PMDD, PPD, or just D?
April 3, 2016 12:36 AM   Subscribe

I've had some severe mood issues around my period since having my son ~5 months ago. Unsure what it is, who to talk to, or what to do.

YANMD (and I'm willing to talk to mine about this) but I wanted to pass this by the hivemind first. In November I had my son and for the most part haven't had severe postpartum mood symptoms apart from a bit of baby blues around 4/5 weeks.

That was until I got my period in February. I didn't know it was coming because I'm BFing and didn't expect it at all but the week leading up to my period was horrible and I thought I was going crazy. I was unreasonably angry at Baby Curls for crying and being difficult to sooth (and had my husband take over baby care during those waves). I cried for hours on end and my self esteem was down in the dumps. I was ticking all the boxes for PPD until my period started. Then it all evened out.

Fast forward to this last week where I went through almost the same symptoms. Irrationally upset and angry, needing to pass off the baby, crying for no reason, feeling down about myself, and then my period started and the symptoms have dropped. This time I thought my period might be coming so I started to look up mood disorders associated with menstruation and found out about premenstrual dysphoric disorder.

It was really like reading a narrative about the last week but it also occurred to me that the symptoms almost entirely overlap with PPD (and regular depression). I also recalled that my periods brought on extreme moodiness as a teenager but I got over it (I mean, for a few years it was rather rough for people to be around me leading up to my period but my mom thought it was a teenager thing). I have PCOS and spent years with amenorrhea (unless I was on the pill or on fertility treatment). When I was a teen and had the horrible mood issues around my period I was on the pill then - so I don't think going on birth control would greatly help with this if it's hormonal.

I'm not asking for a diagnosis but I'd like to know if other women have gone through both PMDD and PPD. If you have, how are they different? What helped with PMDD? I really don't know how to broach the subject with my doctor. Do I just call them up and say that I go slightly crazy before my period and would like their advice? I'm also very hesitant to be diagnosed with a mood disorder. Will that kind of diagnosis in my medical charts negatively impact how providers treat me?
posted by toomanycurls to Health & Fitness (6 answers total) 3 users marked this as a favorite
I also have had lousy PMS while breastfeeding (as one anecdata point). The way I thought about it is that your estrogen levels are lower while you're nursing a baby, and that estrogen affects serotonin and other neurotransmitters, so already low levels of estrogen dropping yet further might have any number of effects on well being :(

I don't think that this will negatively affect how your doctor sees you, and I'm not sure even that you need to jump to the point of "diagnosis." I'd just call the doc and say "I've been having these terrible dips in mood right before my period. Is that typical? Would it make any sense to test my hormones? What are some treatments for this?"

I read The Hormone Cure when I was feeling the worst out of whack, and it didn't do a lot for me because her recommendations involve a lot of dietary, sleep and stress changes, and those can be some pretty hard things to do when you're a bleary zombie chasing a baby. But maybe you are more put together, in which case I'd say check it out in addition to calling your MD :)

I hope you figure out something that works for you! Congratulations on baby curls.
posted by hungrytiger at 1:18 AM on April 3, 2016 [1 favorite]

When I was going through my difficult time, I read somewhere that PMS is worse when you have spent most of your time not seeing to your needs. It's like we can put on a smile and bottle everything up until those few days before, and then it all comes out. What helped me was starting a journal and doing more for myself.

Right now you are a new mom with a baby. If you can afford it, hire a sitter once a week just to have you time. If you can't, hand baby over to the needy grandmother or aunt. Talk to your husband about budgeting more money just for you to be frivolous with, and for scheduling date nights.

You were a full human with needs before you became a mom. Motherhood can muffle us if we let it. Be your full human self again. Fight for it.
posted by myselfasme at 6:20 AM on April 3, 2016 [1 favorite]

I really don't know how to broach the subject with my doctor.

This is a medical problem, not a personal failure or weakness. "My period just came back and I am having funtionality-impairing depression and rage immediately beforehand. This has been a problem off and on since I was a teenager, but under the current circumstances and given the severity, this time it's a big deal and I need help for it." Presumably your doctor is familiar with women's health issues and post-partum health issues, and won't be startled at all. (Ideally, they'd be asking you about this without you even having to bring it up, but some doctors tend to softball this as "and are you feeling okay?" which a lot of patients assume is a physical health question only. But also some doctors are kind of crap about mental and endocrinological health, and in that case you have to pick up the ball there.)

