I remember sitting on my psychiatrist's fancy white couch six months after giving birth, perched on the edge of sadness. I had already been diagnosed with post-partum depression and prescribed anti-depressants. They were helping me cope with the chaotic day-to-day life of new motherhood, but inside I was still struggling emotionally. What I couldn't figure out was why it seemed to be worse at certain times of the month.
I waited quietly, feeling like a mental health specimen on display. I listened to her high heels click across the wooden floor of her office. It seemed to be taking her forever to evaluate my answers on the questionnaire. All I could think about was the beautiful baby girl waiting for me at home. Why was I here with this stranger and not there with her?
The answer appeared in the form of an acronym I heard for the first time that day: PMDD. I had no idea what it stood for, just a vague notion that it had something to do with PMS. My doctor explained that while the majority of women experience only mild or occasional premenstrual syndrome symptoms before their period, a "lucky" few (less than 10 per cent) suffer from a severe form of PMS called premenstrual dysphoric disorder (PMDD).
When I have PMDD, it's like I have no psychological buffer, nothing to protect me from life's petty, everyday problems.
The symptoms my doctor rattled off read like one of my journal entries. Increased irritability? Check. Volatile mood swings? Yep. Sore boobs? Uh-huh. More interpersonal conflicts? Definitely. Weepy for no real reason? Exactly.
Suddenly everything made sense. Now I knew why I felt like the worst version of myself for a week and a half of every month. The truth washed over me in a wave of relief: I wasn't going crazy; my hormones were. There was actually a reason why I felt so awful. The good news was that I finally had a name for what I was feeling. The bad news was that it's incredibly difficult to treat it.
Most people I know have never heard of PMDD and don't even know what it stands for. Others just downplay it as run-of-the-mill PMS or laugh it off as something normal that all women experience at that time of the month. But that's not right.
PMDD is like PMS on steroids; it's not just a bad mood or feeling over-emotional for a few hours. It's an ongoing pattern of severe premenstrual symptoms (both physical and psychological) that interfere with your daily life and relationships.
When I have PMDD, it's like I have no psychological buffer, nothing to protect me from life's petty, everyday problems. I find myself incapable of feeling anything small -- all my emotions seem like a big overreaction. Sometimes I catch myself picking fights with my husband for no good reason except that I really want to argue with someone.
It takes conscious effort on my part to recognize what I'm doing and resist my instincts. I try to get out of the house, take a walk and listen to some music to distract myself. Paying more attention to diet is important, but it's hard to avoid chocolate, carbs and caffeine during this time (when it's pretty much all I want to eat).
One of the best things I've done to combat PMDD is track my symptoms in an app. Whether it's feeling bloated, having a migraine or being extra-irritable, it all gets stored and recorded for future reference. This allows me to see how I'm doing month over month; it also helps me predict which days might be the most difficult.
The fact that PMDD can cause major disruption to my routine and relationships is the reason why I take it so seriously. I know on an intellectual level that it will eventually pass, but when I'm caught in the grips of it, it's very easy to give in to it and just be downcast.
Recently I set up a calendar reminder that pops up about a week or so before my period. It's a signal to help me be more aware of my upcoming moods, a hint to be kinder to myself during this time. Keeping my husband in the loop is also incredibly important. We try to avoid having any serious conversations since arguments can easily spiral into drawn-out debates.
PMDD also affects my relationship with my little girl. I'm an exasperated and drained version of myself when I'm with her. Not as present. Sometimes I feel guilty for needing my own time-out. I wonder what could be more important than looking after my daughter? But then I remember: Looking after myself.
It's been two years since I was first diagnosed with PMDD and it's still a challenge. On bad days it feels like my blood pressure is constantly set to skyrocket level. Sometimes the slightest irritation will send me over the edge into a haze of rage. On other days, the clawing anxiety surrounds me like a low-level hum. This is when I obsessively tidy and de-clutter my house. Keeping my kitchen spotless is a way of taking back some control during a time when I feel at the complete mercy of my hormones.
The first-line treatment for PMDD is often antidepressants, or selective serotonin reuptake inhibitors (SSRIs). They're popular because they usually help relieve the worst symptoms. My doctor and I are still experimenting with finding the right dosage for me, but I have to say they do help overall. Some women take them continuously throughout the month, while others just need them for the luteal phase (the two weeks before their period when the world goes dark).
Antidepressants aren't the perfect solution, though. Sometimes the effects wear off, or you need more and more just to maintain an even keel. They can also make you feel strangely numb and cause dreaded weight gain. You certainly don't feel as amorous in your relationships. For me it all comes down to what's more important: my mental health or my looks? My peace of mind or my sex drive?
