I'm tired. She let me know about her PMDD early on and I'll be honest, I did not do a good job of educating myself. She has told me when the lutheal phase is coming, and when it's here, and I haven't done a good job of doing what she needs during that time. She's told me what she needs, and in a perfect world I'd love to provide that to her, but when she yells, it's triggers the hell out of me. I try to be as supportive as I can, try to listen to her endless rants, her anxiety, and be there for her but it's exhausting. I care about her alot but this is destroying me as a person. I've tried to do what she asks me to but the next time it comes what she wants changes. And then it turns on me. Every month we have a huge blow up fight with her telling me it's the last time and that's she's done and me begging her to not be. Me just reiterating to her that we can work on it, I'll do better, I'll be better. Then half the month im the most amazing thing that's happened to her. I cannot tolerate yelling. I won't tolerate yelling. To her, yelling is part of life. I'm not perfect, I've yelled at her when it's gone too far, for which I apologize every time. I know PMDD is not something she can control. She knows yelling is a huge trigger for me, and yet I get no apology. I see so much promise on the good weeks, but the bad ones are just starting to take over my brain. She belittles me, mocks me, says we are incompatible. I say I need space because I don't want to fight and I'm not allowed it. "If you take space when I need you most we are done." She says. Why can't she recognize that she needs space. I get so angry. I know it's a disease and not her but I can't take it anymore. We have tried having conversations outside of luteal, and this last month I thought we turned a corner. Then luteal combined with big stressors in her life unleashed a rage on me that I've never seen before. All because I wasn't helping her in the exact way she wanted. I asked for clarification on something she asked me to do and she flipped out. I kept my cool at this point and was trying to regulate myself. She didn't like my energy and it was like gasoline on a fire. I was trying to keep the situation calm and apologize, reassure that I am here to help and I want to help, let's drop it, and let me help. But no she kept trying to escalate while screaming at me. Then it became disrespectful and I'll be honest, I lost my cool. I didn't want that to happen. I felt terrible. I wanted to be there for her and to help her. I left because she told me to go. Then she called back and said to come back and apologize, I thought this was an opportunity to smooth things out. It was not. She was upset that I took to long to come back and missed my chance. Then 2 hours on the phone about how terrible I am. Then the next day 3 hours on the phone on how terrible I am. The whole time blaming me for her state. I just wanted to get through it so I agreed. Kept apologizing. Didn't raise my voice. I just wanted the ranting to end. When I thought it would she would go off about something else. She threatens to end things all the time, I never have. She mocks me, talks down to me, and tells me I'm a shitty person. I have never done that to her. But I am destroyed. I think about this for days after it happens. Is there hope? Do I end things? It's so confusing. I feel like I am depressed due to this. I feel like I'm losing my mind.
Why it couldn’t be
You accused me of wanting to fuck my guy friends and panick attacked calls and texts when i was out eventually led me to stopping those outings
Your misandry made me feel small and unable to speak
Your complained complained complained
Every job you found had problems and you quit
You talked about killing yourself in regards to working, making me go silent on the financial burden of my portion of rent.
I stopped watching shows just because they had fan service because I didn’t want you to judge me or say anything. You didn’t care I’d just roll my eyes at the the fan service and enjoy the rest of the show a lot. I had panic attacks watching things when characters with big boobs or nudity showed up.
I stifled who I was and what I enjoyed because I didn’t want to draw your ire.
We all have to work somewhat. A complaint here or there is fine but sustained complaining burns out and demotivates me. I can’t handle it because it eats away at my drive to go and work to pay the bills. A 70/30 split of rent and bills sucks when you complain so much about earning your 30
Disassociating through your luteal phases. Yes dear, that sucks, I’m sorry
Molehills into mountains
Such big reactions
Then you told me everyone in you life told you made too big a deal of things. Maybe you do. I don’t want to invalidate you though.
Complaint about having to mask around my friends and family. It tired you so. Social things tire me too but I want someone who doesn’t tire so much and make it a big deal. Complaining about how straight everyone is. I’m sorry I didn’t have more queer friends. I never even thought about your friends being gay, interesting the double standard there
Breakdowns and panic attacks over what to wear. I’m so sorry you can’t see how beautiful you are. You even snapped at me early on how I shouldn’t call you beautiful or that I really didn’t think it. I called you beautiful a couple more times after that but then I stopped because the words felt hollow and you wouldn’t believe it.
Yelling at the dog, tearing down my cats toys, you overwhelm so easy. Wrapped up so tightly the slightest twinge snaps.
