Losing about half of every month to PMS sabotage brain
May 15, 2017 11:40 AM   Subscribe

Because I am already dealing with issues around concentration/motivation/depression, my monthly cycle is seriously impacting my ability to meet my own personal goals and be a productive member of society. Is there anything I can actually do, besides commit to the life of an Oblomov?

Since I was a teenager (I'm 27 now), I've struggled a lot with three things:

1) Doing the things I'm supposed to be doing instead of the things I want to be doing,
2) Focusing when my brain desperately does not want to focus,
3) Anxiety and depression (most likely) resulting from anxiety, which occasionally makes goal-setting and follow-through difficult

It's a familiar story: through most of high school, I had barely any work so I focused on my own things, including writing poetry at 3am and learning to program, neither of which were part of my school curriculum. I got straight A's and went to a good college, and the workload promptly kicked my ass, because suddenly I had to plan on what to do every single day and then actually do it for hours in a row.

I know a lot of students struggle with this and slowly adapt to their new life of taking responsibility for their own actions. But I never really did. I spent most of the time feeling like my brain was stuffed with cotton and I'd gone cross-eyed, until maybe getting hepped up enough on caffeine to pull all all-nighter and do some quality work. My quality work was good quality work and I would excel in courses with loose deadlines, but strict deadlines were killer and I dropped out of the math program to do poetry and literature. I did about 25% of the reading, choosing instead to just obsess about whatever I was writing a paper on and ignore the rest. I made myself invisible during class and never participated, partially due to social anxiety and partial due to not having done the work.

After a couple years of being a shitty, frustrated 9-to-5 office employee who could never focus, I realized I needed treatment and went to a GP and a psych. I'm on a combo of Zoloft and Wellbutrin, which treats the depression and anxiety, and compared to before I feel like a million bucks. For half the month, I'm productive, wake up with a clear head, do the things I need to do and feel like I'm actually competent. Then about three days before my period... poof. I'm sleepy, irritable, foggy-brained, can't focus, can't resolve to do anything, don't get things done, drop the ball, go into hibernation for about two weeks until I regain self-control. Not only do I suck as a person during these two weeks, but any progress I make on self improvement for the rest of the month (eating better, doing my readings, starting homework on time, being a sociable and pleasant person) kind of goes poof too and I lose a ton of time to playing catch up instead of building on my good habits.

It's really frustrating. I've talked about it with my therapist and she thinks I should be screened for ADHD. I agree, but unfortunately I'm currently a student with a student's health insurance, and my school has a policy of pretty much no ADHD meds for any student at any time. The guy who used to do the (very onerous) screening for ADHD meds doesn't even work here anymore, so there's no avenue whatsoever to be evaluated, besides buying your own insurance, which I can't afford. In three months I'll be on insurance through my new job and I will probably see if I can get evaluated then. (I don't even know that this is the problem, but if it is, I'd like to know!)

But for now, is there literally anything I can do? It's so frustrating to be in thrall to my fucking hormones every month and fall behind in all my classes, and I imagine once I start my new job (where I really want to do well!) it's going to be a big challenge. Does anyone else struggle with this? Has anything helped? It would even help to just put things on hold instead of actually making them worse during the Wretched Time, but it's really like my executive function just dissolves for about two weeks and I'm on something worse than autopilot.

I'm currently not on any form of birth control (very occasional condom use) and HBC pill has historically made me sensitive and touchy. I had a Mirena for about a year, but side effects and random bleeding were driving me nuts (and it didn't really affect this issue, I still had the mood swings). I prefer to be on no hormones, but I realize I might need them to treat this.
posted by stoneandstar to Health & Fitness (14 answers total) 16 users marked this as a favorite
Oops, forgot to mention that at one point I was on the Levora pill, which was my best experience with HBC and I felt no side effects. But my insurance provider switched to covering a different formulation for general use a couple years later and I hated the new brand and haven't been able to get a prescription for Levora since. I don't remember if it had an impact on this no-brain thing or if I had these same problems then.
posted by stoneandstar at 11:53 AM on May 15, 2017

Levora is a common generic birth control pill; other names for the same formulation include Portia, Nordette, and probably a bunch of others. It's 0.15 mg levonorgestrel and 0.03 mg ethinyl estradiol. Doctors can usually specify specific formulations for birth control, even on insurance (due to different side effects), so you should not be stuck with whatever random "starter" birth control pill they suggest, although you may not be able to control which generic version you get (Levora vs. Portia and so on.) Incidentally, as a monophasic birth control pill, Levora is well-suited for continuous use, which may be worth looking into with regards to hormone fluctuations, and could be something to ask your doctor about. (None of this is a guaranteed fix, of course, but since it sounds like you tolerated that hormone mix well, it might be worth another try.)
posted by ubersturm at 12:08 PM on May 15, 2017 [3 favorites]

If the Levora worked that well for you, it might be worth seeing if you can source it through another venue and still have it be affordable, like Planned Parenthood or the manufacturer. If nothing else, try it for 3 months and if it makes that much of a difference your doctor may be able to appeal for an exception to your insurance.

