Which is my second point – she can do something about it. We are here, on this sub, seeking advice and support from strangers, because we have tried everything we can think of and it hasn’t helped. In many cases what it hasn’t done is ... it hasn’t gotten her to do anything at all to help herself. If she felt better maybe she wouldn’t lash out so much. But in many cases she won’t even acknowledge there is a medical issue to consider.

So we’re left to fend for ourselves by taking a time out, or distancing, or shutting down. Then we get accused of disrespecting, or triggering her RSD, or stonewalling, or being avoidant. No shit Sherlock. Who wouldn’t want to avoid that garbage. I’m supposed to be “securely attached” while you tell me how awful I am for two weeks straight?

Which brings me to the third point – Is it though? Women with PMDD frequently report gaslighting themselves during follicular into thinking it wasn’t that bad. Symptoms like fatigue, overwhelm, and brain fog can contribute to misremembering. Certainly a lot of partners here report their PMDDer flat out denies having ever said or done the things she said or did during luteal. Again – not everybody – but here, in this context, luteal amnesia seems to be common.

Moreover, as HS pointed out two years ago (linked above), the hormonal cycle that caused all the chaos during luteal now makes her feel great during follicular. We have no such hormonal boost to help us “get over it”. It’s a disorder, a medical condition, so “don’t take it personally”. But that is a big ask when the PMDD makes it very personal indeed.

All of which is to say … we’re in this together, equals, a team. The couples that make it are the ones that can work together against the common enemy. If half the team is AWOL, or worse, discounting and belittling the other teammate, we’re doomed. Who has it worse is largely irrelevant. What can we do to make it better?

I was recently told that I “got the science wrong.” No help, no pointers, no advice, just a reprimand. Then I got accused of a bunch of stuff I didn’t do and called a “motherfucker”. Ahhhh, good times. Nevertheless I’ll try to get this in the ballpark and if I make a mistake I hope someone will correct me. Only without the drama.

The RCOG treatment tiers are what they are because they help most women with PMDD. PMDD has a fairly high misdiagnosis rate (estimates from 40-80%) which can also lead to treatment not helping, or the “wrong” treatment working great. Treating for PMDD when you don’t have it won’t help and accidentally treating the thing you do have will help. Add to that the reproductive system is shamefully understudied and really really complex and there is a great deal of variability in how women react to treatment.

Nevertheless there are these recommendations that are based in science and “should” be the first thing to try. But you have to get it right and the recommendations themselves are fairly cryptic. I’ve written about this before, probably will again, today let’s focus on hormonal IUDs and COCs. Copper IUDs just prevent pregnancy by being an effective spermacide. They do nothing for PMDD so we’ll ignore those.

TL;DR: Hormonal IUDs are crap for PMDD, as are many COCs

The idea behind introducing birth control is to eliminate the rise and fall of the hormones during the reproductive cycle. By taking a mono-phasic Combined Oral Contraceptive continuously the changes that cause PMDD symptoms are muted (if the ovaries remain active) or even eliminated (if the ovaries are shut down completely).

But a daily pill is a task. I can relate. I have a life threatening medical condition and I barely manage to take my pill a third of the time. IUDs are attractive because one office visit and a week or two adjusting and you’re set for years.

There are several reasons hormonal IUDs are not recommended for PMDD. The first is they are all progesterone only – not combined. That means if the ovaries do shut down there is no estrogen and estrogen is vital for all sorts of things, not the least of which is the immune system. But that’s a different post.

But truth is IUDs don’t shut down the ovaries. They lack enough actual hormone to do so. They work by thickening the cervical mucus so the egg can’t reach the uterus, and by thinning the uterine lining so the egg can’t implant if it does get there. So the ovaries are still working and the cycle continues.

Doctors will tell you (her) that IUDs are great. They are a really low dose of progestin, about a fourth of what is in a COC, and that works because it is local to the uterus. It’s right there. And very little makes it into the blood stream. And even if that were true … PMDD is a neurological disorder! So treating it with something that by design doesn’t affect the brain is … a little stupid.

And the progestin all of them use is levonorgestrel. All of them. In the US, Europe, Australia, Japan, China, India … all of them. And levonorgestrel is about the worst thing for PMDD. Wildly popular and effective for birth control, crap for hormone based mood disorders.

For starters Levonorgestrel is a synthetic progestin derived from testosterone. Yes that testosterone. The very hormone blamed for excess aggression in men. Consequently levonorgestrel has high androgenic (Man-like) properties. It increases the chances of side effects like acne and unwanted hair growth. That’s the canary in the coal mine. Visible symptoms that are easy to quantify. Science won’t say, but I have a hard time believing levonorgestrel doesn’t also cause mood changes. Anecdotal data from both subs supports that conclusion.

Levonorgestrel also has high “progestogenic” properties. That means that among progestins levonorgestrel is especially potent. About 50x-100x more potent than natural progesterone. This is part of why it’s ideal for IUDs. A low dose goes a long way so an IUD can last 5 years or more. But it also means that it’s a sledgehammer for folks with a sensitive system. It’ll bind to the progesterone receptors and not let go, leaving the natural (better) progesterone out in the cold. Rather than augment it will take over. So the thing derived from testosterone is in charge and science is bold enough to tell you high progestogenic properties can increase the chances of side effects like mood changes, fatigue, depression and weight gain.

All these factors combine to shatter the myth that IUDs are local to the uterus and therefore won't affect the brain. Levonorgestrel is 50x-100x more potent than natural progesterone so a little goes a long way, and at least a little does get into the bloodstream. And levonorgestrel, like all steroid hormones, is fat soluble. That means the blood/brain barrier does not exist so the levonorgestrel has free reign.

Many COCs also use levonorgestrel as their progestin. The dose there is about 5-10x the dose in an IUD and they will effectively shut down the ovaries. But the sledgehammer analogy still applies. Now there is an extremely potent progestin, derived from testosterone, just dominating the system. Anecdotal reports are often "Now she's just angry all the time." Gee - I wonder why?

Meanwhile Yaz is specifically recommended by RCOG, and the only COC approved by the FDA for treating PMDD, because it contains drosperinone as it’s progestin. Drosperinone is a fourth-generation (“newer” per RCOG) progestin that is derived from spironolactone. Spironolactone, in turn, is a diuretic. Drosperinone inherits Antimineralocorticoid properties from this lineage. That means it helps prevent bloating.

But also drosperinone has low progestenic properties, so it will augment instead of taking over, and anti-androgenic properties. The latter means it actively binds to the testosterone receptors, blocking the natural testosterone from binding, to help reduce agitation, irritability, and aggression.

That said drosperinone is still a synthetic progestin. Some women just don't tolerate a synthetic so even Yaz or Yasmine (same thing but 50% more estrogen) can cause an increase in symptoms. For some.

The birth control page at the other sub’s wiki has a chart with all the progestins listed. Highly recommend looking up the progestin in your loved ones BC and checking the chart.

Is very exciting. Somebody really hates the book.

I mean they really, really ... really ... hate the book.

They hate it so much they spent a good ten minutes prompting some A.I. to write a scathing four paragraphs. And let me tell you that A.I. didn't hold back. It got virtually everything wrong but ... with confidence!

You should read it. The review - I mean - but also the book. :)