I don't want to live my life as two weeks on, two weeks off. If medicine helps me bridge the gap between PMDD and the rest of my life, I will happily continue taking it. I don't want to be at a loss or feel like an emotional write-off; I just want to feel like myself for the whole month.
Follow Tara's story as she writes about finding the poetic moments in the chaos of everyday parenting.
Follow HuffPost Canada Blogs on Facebook
MORE ON HUFFPOST:
According to Dr. Suzanne Wong of the Department of Obstetrics and Gynecology at St. Joseph's Health Centre in Toronto, and associate professor at the University of Toronto Department of Medicine, there a several reasons as to why you can get an extremely heavy period. "Periods can be heavy in women with a diagnosis of uterine fibroids or polyps or a thickened uterus called Adenomyosis," Wong tells The Huffington Post Canada. Heavy bleeding has also been associated with a genetic bleeding condition called "von willebrand’s disease" in adolescence. Both scenarios should be examined by your doctor. Perimenopausal hormone shifts can also cause heavy bleeding in women between the ages of 41 and 51. Wong notes that periods during perimenopause may also be irregular before they cease all together.
Unlike extremely heavy periods, which can signal other health issues, light periods aren't as much of a concern. "The normal amount of bleeding is variable and ranges from light to heavy depending on the woman," Wong explains. As long as your periods are regularly occurring (every 23 to 35 days) there should be no concern. "If the amount of flow changes to become lighter it may represent a slight hormonal shift that is probably of no significance," Wong says.
If pregnancy is not a possibility, a late period can usually be explained by a hormonal change. Factors like changes in weight, emotional stress, eating disorders, high performance athletics or having polycystic ovarian disease can cause women to have a delayed or missed period. "If you miss one period, this means that you did not ovulate that month and there should be no concern if they return to a normal pattern," Wong notes. If you aren't already keeping track of your period, Wong recommends getting a calendar or an app to do so. That way, if your periods are late (occurring at intervals greater than 35 days) persistently over six months, you'll know and be able to show your doctor.
Just like late periods, early periods usually have a hormonal cause including stress, polycystic ovarian disease or thyroid hormone abnormality, says Wong. And abnormal spotting or bleeding can also be mistaken for an earlier period — if you are concerned, check with your doctor.
Brown coloured blood is common during the final days of your period. According to Wong, this is a result of the blood that has been settled in the uterus being expelled.
"Missing a solitary period is likely from a temporary hormonal imbalance, usually caused by stress," says Wong. But birth control methods like the pill, patch, ring and IUD can also cause very light or non-existent bleeding. If your periods become regular again after a missed period, then there should be no cause for alarm. However, if you regularly miss periods or have an irregular bleeding pattern, you could be experiencing hormonal issues caused by stress, abnormal thyroid levels, or polycystic disease. As a reminder, if your period is irregular you should consult your doctor.
Periods can last anywhere between two and seven days, but anything more than this is considered a prolonged period. "If you have periods lasting more than seven days on a regular basis, you should contact your doctor," says Wong. Prolonged periods are often associated with heavy periods, and can lead to iron deficiency anemia that will affect your overall health.
According to Wong, this is actually a normal side effect of starting a new birth control pill, especially on that is low dose and is referred to as "break through bleeding." If this is happening in the middle of the cycle, then it is likely hormonal and of no concern. But if it persists more than three months, Wong recommends seeing a doctor to adjust your medication and rule out other causes such as uterine/cervical polyps, and infection. It is also advised to get an updated pap smear and cervical cancer screening in this scenario.
Spotting can be a side effect of being on a birth control pill, or using a copper IUD, Wong explains. Spotting can be due to infections (STDs) and, or more concern, a sign of cervical cancer. Harmless causes of vaginal spotting between periods can also include polyps on the cervix or a condition called "cervical ectropion," which are sensitive cells that protrude on the exposed surface of the cervix and are prone to infection and abrasions, Wong explains. Your doctor should be able to detect both of these conditions during a pap smear.
"Clotting can be a sign that your periods are very heavy," says Wong. (Check out the heavy periods section for more information).
During your period, the lining of your uterus produces a natural chemical called prostaglandins, Wong says. Prostaglandins causes small contractions of the uterus to help shed the lining during your period which can cause cramping. It also affects the intestines and can increase movement of the bowel, which results in more frequent bowel movements and sometimes, diarrhea.
Follow Tara Mandarano on Twitter: www.twitter.com/taramandarano