I would suggest discussing this with a gynecologist, though, since they may have other resources and may be able to recommend some testing that might give a little clue to what's exactly happening in those two weeks. It might be that you need a hormone assist for just part of the month, though I think doctors tend to default to the pill rather than fine-tuning what you actually need.
posted by Lyn Never at 12:10 PM on May 15, 2017

Thanks, uberstrum; as a note on that, my attempts to get a prescription for a similar pill (in the same formulation, the Nordette family, whatever) haven't gone well; doctors tend to look at me like I have grown a second head and say things like "if you tolerated that, you should be fine with [insert whatever low dose random thing they want to prescribe]." A lot of women on MeFi seem to have an easier time with this so tips on how to get doctors to listen to me about this kind of thing would also be helpful... I only feel I can be so pushy without coming across as a problem patient.

Also, just to restate, I know for a fact I tolerated that pill well, I do not know for a fact that I had these same issues back when I was taking it, or whether they helped/hurt in this area. I just remember my moods being relatively stable; not sure about my motivation/focus.
posted by stoneandstar at 12:11 PM on May 15, 2017

If you can possibly find a doctor who will be very willing to work with you, I'd advocate for just trying a zillion different pills until you can find one you can take continuously without breakthrough bleeding. I did this for my endometriosis and the effects on my bipolar disorder were just icing, but it really has been so much easier to get the mood disorder stable without having giant hormonal fluctuations all the damn time.

It was a pain for about a year of trying things, but I've been on this pill about 3 years and no periods. So, it can be done. And hopefully said doctor will also understand that some people are just acutely sensitive, so trying several generics that are supposed to be the same can actually have different effects.

Honestly, I'd tell you to push, and if you push your doctor away, see if you can find another. There's no one else to advocate for you. It sucks, but it's true.

I hope you can find your magic pill like I did!
posted by fiercecupcake at 12:20 PM on May 15, 2017 [4 favorites]

Oh hey, I am a lot like you. The only pill I've been on that keeps me from being a zombie 2 weeks of every month is name-brand Yasmin. I have tried every generic version that it comes in and my symptoms always return with a vengeance. My last couple of GYNs were convinced when I told them what happened when I take Yasmin vs the generics and they now write the RX to be name-brand only and my insurance covers it. My most recent GYN commented that even though the active ingredients are supposedly the same, the generics are often manufactured in a wildly different facility, may use fillers and other inactive ingredients that are causing me issues, etc.

(I am not saying you should try Yasmin, just that there is hope in convincing a doctor that you really need one specific brand of the pill and that other ones you've tried haven't worked).
posted by joan_holloway at 1:09 PM on May 15, 2017 [1 favorite]

A lot of women on MeFi seem to have an easier time with this so tips on how to get doctors to listen to me about this kind of thing would also be helpful.

If you just respond to them with "No, I need exactly the same pill, not something different. I've tried several other options and this is what works." I cannot imagine anyone responding to you with other than "OK, sure" - why, because there's really no reason it should matter to anyone which pill you're taking. They're not getting kickbacks from anyone, HBC are not controlled substances, it's really just a matter of whatever the patient wants in most cases. If they keep trying to give you something different, keep saying no, although it baffles me to imagine why anyone would want to fight that battle.

Don't worry about being seen as a difficult patient - this is something you can do at Planned Parenthood with a nurse practitioner you're never going to see again. Doesn't matter what they think of you. Best of luck and hope you're feeling better soon.
posted by treehorn+bunny at 1:11 PM on May 15, 2017 [4 favorites]

Not only do I suck as a person during these two weeks, but any progress I make on self improvement for the rest of the month... kind of goes poof too

This was me for years. It really felt like, no matter how hard I tried, I had to rebuild my life every month. It was horrible.

I tried birth control, Mirena, estrogen & progesterone & blah blah blah -- eventually I was referred for a hysterectomy. Yes, people get them for PMS (This blog talks a lot about it).

I hope you're able to go back & get that pill that worked for you, but if it stops working or anything else happens that means you need to look for more solutions, keep pushing your doctors to look for them. Many doctors don't know/don't care about severe PMS & its treatments. It's frigging awful to lose half your life to it every month. Don't give up & good luck.
posted by diffuse at 2:08 PM on May 15, 2017 [1 favorite]

So among my many reproductive bit issues, I have PMDD. Unmedicated, I had the symptoms you describe. I was already taking an SSRI, but my GYN prescribed an SNRI for the PMDD time. I now take only the SNRI (Pristiq) full time and my premenstrual symptoms now consist of a few hours of fatigue and sadness the night before I bleed. I do have a Skyla IUD for endometrial cysts, but that happened in the past year and causes me to cycle every 14 days, but the SNRI has made me functional for over ten years now.
posted by Ruki at 4:06 PM on May 15, 2017

If your regular doctor is not being helpful, is there a Planned Parenthood in your area?