I’m sorry I couldn’t communicate better, I felt I couldn’t. Maybe these reasons can help you understand why. I don’t think this could have worked long term.
So many times you sold yourself short. Afraid of failure. You sowed the seeds of doubt in this relationship throughout. “Are you sure you want to be with me?” “I can just leave” I didn’t feel them then but you planted those seeds. I wanted to make this work. I understand now what you meant, when you said I fell in your trap.
Thanks for reading. It’s not all her fault I definitely have avoidant tendencies to work on but damn I’m empty and ready to move out and start re calibrating myself
Me (21M) and my gf (21F) have been together for about 8 months, and it’s both of our first relationship. We initially connected as best friends, as we shared almost every hobby and interest. A month into that, we both realized that we liked each other, so I confessed to her.
At the start, it’s been the best couple of weeks of my life. We hung out twice a week, and it was never enough for me. But 10 days before her period, she would become very avoidant and critical of me. She would suffer from depression and major self-esteem issues, and I’d be there to reassure her every step of the way the best I can. Not once have I ever been mean to her or purposely upset her - I’ve been nothing but supportive and loving to her. But she’d always find a way to put the blame onto me by saying I’m not doing enough for her. I’m guessing this could be some form of PMDD, and it feels like I only get to see her at her best for 1.5–2 weeks a month.
For reference, I drive an hour to her city every time we want to hang out, and she expects me to drive another 30 minutes to an hour to the spots she chooses. I don’t mind the driving, but she expects me to plan out dates for her when I’m already mentally and physically drained from all the driving. I also pay for everything, including dates, gas, etc.
The main issue: we found out we both had a day we could hang out, but she wanted me to plan something. I didn’t know what to do, so I just suggested a cafe or something because I also had to work a 7–3 shift that day. Once I got to her, which took an hour and 10 minutes due to traffic, she suggested we go to a cafe that was another 25 minutes away. To be honest, I was extremely exhausted from work and all the driving, so I suggested we just find something in her city, and she had a full-on breakdown. She started crying on the verge of a panic attack, saying she was excited all day and got ready to be taken out. I tried to comfort her for almost 2 hours, but the whole time I felt so suffocated and drained. She could tell at some points that I was uncomfortable and exhausted, which made her even more upset. In the end, I drove to the cafe that was 25 minutes away, and when we got there, she was still upset.
I’m not the best at expressing my emotions due to my childhood, so I tend to keep everything in and try to be the supportive one. But in the days after that, I genuinely didn’t have it in me to want to talk to anyone. Even sending a good morning text tired me out. I didn’t even have the energy to talk to anyone at work either.
I’m so scared of what my feelings toward her are leading to, and I really want things to work with her more than anything. Does anyone have any advice or guidance?
Thank you.
It's been three years since this awful condition completely changed my wife and best friend (which coincides exactly with when she stopped taking BC).
I've dealt with it all: gaslighting, denial, rage, you name it.
I'm so thankful I found this community recently. It was like I could have written many of these posts myself. I am so incredibly isolated and lonely, but this sub helped me feel a little less so.
I did it again tonight: I asked for empathy / understanding which led to the predictable outcome of me apologizing for nothing, groveling confusedly, and being left sad and confused. I know not to engage during luteal, but its so hard to tell when its actually over, and my wifes bad time extends beyond sometimes or shows a bit during other parts of the cycle. She has never really fully admitted to how cruel her actions are during these times.
I'm starting to realize that I enter what seems to be a sort of daze / disassociation when I'm stressed around her. I can absolutely feel her disgust towards me when I do (which she of course denies). Its like the more affected I am the more she hates me. Anyone else experience this?
Thanks for giving us a place to vent. I am so grateful that this community exists. Hang in there everyone
First off I would like to say I am still doing my research about PMDD so forgive me if ‘episode’ was the wrong word. Anyways - my girlfriend has PMDD and it is really severe and debilitating for her. She has no help for it so she deals with it by herself. I try to be very understanding and I actively am still learning about it to know what she goes through better. The problem is is I feel like when she is going through these horrible few days where she is angry and upset, I never do anything correctly. I feel like I am constantly fucking up and making things worse. I have asked her many times what she needs in those moments and all she tells me is support. But when I do listen and try to be there she gets angry. I don’t think anyone but me has seen her anger when she is having these days, and I have just attributed that to the fact that I am her partner and she talks to me the most so its easier to take those emotions out on me. I feel really hopeless because we always end up fighting during this time and I want to understand how to help. We get into fights where they get absolutely nowhere and it is circles and circles over and over again. I really love her and this is not meant to make her look bad she is lovely and I know she always hates these moments after she feels better and does not like to be angry. Does anyone else experience this? Whether you are a partner of someone with PMDD or you yourself have PMDD I would like any advice
So many of the posts I’ve read throughout the past few years sound like they are coming from partners cut from a similar cloth. The words often used when describing themselves are “patient, supportive, kind, understanding, and loving”. As a PMDD partner myself (38m) I would describe myself with these words as well.