You will be fine even if you have to have a mood disorder listed in your medical history. It is preferable to the kinds of things that can happen if you refuse to seek treatment for fear of having a medical history.
posted by Lyn Never at 9:15 AM on April 3, 2016 [1 favorite]

By the way, if you're really worried about talking to your OB/GYN (though they ought to be well-versed in this), you can try talking to your pediatrician first. They really ought to be asking, too.
posted by Lyn Never at 9:16 AM on April 3, 2016

I found that a similar thing happened after my postpartum period returned at 13 months. I was off the pill for a few years before we conceived, so I'm not sure if my PMS symptoms have genuinely gotten worse or if they largely only appear worse in contrast to the anovulatory moods I've had while breastfeeding ("postpartum elation" is how my husband referred to my state during early breastfeeding; I was more even-keeled than I've been since I was about 12).

Hormonal birth control is not an option for me for several reasons, including that I'm still breastfeeding. I also had mood-related symptoms on the pill, though they varied according to brand. They weren't as clearly cyclical as my moods off the pill, though they were generally more intense.

The way I've dealt with it might sound a bit woo-based for metafilter, I'm afraid. I've decided to take this time to really get to know my hormonal cycles and how they impact my mood, relationships, and creativity, since most of my adult life has been spent on birth control hormones. If you haven't read Taking Charge of Your Fertility, this is a good time to do it. I've found that tracking my cervical position and fluids helps me figure out where I am in my cycle (which is still somewhat irregular thanks to breastfeeding) and how that corresponds to my mood. I'm also doing much more intense tracking of my cycle and mental state, nearly daily.

It's been about a year, and it's been an incredibly helpful, illuminating process. I've found that certain arguments or depressive habits (googling people I feel competitive with, for example) are huge red flags that my period is soon to come. During this time, I start to clean more and engage in nesting-like behavior. My milk supply is also lower, and I'm sometimes more irritable and touched-out toward my toddler. My cycle is something now openly discussed within my relationship, not just "Hey, I got my period, not pregnant!" but rather "My period should be here in a few days and I'm feeling agitated." I think there's some resistance to discussing one's cycle as it pertains to relationships and moods because within our society that suggests that this mental state is "imaginary." It's not, though. I now recognize that my mood is impacted by powerful chemical and hormonal forces, which are just as real as any external, visible force. That's not to justify acting like a jerk according to your cycle but rather to recognize and own the fact that it has an impact on your perception of the world around you.

I've done some reading about cycles and creativity. It's difficult to find resources for this that aren't completely crunchy, silly stuff, but regardless I have been able to extract some wisdom through posts such as these:

These days, during my PMS phase, I try to engage myself in productive physical work. It's a good time to do gardening or household projects, to clean spaces I've let get messy over the previous phase of my cycle. I try to up my iron intake (my period was very heavy before I started doing this) and don't let myself sit and do too much sedentary work, which inevitably makes my anxiety spiral. I do my best not to act on my thoughts during this time, but simply acknowledge my anxieties as something which may need to be addressed once my period arrives. With an infant, this is a good time to strap your baby on your back or into a stroller and just walk, get fresh air, get moving. I try to resist the urge to throw out things that are bothering me during this time--book projects, relationships--which always feels like what I want to do in the moment. Knowing that I can wait, that I have time, that if something is still bothering me when my period arrives, then I can act then has been intensely liberating (I will say that I'm not sure any of this would be possible without having gone through CBT several years ago). This is going to sound super silly, but since I'm watching a lot of Mister Rogers with the kiddo lately, I find myself singing The Mad That You Feel a lot. Knowing that my feelings are real, but that I don't necessarily have to act on them right now, is so, so empowering.

The benefits to this for me have been huge, not only in that I've gained a new vocabulary and understanding of my own physical processes, but in that I've also been able to channel and master the more productive phases of my cycle, too, like the optimism and creativity that comes right at the end of my period. It's been scary, in a way, to try and work with my cycle instead of trying to negate or dismiss these feelings, and I know it might not work for everyone. But I think talking about these things is the first step. What you're experiencing doesn't seem to be unusual among the postpartum women I know. You're not alone.
posted by PhoBWanKenobi at 9:18 AM on April 3, 2016 [7 favorites]

Before I opted for a hysterectomy, I also had mood swings and depression before my period (although not near the level you are describing). My OB suggested taking Prozac for the 1-2 weeks of PMS before my period. They prescribe a much lower dose than what is typical for SSRIs (I believe he said it was 1/10th of the usual dose, so maybe 2mg?) but it will help with the mood changes that come with this hormonal upheaval. If you're open to taking meds - and I am not sure how this affects breastfeeding and/or if medication is an appropriate choice while doing so - this might be a conversation to have with your OB.
posted by sealee at 5:11 PM on April 3, 2016

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