Reverse PMS?

October 31, 2010 1:01 PM

Period Questions: Why do I feel fine the week before my period, then depressed, tired, anxious the rest of the month? Help me have a more productive discussion with some sort of medical provider.

I feel like I have reverse PMS. The week before my period, and the first days of it, I feel GREAT. I don't need as much sleep, I'm in a great mood, I desire healthy food and can handle cravings for sugar and fat just fine. I feel creative and competent.

Then I get my period and two days later, I'm exhausted, irritable, craving sugar and eating Nutella straight from the jar. This will continue for about 2-3 weeks until it's time for my period again.

During the "good" times, any medications I am work just like they should, I am able to exercise, I don't feel as emotionally overwhelmed by everything.

During the "bad" times, Adderall and anti-anxiety meds do little to nothing. I get nothing done at work or home. i want to be alone and sit curled up in a blanket reading or watching movies or tv.

My boyfriend of 5 years has also noticed this change. In fact he can tell just as well as I can now when I'm getting my period. I've never needed to keep track of my period because I always know - one night I wake up early, like 5am and feel fine, as if i just "snapped" out of a bad phase or something. I have been keeping track of the last few months and it's pretty obvious it's not just a random thing.

I have been on birth control several times over the years, various pills and the Ring, and after a few months, it just made the bad symptoms so much worse, so so so much worse, like crying spells and worse irritablity.

What gives? As an example, I slept until 930am (which was about 9 hours of sleep), but after i came downstairs, i fell asleep on the couch again for another hour, just completely zonked out. Then we went to eat at the thai place we normally go to, I was so exhausted, I had to come home and lie down again. Slept like i a rock for another 3 hours. And I can feel my irritable mood is back. Fun.

I've tried to talk to my GP about it and really gotten nowhere. He thinks my ADD and GAD are to blame. I've been on several different SSRIs and they made me feel like hell. Zoloft made me a zombie. My pdoc and counselor are mystified. I'm thinking of going back on BC and making an appt at Planned Parenthood,which is where I have always gone for lady parts stuff. I know they'll just suggest another BC. I've been on triphasic and monphasic. I've been on Yaz, Seasonique, Ortho Tri Cyclen, Nuva Ring. and some other thing i can't remember.

I'm just tired of having only 7-10 days where I feel productive and alive out of 30 where I feel miserable, depressed, achey, and tired.

posted by sio42 to health & fitness (9 answers total)

Maybe PMDD? Rather than going back to your GP for this, look for a gynecologist who specializes in menstrual disorders. It might take a lot of hunting, but you should be able to find someone willing to work with you to solve the problems.

You can call your insurance provider and ask for a list of in-network OB/GYNs and then look each of the docs up online to find out what their specialties are. Or call their offices. Look on Yelp for reviews. Also ask friends who they see and if they're happy with them.
posted by phunniemee at 1:09 PM on October 31, 2010

When you were on the pill, did you still have the good 7-10 days? Was it the same with all pills? That might help provide a clue about whether this is tied into the way a particular hormone, or that hormone's rise/fall affects you.
posted by needs more cowbell at 1:26 PM on October 31, 2010

most women I know who have closely examined their mood and their menstrual cycle, have identified a consistent pattern to their moods. For those whose life is severely impacted by the moods they have spent years trying to create a management plan which usually includes:

seeing a female doctor
using birth control (a lot of trial and error until a suitable one is found)
modifying diet (eg alcohol, sugar, etc)
modifying lifestyle (maintaining an to an exercise routine)

SO i'd suggest continuing to try and get your personal balance right. This is what i've had to do.

I have one friend with ADD, she had a long struggle to find medication that helped the ADHD, when she finally found a good medication, she said that her menstrual cycle related stuff also stabilised.

So maybe its about finding a doctor who will work with you on all these aspects together.
I hope you can sort it out. Good luck.
posted by MT at 1:27 PM on October 31, 2010 [1 favorite]

The phase of your cycle during which you're feeling good is the luteal phase. It's marked by high progesterone and lower estrogen, although there are other more complex hormonal factors. Progesterone is absolutely the hormone that makes many women feel kind of like shit right before their periods, so the fact that you call it "reverse PMS" is interesting. I have no clue why you would feel this way, but I would possibly ask for a referral to a reproductive endocrinologist -- they'll be most familiar with normal and abnormal variations in your menstrual cycle, and may help you find some tighter correlations.
posted by KathrynT at 1:40 PM on October 31, 2010 [5 favorites]

Given what KathrynT explains about progesterone/estrogen levels, have you tried any progesterone-only contraceptives? It'd be interesting to know whether they affect you more positively than the combined estrogen/progesterone contraceptives you've tried. Progestogen-only contraceptives include pills such as Micronor, the implant Norplant, and the IUD Mirena; seems like you'd want to try the pills as a test, before trying any of the longer-term methods.
posted by Ery at 2:45 PM on October 31, 2010

As KathrynT mentioned, your levels of progesterone and estrogen both fluctuate during the menstrual cycle -- google "hormones menstrual cycle" and you'll find a number of charts. You may be affected by absolute levels of progesterone or estrogen, or by rapid changes in one or the other, or by the balance of the two. Some women, for instance, have mid-cycle depression, when their estrogen begins to drop from its peak.

It sounds like you've got a pretty good handle on when your symptoms occur, but it can't hurt to keep a log, keyed to the day of the menstrual cycle.

Try to find a doc who is familiar with PMDD (premenstrual dysphoric disorder); although your symptoms aren't strictly pre-menstrual, it does sound very likely that they are keyed to some of these hormone fluctuations, and a good doc should be able to help you figure out how to address this. Some treatments for PMDD can include adjusting or changing birth control, antidepressants (either taken all the time or only during the phases when you have trouble), and cognitive behavioral therapy. You'll want somebody who can help you think through the different options, and work with you until you find things that work.

Good luck!
posted by wyzewoman at 3:08 PM on October 31, 2010

i have an appt next week with the reproductive health dept at the university hospital.
i figured i'd give them a go even tho i normally go to Planned Parenthood for birth control.

the hospital has a reproductive endocrinology clinic if i would need to be referred for testing.

i'm glad i have some better terms to use now and that bit about what hormones are supposed to be having a particular effect is interesting. maybe my hormones are backwards? i don't believe i've ever knowingly tried a progesterone-only BC pill. but i've been on a lot of different ones.
posted by sio42 at 10:02 AM on November 1, 2010

Are your periods heavy at all? Low iron or even anemia might be involved, so make sure you get your iron levels tested. If your iron is at all low, iron pills will help you feel better. Slow Fe is good because it shouldn't make you constipated or anything. Whatever you do, do not get iron supplements from GNC because they have nowhere near the amount of iron that doctor recommended iron pills have.
posted by serena15221 at 11:23 AM on November 1, 2010

my periods were very heavy when i was younger, but not so much anymore. i also don't get as bad of cramps as i used to get when i was a teenager.

also, to answer someone's question ... when i was on BC before, the "good" days slowly went away and i would end up with very stereotypical PMS mood swings - crying at nothing etc. the way it is now (and has been for the better part of 10 years) is that i get cranky and sensitive in the middle of my actual period, not before.
posted by sio42 at 12:02 PM on November 1, 2010