[LaurieM35]

Ok many of you older members may remember hearing me complain alot last year about headaches and severe mood swings about 2 weeks prior to Aunt Flo coming to visit. Karen C and I use to chit chat all the time about what it could be, she always kept telling me it was hormonal that I should seriously check with my doctor about some hormone testing and all that good stuff. Well I finally did today. Had my yearly today and the diagnosis is in. She couldn't believe I have gone a year like I have, seeing me the way I am today. I have PCOS and if I am not on the birth control pill I do not have a period, when I do take the BC pill two week prior to AF hitting I am a witch and MEAN mood swings, I have migranes and just dont' want to be around anyone. That is why I always stop taking the BC pill cause it gets SO bad. The older I get the worse they get. So besides my sugar being low and insulin being high, diet will correct this problem, I am also suffering from a serious case of PMDD:
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Premenstrual Dysphoric Disorder
(PMDD)
Twenty to fifty percent of women between the ages of 30 to 40 with regular menstrual cycles experience premenstrual syndrome (PMS) as a regular physiological occurrence every month. In more severe cases, affecting three to five percent of menstruating women, this syndrome is labeled as premenstrual dysphoric disorder (PMDD) . Patients with severe PMDD are at risk for developing postpartum depression. Furthermore, women successfully treated with antidepressants often show breakthrough symptoms of depression in the premenstrual phase of their menstrual cycle. All that is needed is a small increase in the dosage of the antidepressant premenstrually.

PMDD Symptoms
Women with PMDD complain of irritability, anger, tension, marked depressed mood, and mood lability (crying spells for no reason, verbal outbursts, or tantrums ) to such a severity that quality of life is seriously compromised. In addition to these symptoms, some women complain of lethargy, sleep disturbance, limited concentration and a host of physical symptoms such as breast tenderness, headaches, joint and muscle pain, bloating and weight gain.

The primary symptoms that distinguish premenstrual dysphoric disorder from other mood disorders (i.e., major depression) or menstrual conditions is the onset and duration of PMDD symptoms -- with symptoms appearing during the week or so before and disappearing within a few days after the onset of menses -- and the level by which these symptoms disrupt daily living tasks. (This diminished level of functioning is generally in great contrast with the same woman's interactions and abilities at other times during the month.)

The symptoms of PMDD may resemble other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Consult a physician for diagnosis.

What PMDD Is Like

Kym says, "on my last bad day, I got very suicidal. I felt like I couldn't take being like this anymore. The worst part of it was knowing that on any other day, I liked my life, that it was this illness making me feel so worthless. I couldn't help myself, though. The feeling was so strong. I didn't attempt to act on my impulse. I pray I never do. It's just that it feels overpowering. I'm afraid on those days. Afraid that maybe next time I won't win the PMDD battle."

"On that day, my two beautiful girls watched me lay in bed and cry uncontrollably. They even made me little cards to tell me they love me. I felt ten times worse because in my heart, I wanted to jump out of that bed and be normal. I didn't want them to see that. I love my children and I want to protect them from stuff like that, but my hormones had a stranglehold on me. They didn't know I was suicidal, depressed, or anything else. Just that mommy gets this way every month, that mommy is sick. And in a few hours, mommy will be back in the kitchen baking a pie like nothing ever happened."

(Used with permission. © 2003 Kymberlee Hose)



What Causes PMDD
Although the exact cause of PMDD is not known, several theories have been proposed. One theory states that women who experience PMDD may have abnormal reactions to normal hormone changes that occur with each menstrual cycle. This may include the fluctuation of estrogen and progesterone levels that normally occur with menstruation causing a serotonin deficiency, in some women (Serotonin is a substance found naturally in the brain and intestines that acts as a vessel-narrowing substance, or vasoconstrictor). Additional research is necessary.

How is Premenstrual Dysphoric Disorder Diagnosed?
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Aside from a complete medical history and physical and pelvic examination, diagnostic procedures for PMDD are currently very limited. Your physician may consider recommending a psychiatric evaluation to, more or less, provide a differential diagnosis (to rule out other possible conditions). In addition, he/she may ask that you keep a journal or diary of your symptoms for several months, to better assess the timing, severity, onset, and duration of symptoms. In general, in order for a PMDD diagnosis to be made, the following symptoms must be present:

over the course of a year, during most menstrual cycles, five or more of the following symptoms must be present:
depressed mood
anger or irritability
difficulty in concentrating
lack of interest in activities once enjoyed
moodiness
increased appetite
insomnia or hypersomnia
feeling overwhelmed or out of control
other physical symptoms
symptoms that disturb social, occupational, or physical functioning

symptoms that are not related to, or exaggerated by, another medical condition

What is the Difference Between PMS and PMDD?
The physical symptom list is identical for PMS and PMDD; while the emotional symptoms are similar, they are significantly more serious with PMDD. In PMDD, the criteria focus on the mood rather than the physical symptoms. With PMS, sadness or mild depression is not uncommon. With PMDD, however, significant depression and hopelessness may occur; in extreme cases, women may feel like killing themselves or others. Attributing suicidal or homicidal feelings to “it’s just PMS” is inappropriate; these feelings must be taken as seriously as they are in anyone else and should be promptly brought to the attention of mental health professionals.