While you work on a better solution, I suggest planning for those "PMS dips" in the month. On a good executive function day, plot your expected dips on a calendar. As you plan other things and make commitments, plan around those days. When you can, try to meet deadlines before the dip or get them pushed back to after the dip. If you have a report due in the middle of the dip, try to get it done beforehand. During the bad days, try to figure what the bare minimum is that you absolutely have to get done and do that (if you can figure it out ahead of time and set up a reminder for yourself, even better).

During the dip make sure you get enough sleep, drink plenty of water, eat well and exercise.

I've been having intermittent brain fog myself which I just recently realized might be connected to my period. I'm on ADHD meds which help me most of the time but don't keep the fog from happening. Running really helped me with both my mood and cramps a few years ago and I intend to try it again to see if it will help with the fog. When reading about ADHD I've read things about sugar contributing to distractability, so you might make note of whether what you're eating affects the fog.
posted by bunderful at 4:43 PM on May 15, 2017 [1 favorite]

I don't have any good answers for you, but wanted to chime in with a "me too, exactly" and thank you for posting this.
posted by colorblock sock at 5:20 PM on May 15, 2017

I started taking birth control and skipping the placebos so I never got my period. It took like three months to really work and then I didn't get any of the annoying PMS stuff: headaches, blemishes, soreness, gastrointestinal issues, etc. They all stopped.

But then I had to switch insurance and they wouldn't cover the birth control I was taking so I switched to a different one and it did not work. I got breakthrough bleeding and blemishes as if I wasn't taking the pill at all. So I called around to see what it would cost to buy my preferred birth control out of pocket, and I ended up paying around $60 for a six-month supply. Some pharmacies were much more than that, so I called around to get the cheapest one, and surprisingly, it was the local, non-chain pharmacy.

I personally would consider doing that, especially if you have a birth control you know works for you. But you might just have to find a birth control that works well for you. I know women who have tried a few before getting the right one.
posted by AppleTurnover at 6:12 PM on May 15, 2017 [1 favorite]

I have a lot of these same problems, and it wasn't clear to me exactly how cyclical they were until I got pregnant (which felt a lot like being on the pill to me) and then breastfed (which felt like being prepubescent and wonderful). Since my cycle has come back at 13 months postpartum, cyclical mood changes have returned. I've had good results with taking a calcium/magnesium supplement (Natural Calm), though I have to be careful with dosage or I get diarrhea. I also just chart obsessively and work on being communicative with myself and others about what's going on. Basically, skills I developed years ago in CBT.

This might sound like woo, but I also try to focus on what I do well during those PMS times. For example, I am really, really good at cleaning and rearranging furniture and doing household projects. Not only do I get my laundry done, but I fold it and put it away, too. It's a good time to think about my relationships (but not act on those feelings), to journey and self reflect on things that I'm not happy with in my life and might need to change in the future. I say this sounds woo-ish because I first read about something like this on a very woo-filled website about harnessing your moon goddess or something. But since hormonal supplements don't work for me, it feels good to just know and be able to expect that I won't be particularly productive in x, y, and z (for me, writing, art, work projects) but I am really good at doing these other things--which often go undone during the rest of the month.

I don't know precisely what this might look like for you, but I'd do some thought work: what do you want to be doing when you're PMSing? Researching a new obsession? Cleaning? Are you hypercritical, say, of your own relationships? Are there any ways to do those things with work or school? Can you dip into a new research area, reorganize your calendar, sort your email, do that sort of thing that might in some ways be "procrastination" but will benefit your work the rest of the month? What would your life look like if you said, "Okay, I won't get this type of project done this week" and then moved your deadlines around so it didn't matter so much?

I've also just tried to shift my narrative around those times. Like I don't suck--self-loathing gets me nowhere, personally--but my strengths are different during this time. I'm less creative and less industrious but I'm also harder and sharper, and sometimes that's good, too.

It also does sound ADHDish to me--I'm probably ADHD-inattentive type, though I haven't been formally diagnosed. I do use a lot of hacks that seem to help people with diagnoses--for example, timers, when I'm under deadline, using friends for accountability, working while I watch TV, that sort of thing. Even without ADHD meds, there's nothing stopping you for researching ways that others with ADHD handle productivity!
posted by PhoBWanKenobi at 6:17 PM on May 15, 2017 [5 favorites]

PMDD here also, and agree with others that taking the pills continuously (no placebo, and no period) did the trick (while also on anti-depressants for the chronic depression). Also agree that a Planned Parenthood or the like should hopefully be more receptive if you still have no luck getting others to listen. Good luck!
posted by evening at 5:33 AM on May 19, 2017

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