I’m an introverted liberal. I bet most of you are as well.
I’m accepting, tolerant and compassionate. I feel like possessing these traits is a must in order to maintain in a relationship with someone afflicted with PMDD.
I mean, could you imagine your token right wing conservative male putting up with the behavior that we deal with on a monthly basis ?
I imagine it would be a lot of fire and brimstone throughout a very short lived relationship. In my opinion, these type of men simply lack the personality traits that PMDD needs in their partner in order to have any hope at forming a long term relationship.
Sometimes I wonder if I’ve turned into a total push over. I wonder if, rather than continuing to walk on eggshells, get screamed at over trivial things, and irrationally blamed for anything and everything, I should try the “fighting fire with fire” approach.
I wonder if the PMDD hostility actually thrives on an over abundance of tolerance and patience shown by their partners.
There were two occasions when I absolutely lost it during an argument in her peak luteal (37 f) and it lead to ME terminating the relationship for a change.
Wouldn’t you know it, a few days later she reached out and apologized. It’s not something that I’ve repeated, because it’s not who I am and because I am madly in love with my girlfriend of 4 years. But I was curious to hear if anyone noticed a difference in how their partner reacted during the times where you may have verbally lashed out in retaliation to cruelty displayed in a fiery luteal phase as opposed to the patient and tolerant way that you would normally react?
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 need advice on how to handle a girlfriend with PMDD just when I think it’s getting easier it just got harder and harder. I’m starting to realize that there’s no end in sight but I love this girl. I want best for this girl, but this will never end will it the fight? Arguing over small details, an argument as close as moving a thumbtack over an inch and making it seem like it’s a terrorist attack. I need to know what type of improvement I can deal with our conversations I need to make with my partner.
My PMDD partner and I have been together for almost 3 years. We've been living together for 2. My partner got their diagnosis 8 months ago.
Backstory:
Each time we argue it's either something that is a small issue or can easily be me double checking and confirming plans for the weekend. But, the arguments keep getting bigger and bigger.
In the past my partner kept bringing up the fact "I can always just move out" we usually both simmer down overnight and sometimes the next couple days, no contact, just space until my partner apologizes or if there's something we need to talk about with life that requires us to talk.
When there's an apology I always say to them, "It's fine, it's trial and error we'll get it figured out it's going to take some time. We'll get through this."
Current Day:
Today we had an argument on the phone that moved to texting over me getting my partner an ice cube tray that they didn't ask for.
I thought it would be something fun to have for ice cubes since the mold was shaped like a pear. But, apparently that was not the best idea. (I also have the mindset of if I can replace or fix something that is starting to fail why not just do it and be done with the hassle of the old product)
This eventually turned into my partner saying to me in a text message :
You come up with solutions to things where a problem doesn't exist to begin with
Why are you seeking things out to try replacing? Is what we have just not good enough for you anymore?
Am I not good enough anymore or what? Are you going to try fixing me or replace me down the road?
You seem to do that with objects so why not.
I replied with:
I can't believe you would even say something like that, I'd rather talk when you get home.
Why would that not be something to talk about, because that tells me that that's how you think of me and that fucking hurts.
Afterwards:
I was absolutely furious and hurt and I never got an answer back and decided I guess I'll move out. I packed almost all of my stuff by the time they came home.
Stopped in our bedroom and saw the photos of us on the wall and thought "WTF am I doing? I'm just going to let the damn thing win? I sat in the living room crying for a bit after realizing what I was doing and then talked to my partner on the other side of the bathroom door.
I told them I have loved them for almost 3 years and I still do, and that me packing my shit is just proving that this PMDD is doing what it exactly wants.
TLDR: Partner and I argued. Words were said. I started packing, realized what I was doing and now I'm here writing this post.
What do I do? What did I do?
I feel so lost and empty because I don't want to lose my partner but any attempts I make to try and support them just get absolutely shot down. I could move my eyes wrong and then it all backfires. They always want space but I always want to help and it's a constant push and pull deal.
