Today I have a moderately bad case of pre menstrual dysphoria. PMDD symptoms came along with the severe depression and in general month to month throughout recovery it’s been getting better.
But this month I seem to have slipped back into feeling very overwhelmed and struggling to read, listen, cope with light or touch. Sitting outside closing my eyes and listening to birds and insects and wind helps me stay in the moment and keep calm.
I ate some soup and potted up echeveria apus cristata (pink and green succulent) leaves I’ve been rooting. I’ll pick some more strawberries and maybe paint my nails innabit. All while hoping this blows over soon.
I’ve had support for depression symptoms through my GP but when I’ve requested specific help for increased suffering in the week or so leading up to my period I have been ignored. This isn’t me being hyperbolic. When I try to explain symptoms and timings and intensity the conversation is changed to am I coping on my medication and the call is ended.
At it’s worse, my pre menstrual dysphoria symptoms would include very severe suicidal urges and paranoia. I would be crippled by fear and imagine scenarios where I am about to come to harm which felt in the moment very real. I wouldn’t leave the house for fear of completely losing it or trying to hurt myself.
I received 13 sessions of CBT therapy on the NHS. Throughout the course of therapy I would do weekly mood check-ins rating severity of symptoms. As my general depression symptoms began to ease my therapist noticed a strong pattern of pre menstrual dysphoria. With my permission she contacted my GP to let them know and suggested that I may need additional support.
A few months before my therapist discussed this pattern my dad had pointed it out to me. He noticed how bad I got in-line with my cycle and brought it up in conversation. My mum and dad then helped me to track my symptoms throughout the month. My mum found me a PMDD symptom tracking sheet online. My dad would ask how I was each day.
Following these discussions with my therapist and parents I wrote multiple letters and requested multiple appointments with my GP (phone only due to the pandemic) for help with the PMDD symptoms. This was over a series of months. I described how intense the suicidal urges were, exactly the thoughts and plans I had. I let my GP know I was keeping a mood diary and could send it to him whenever he wanted to review it.
I asked for a referral to a gynaecologist if my GP didn’t have the means to explore the cause of the symptoms. I asked to discuss oral contraceptives as treatment. Most appointments were only 2 minutes long unless I was feeling well enough to press my point (to no avail) in which case the call time might reach 4 minutes.
I asked for second opinions within my GP surgery. I spoke to two other GPs. The first was a locum doctor who asked detailed questions and then gave me the phone number of the local crisis team and booked an appointment in with my regular GP. The second, after I had described that I specifically needed help to alleviate severe suicidal urges and paranoia and that I didn’t feel safe, asked if I had considered trying to lose weight – and even though I began to sob down the phone they continued to ignore the severity of distress I was in and after a few minutes ended the call.
Now I have done everything in my power to get better. I chose early on to get better and to not give in to suicidal urges even though my suffering was unbearable and this illness has by far been the worse experience of my life. Even when I had not slept for days and had been crying for hours and could barely string a sentence together or do anything for myself – I would still ask my mum to go a walk with me, even if I could only manage 5 minutes, and I was in complete agony and sobbed the whole way.
I would have died from suicide or self-neglect if I didn’t have amazing parents that found the strength to try and make me eat and drink, pick up prescriptions, endure me crying everyday for months, allowed me to live in their house and have the patience and attentiveness to help me keep safe.
When I first broke down in July last year my mum had planned to bundle me in her car and take me to A&E. But she so happened to have an appointment with a nurse at the same practice I’m registered at and broke down in tears to the nurse and then wrote a quick note to my doctor. I’m very glad to have not been hospitalised, but the lack of input from the GP / primary care has left me wondering would I have been in some way better off to have gone into hospital as a means to receive secondary care.
The only input my GP has offered other than prescribing anti-depressants (I accessed therapy through self referral) is that he gave me the name of a private psychiatrist that may or may not be appropriate to contact and if I wanted he would give me a letter of introduction for me to then contact this psychiatrist. I would then have to pay whatever some of money to be diagnosed, but with no explanation as to what the follow up would be. PMDD is not widely known about but understood reasonably well. Mind and the NHS amongst others all detail causes and treatments. However my GP will not engage with further discussion of the symptoms I’m experiencing beyond offering anti-depressants and sleeping tablets.
The response I’ve received from the GPs I’ve spoken to is that menstruating women get bad pre menstrual symptoms sometimes and that’s the way it is. There seems to be no way of getting referrals to secondary care (gynaecological or psychiatric) unless – I assume – you become hospitalised by your condition, and even then it’s not a given.
My hope is my PMDD symptoms continue to ease as my depression symptoms ease – and that’s all I have to go on right now. But given the severity of the symptoms I’ve reported and percentage likelihood of suicide attempts by those with PMDD I cannot fathom how there is not more support available or that it isn’t taken more seriously. It seems to form part of a wider picture of women reporting pain and illness only to be not taken as seriously as men – that women were made to suffer and regardless of what medical interventions are available women are not worthy of them.
Like I said, I think there is a good chance these PMDD symptoms will subside for me, hopefully entirely in time, as they were brought on by this severe bout of depression. However 5% of women suffer with PMDD with many more suffering with 5 or less symptoms. So how is there not a readied response of treatment when severe PMS symptoms are reported?
I wrote these thoughts and recounts down in snippets over the course of the day. I’ve now painted my nails and eaten freshly picked strawberries. And in a few days I’ll feel more like myself. But as the anxiety and hopelessness brews in my chest before I try to sleep again I can’t help but feel there should be more support for anyone going through this.
