Tug of War with PMDD
‘Tug of war’ has long been my analogy to describe my experience with PMDD. It’s just like the game we played as kids, except in this case it’s just me up against a 9-foot, 300-pound, monster! I dig my feet into the ground, feeling as though my only option is to hold onto the rope and pull.
Five years ago after coming off the contraceptive pill for the first time, I found myself experiencing a significant decline for a week, every 4 to 6 weeks. The days would blur together.
The tug of war looked like constant crying (without reason), brain fog, fatigue, dissociation, staring at walls, and feeling so depressed that I felt physically unable to move.
I spent days in bed.
I felt limp, irritable, socially withdrawn, and avoidant.
The hopelessness was overwhelming.
Anxiety was also ever-present – paranoia, overthinking, and rumination.
My supportive partner felt equally as helpless in trying to get through to me during these times.
I felt like a different person.
I’d convince myself that I was unlovable, that I was ‘too much,’ and that I was an imposter within my relationships.
The tug of war was exhausting and defeating.
A week later when my period arrived, I would return to my usual self –active, energetic, humorous and social.
I began tracking my cycle and did so for 6 months. I recognised a pattern between the tug of war and the corresponding stages in my cycle. Being a therapist, part of my job is to explore, assess, and provide answers for my clients about their internal struggles. I was determined to do this for myself also.
After reading a substantial number of articles about hormonal health, I finally saw it – Premenstrual Dysphoric Disorder (PMDD). The relief in that moment was overwhelming!
At the time, I realised that PMDD was only recently classified as a depressive mood disorder in 2013 – news to me as an early career psychologist! PMDD was still in its infancy in being recognised as a significant condition. I read through the Diagnostic Statistical Manual (DSM-5) criteria and every symptom that I checked off brought relief and reassurance.
The more I read, the more validated I felt. I learned that the cause of my physiological and depressive symptoms was my brain’s difficulty in managing the changes in estrogen and progesterone during the luteal stage of my cycle each month. Though I felt relieved, I also felt incredibly sad. There is no cure and the research (whilst building) was still limited at the time.
As well as this, the many personal stories and lived experiences I read highlighted the difficulty in finding supportive/empathetic health professionals with an understanding of the condition. The consensus in the PMDD community was to self-advocate for diagnosis and treatment. So I decided to do just that, in the same way that I would support all of my clients to.
Self-advocating quickly became tiresome. The grief and disappointment emerged. I was met with different doctors who invalidated my experience and refused to consider my symptoms - “Don’t all you females complain about these things each month anyway?”
I had to take matters into my own hands until I could find a supportive doctor. So I made some big lifestyle changes with the hope to find relief in the struggle. I began personal training and Crossfit, took up running again, practiced mindfulness meditation, took supplements and arguably the most helpful at the time – began therapy with a lovely psychologist who validated the diagnosis and helped me work specifically on my depressive symptoms. It didn’t stop the tug of war each cycle but it did energise me a little more so that I could hold onto that rope.
Fast forward to the present and my tug of war experience is significantly different. I have a great treatment team - an empathetic doctor, a Naturopath, and a new therapist. I’ve since shared my diagnosis of PMDD with a few very close friends and family and it was one of the most vulnerable yet rewarding experiences I’ve had (aside from this blog!). I had to face my biggest fear and source of shame – that people will leave me because I’m ‘too much.’ Instead of the anticipated abandonment, I was met with an incredible amount of support and unconditional love (thank you – you know who you are).
Many of my loved ones had never heard of PMDD nor did they ever suspect my struggles. I realised how well I had learned to mask over the years, how to minimize how I was truly feeling and how to avoid detection when I withdrew.
The tug of war is still ever-present and the depressive symptoms fluctuate in intensity each cycle but I don’t feel alone anymore and I’ve realised how powerful that is.
As a great friend once said in response to my shame, “You don’t choose to feel this way.”
I’ve come to accept what I can and can’t control about this tug of war.
I can’t control the hormonal changes nor the fluctuations in my cycle, but I CAN control how I see my PMDD and my relationship with it.
I realised that pulling and struggling just depleted my energy and internal resources even more. I realised that fighting it, didn’t change it. So instead I accepted it, I chose to drop the rope. I decided to put my energy towards self-care, rest and recovery instead.
I learnt to be kinder to myself, softer, and more self-compassionate.
I focused on the resiliency that came with the heaviness. That if I can get through the worst PMDD days, then I most definitely can push through any challenge.
I’ve used this approach to encourage myself to be brave and try new things. In the last 2 years I’ve competed in Crossfit competitions, completed an aquathon, run my first full marathon and 2 half marathons, as well as taken up rock climbing and pole fit classes. My most recent half marathon in December 2021 was completed during the week of a PMDD tug of war. Whilst it was incredibly hard, it’s now one of my proudest moments.
There is still so much to learn about PMDD. It affects 1 in 20 reproductive women and those assigned female at birth, yet there is still a gap in the literature. Thanks to resources like IAPMD, awareness and education is growing and the conversation around hormonal health is building.
**My story is dedicated to those in my circle. On the toughest days, they are my tug of war teammates. Their love, support, patience, and compassion have become my greatest source of strength. Thank you.
MEET ASHLEIGH
Part-time psychologist. Full-time dog lover, plant grower, and fitness enthusiast.