I know to not take anything personal when their PMDD flares up out of nowhere but it's been getting harder to tell when it's an episode or just a general argument. Harder yet, to accept the apologies at full value as well.
I’ve been with my gf for almost 8 months and I’ve witnessed her pmdd episodes at least 5-6 times and it always ends up her ghosting me and me needing to apologize. I’ve been nothing but supportive and reassuring but during these times she’s extremely hyper critical and would get emotional at anything I do, saying she’s worth more than that. But I’m not sure how much more I could give without it draining the life out of me.
2 days ago she had a really breakdown about me being exhausted and not being what she expected from me that day. I’m not sure why, but my entire outlook on her changed. I felt so physically and mentally drained that even talking tired me. Yesterday I texted her how drained I felt and that I don’t feel confident in having a conversation. Instead of asking what’s wrong, she ghosted me. And it’s making my resentment build.
I really want things to work as outside of luteal, she’s the girl of my dreams. Does anyone have advice or gone through something similar?
Tonight she threatened to take our son away from me, she informed me she has been telling her councilor that I abuse her. So if I call the police she will have our son taken away from me.
This started with me saying I was going to shower after I got home from work (I work in road construction, I was covered in rock dust and dirt, also probably some tar.)
This was not what she wanted to hear and led to a full blow screaming match about who was going to dry and put clothing on our 3 year old son after she dragged him into the shower with her. During which she seems to enjoy calling me a cunt in front of our son.
This is has been my new normal since she when off her ssri because it wasn't working for her depression. Now as of a couple of months ago she has told me she has PMDD.
I'm not sure if the ssri was helping manage it before, but from my perspective it just seems to be getting worse over the course of this year.
After she had calmed down and our boy was dressed I was trying to chat to a men's helpline, they were not helpful.
She saw me typing on my phone and has since accused me of reporting her to child services.
Basically can someone on her please tell me if this is the type of thing I'm going to have to deal with for as long as we remain together?
Because I had been thinking I'm just in an abusive relationship for awhile now, tho I had that opinion after her behaviour towards me when she has been drinking. But I can't remember if she was ment to be in a PMDD window during those times as we had just had our baby so periods were not a happening thing.
Sorry I seem to be rambling, but I'm trying to figure out if all the "you trigger me" and "your responable for this because you know I'm a week out" is just her way of excusing the abusive behaviour or is actually something I am now expected to deal with 2 weeks of every month?
Hi everyone, I am an almost 34-year-old mother of 3 children. I became a mother for the first time at 27. I have never been able to tolerate the hormones from the birth control pill, and my pregnancies were really not relaxed either, partly due to the hormones. There isn't much difference in age between the last two children. The second was 6/7 months old when I was pregnant with the third.
I have ADHD and in the past I also built up some trauma-related anxieties that aren't even noticeable in the weeks outside the luteal phase. I have used 3 SSRIs and they don't work at all, various mini pills, pills with only progesterone, etc. I’ve tried the Yasmin birth control, the Yaz birth control and waaaaay back other birth controls.
I am currently taking Utrogestan 100 mg in the evening during the second half of my cycle, but I haven't noticed anything yet. My symptoms during the luteal phase are severe: crying spells, thoughts of unaliving myself, anxiety, fatigue, gloom, feeling like a completely different person, sometimes being very easily irritable, depressed, etc. Please let me know what helps/helped you?
6 months I have told my partner she needs to get help, 6 months I told her the yelling and way she speaks to me needs to stop otherwise we will not last. Took me to breaking point of going on a holiday where she had a episode at one stage and locked herself in the hotel room not letting me in then I tried to break up with her, and there was screaming yelling crying physically not letting me leave. Second time right before the end of the holiday she is screaming at me middle of the streets, finally we went back to the hotel room and I lost my cool. Said a bunch of things I shouldn’t have, the next morning we are talking about the night before and apologising and she tells me she was recording me the whole time. I couldn’t believe it, all the episodes she has had and how patient I’ve been for 6 months and calmly and politely I’ve asked her to get help, I admit I shouldn’t have snapped but when you feel like your talking to a manipulative child for so long it’s hard not to. I broke up with her on the spot and said if I become that bad of a person when I’m with you it’s clear this isn’t gonna work, she did the same shit as always, apologising and begging crying ect. I agreed after a few hours just to keep her quiet. I said she has till the end of this month to get help otherwise we are 100% done, but honestly, after having to deal with this for so long and communicating and not getting anywhere, I feel like I have lost feelings, it sucks so bad how 1/2 or 2/3 of the month someone can be your best friend and then the rest it’s so painful. I am wondering if she does get help if it’s too late now, can I re gain the feelings I think I have lost? I find myself constantly exhausted and depressed since my return 3 weeks ago, having to constantly again and again 30+ times a night give someone reassurance can become so exhausting. She still snaps but not nearly as bad and when I pull her up usually stops. She has gone to a doctor will start taking primrose oil and if that doesn’t work anti depressants, and is going back to see her psychologist who helped immensely prior to 6 months ago. But I seriously don’t even know if I love this woman anymore, or if I’m just holding on bc she’s my best friend. Wondering if anyone else has experienced something similar and if change actually happen and you stayed, did the spark come back? Or have I been pushed to my limits?