Women who have a history of depression are at increased risk for PMDD. Similarly, women who have had PMDD are at increased risk for depression after menopause. In simplest terms, the difference between PMS and PMDD can be likened to the difference between a mild headache and a migraine.

PMDD Treatment
Treatment for PMS depends on the severity of the symptoms. For mild cases, treatment recommendations include diet modifications such as high carbohydrate meals and reducing salt, caffeine and alcohol, as well as a variety of methods for stress reduction and relaxation such as exercise, counselling and stress/behaviour management strategies.

For severe PMDD, treatment is more aggressive, often requiring pharmacological intervention in addition to nonpharmacological treatments. The selective serotonin reuptake inhibitor class of antidepressants are effective in the treatment of PMDD. Fluoxetine (Prozac - Serafem) has been widely studied and found to be effective in reducing symptoms of tension, irritability and dysphoria. These results have been replicated with sertraline (Zoloft) and paroxetine (Paxil). Use of the SSRIs is positive as well in that side effects, such as nausea, diarrhea, headache, and insomnia, to name a few, are minimal and reportedly tolerable by the majority of women.

For some women, even more drastic measures must be taken to ameliorate the symptoms of PMDD. For these women, hormonal therapies are necessary that work by suppressing the menstrual cycle. Effective hormonal therapies include gonadotropin releasing hormone (GnRH) agonists, estradiol and danazol. With respect to the GnRH agonists, women may not be able to continue with this form of therapy in that side effects are similar to symptoms of menopause. This, then, can increase the occurrence or severity of osteoporosis. With estradiol treatment, women must be concurrently treated with progestogen to prevent endometrial hyperplasia. Danazol is effective, however, that has quite a severe adverse effect profile due to its androgenic and anti-estrogen properties. In addition, danazol treatment affects menstrual cycle length. Thus, the side effect profile of hormonal therapies makes them less tolerable in the treatment of PMDD.

For some women, the severity of symptoms increase over time and last until menopause (when menses ceases). For this reason, a woman may require treatment for an extended period of time, and may require several reevaluations to adjust medication dosages throughout the course of treatment.

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So now she has prescribed me with a different BC pill, a pill I can't remember the name off the top of my head but you know in the BC packs you have that last week of white pills aka sugar pills? Well this brand of pills does not have that, it has a 4 week supply of the BC to keep my hormones at an even kill every single day, also she has given me a continous prescription of migraten, a migraine pill to take when the migraines hit. Also she has put me on Sarafem which is suppose to help with the following:

depressed mood
anger or irritability
difficulty in concentrating
lack of interest in activities once enjoyed
moodiness
increased appetite
insomnia or hypersomnia
feeling overwhelmed or out of control
other physical symptoms
symptoms that disturb social, occupational, or physical functioning

symptoms that are not related to, or exaggerated by, another medical condition


So we will see if it helps or not and if I can have a normal life again!!!

Wish me luck that this helps!!

[LaurieM35]

If this doesn't help me, then we are going to stop AF all together for the most part and then give me something about every 4 months to have AF just so I won't set my self up for cervical cancer.

[sharoncity]

Well, it is good that you finally got an answer. I hope the pills work for you and you get some relief. How horrible that some women have to go through this each and every month! I wish you all the best with the new course of treatment Laurie!

[hockeyfan7]

Laurie,

I hope taking the BC pills every day works for you.

I do kind of the same thing because I have some bleeding disorder I can't pronounce and can't spell. For 3 months I skip the blank row and go to the next pill pack and don't have a period. Then the 4th month I do.

After 3 years of doing this, my period has gotten way lighter and shorter in length.

[LaurieM35]

Well I am hoping between the BC pills adjustment and the Serafen that something will get me back to normal!

[babygirl10445]

Oh Laurie...The doc that I work for Highly reccommends Sarafem. So I hope it works for you!!!

[floridarusty]

I will keep you in my prayers Laurie that this is the answer for you.

If you have to change your diet to a high carb, you can still lose weight but don't you dare leave this site..........we will hunt you down and USE THE WHIP!!!

Phyllis

[LaurieM35]

I will NEVER eat a high carb diet, NEVER!!! High carb and PCOS just don't mix for me! LOL!

[Lafayette]

I honed in on the "high carb diet" part, too. It certainly explains why cakes, cookies, etc. seem like such a good idea when we have PMS!

I swear, I have every female reproductive issue under the sun. I got so many conflicting diagnoses and lousy side effects, including an onset of menopause at 25, that I quit taking everything five years ago.

I had really good luck with exercise and my weight loss a few years ago. I'm hoping to get back that relief. So are a few other people in my life

Good luck!