It’s nice to have a place to vent and I know people are feeling and going through similar situations
I've read these posts for quite some time and learned a lot about how to be the best supportive partner I could. Well...it finally happened and honestly I'm not sure how to feel right now. We both were previously married and had been together for 4 and a half years. The most destabilizing part to me has been the last two years - hearing that I wasn't a good partner, I wasn't showing up, I was avoidant or inconsistent. After some time I started to believe it and the guilt got so heavy. In the last 6 months or so she was put on medication for ADHD and her best friend became chatgpt. I don't know what it was but the echo chamber of the AI always agreeing and the the responses that I would get from her that were obviously written by it. When I'd try to talk about how the connection felt so distant, that too became my fault.
Part of me feels relieved, but also sad and lost. I'm not really asking any questions, just sharing.
Hi everyone first time poster in this subreddit.
I have been dating someone for about 5 months and just during her last period did she mention that she thinks she might have PMDD. Her previous periods have been textbook PMDD in retrospect, so it absolutely makes sense and her symptoms check out.
So she is in her luteal phase right now, but we haven't had a chance to make a plan for her luteal phases yet since this is all so new. She's in a bad place and this morning was very angry at me and says that she needs to have a heart-to-heart. I told her that I don't have capacity until X Date (after her period starts) and ideally X Date (when her period ends), so it would be best if we could have the heart-to-heart then.
She says it's urgent and that I really need to prioritize it, otherwise she can't move forward relating. I'm not sure what to say or do, since we haven't had a chance to make any plans yet since it's all so new. According to all the wonderful resources here, I shouldn't engage with her right now.
Does anyone have advice for what I should say or how to handle this?
Update:
I tried the following.
So I've told her that unfortunately doesn't work for me then. This is so painful, I miss her so much and I just want her to be ok.
Reading the posts here, it's clear I'm not alone in what I'm going through ... which brings me some comfort.
My wife has always had intense PMS, but in the last 5yrs it's exploded into full-on divorce threats most months. It always passes, and the other 3/4 weeks are what I'd call "normal".
But if I could really narrow in on one thing that I want advice on, it's this:
Even when my wife is deep deep deep into those days, she is able to act largely rationally and insists on having endless "rational" discussions with me, where not taking part is not an option.
Invariably these start innocently and collaboratively and I miss the hint before it turns into "here's what you did wrong, I need you to promise you will never ever do that again, will never ever be frustrated with me, etc. I know that's not fair and it's unrealistic, but that's the kind of man I need ... can you do that?".
I don't see how I can lie and say "I absolutely can do that" because of course I can't be perfect, and I've been told 99% is not good enough.
I don't see how I can be brutally honest and say "that's too much" because that gives her validation for all her anger (i.e., "yep, I'm right, my husband doesn't care about me").
I've tried hard to find nurturing honest words of affirmation ("I understand, and I'm going to work really hard and do my absolute best") but that quickly gets interpreted as either "no way" (see above), or "that's not an answer, let's try this again for another 30min".
This is consuming hours (plural) every day. I'm not "allowed" to leave the conversation, regardless how harsh/pointed it becomes, because that "shows my husband doesn't care about me when I need his support".
I've also tried "I absolutely want to talk about this ... can we do that in 3 days?" which gets shot down with "in 3 days I'll have forgotten about the pain I'm in now, and then we'll do nothing to prevent the pain next month ... I want to make a decision NOW about whether I'm going to stay in this marriage or not".
Please ... anyone who can related to this ... tell me your stories ... tell me you found a way to survive this. I really feel like each month is turning into a race between "how long is she going to be suffering?" and "how long is it going to take her to research a divorce lawyer?".
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.