For a few days each month, I sleep a lot. I go to bed early. I drag myself out of bed late. I power nap throughout the day.
For the hours I’m awake, I often struggle to find the right words in my soupy brain. Sometimes I find it hard to follow arguments, and arrange sentences, and turn paragraphs the right way up.
I bloat up. I avoid alcohol because it makes my skin itch. Sometimes, I get flu-like symptoms. I get anxious. Like, very anxious. I feel worthless and alone and I get depressed.
I stay home as much as possible. I avoid decisions. I avoid people.
When my period comes, I feel a wave of relief and I grin to myself. Welcome back sanity.
Until four years ago, I had never given much thought to my periods. I never remember them being a big deal as I grew up. Sometimes you got bad cramping, sometimes they were heavy, sometimes you got moody. That was as bad as it got for me: an inconvenience.
For most women, that’s as bad as it gets. But for a minority of us, it’s a lot worse.
No one is certain why some women get hit with severe PMS or premenstrual dysphoric disorder (PMDD), but most agree it exists. What medical experts do know, is that it affects between 2 percent and 8 percent of women in Europe and the US. And it’s something to do with hormones.
Broadly, “it’s about differences in the way the brain responds to fluxes in the hormone levels,” says Xenia Protopopescu, a New York-based psychiatrist who specialises in women’s mental health. Some women’s brains and nervous systems, it seems, are more sensitive.
But emotions and behaviours are complicated and PMDD is unlikely to be triggered by just one factor, she adds.
“There is not just one thing that causes depression. There is not just one thing that causes schizophrenia. And I don’t think there’s one thing that causes PMDD,” she said. “I think it’s an experience of severe mood changes, or severe behaviour changes around the menstrual cycle that different women might arrive there in different ways.”
I’m not sure when my journey started.
In 2012, perhaps. I’d been working as a journalist in India for a year when the changes became clearer. I would feel depressed for a few days, which would evolve to add a high fever and a cold. I’d feel exhausted.
Worst of all, I would cry at inopportune and absurd times: at a lawyer in his office because he implied that I was responsible for colonialism; at a businessman who had been accused of stealing shipments of wheat meant to feed the poor; at a doctor who shouted at me for suggesting there was no evidence that homeopathy cures cancer.
I would feel so frustrated as the silent tears would slide down my face. This wasn’t professional, and this wasn’t a great way to represent women. It felt like I was setting back the Cause. I felt embarrassed for my colleague Chandan, who invariably was there with me, wearing a look of bemusement and concern.
Three days ago, I sat at a small table in my studio apartment above Camden Street and sent a Google Chat message across the world to Bangalore. I hadn’t been in touch with Chandan for a while.
We’d tag-teamed on stories for a newspaper in Kolkata, a couple of misfits, a chinos-and-shirt-clad foreigner often caked in mud, and an Indian kid with square hipster glasses and a love of ripped T-shirts and beat poetry.
I’m working on a story about how I’ve gone a bit crazy, I sent. Can I ask you something? Do you remember how I used to cry at weird times?
From 8,400 kilometres away, the message came back quickly in a square speech bubble. “I don’t remember about that,” he wrote back.
Seriously? I thought.
What about the time I cried at that guy in court because he brought up colonialism?
“That idiot had no reason to bring up colonialism and make you feel guilty about it,” he replied.
What about crying at the business man sat in his cushy office?
“I think you cried in that wheat story because we were not getting anywhere,” he said.
Besides, he said, he cried just a couple of days ago over a girl. So if I was going crazy, so was he.
Chandan might have a point. Were hormones to blame back then? Or was it just the fact that sometimes people around me were acting like douches?
We do tend to over-attribute emotional problems among women to hormones, says Dr Sarah Romans, Professor of Psychological Medicine at Otago University in New Zealand.
Often, it seems that “men and women blame her ‘hormones’ for her mood when a more cogent cause is coming from stress, poor social support, poor physical health and so on,” she told me in an email.
In 2012, Dr Romans and a team of researchers carried out a review of 41 studies to see whether there was evidence that the menstrual cycle is the cause of negative moods in most people. They found that there wasn’t.
The studies “failed to provide clear evidence in support of the existence of a specific premenstrual negative mood syndrome in the general population,” the paper said.
In their review, 18 (38.3 percent) of the studies found no association of mood with any menstrual cycle phase. Another 18 (38.3 percent) found negative mood in the premenstrual and another menstrual cycle phase.
Seven studies (14.8 percent) reported the “classical premenstrual pattern” with negative mood found in the premenstrual phase only. Finally, four studies (8.5 percent) found greater negative mood in the non-premenstrual phase only.
This was the main takeaway of the report: “this puzzlingly widespread belief”, that women get bitchy when they get their periods, “needs challenging, as it perpetuates negative concepts linking female reproduction with negative emotionality.”
It’s not that severe PMS doesn’t exist, she says. “A minority of women have this pattern which can be identified with careful prospective daily symptom ratings.”
But many more show patterns of depression and anxiety all the time, it just gets worse in the premenstrual phase of the month, and so “it becomes the premenstruem which gets focused on (naturally because the symptoms are most severe then).”
For me, in mid-2013, when my husband and I moved to Ireland, the cycles of depression and normality just got more jarring. The stretches of depression and anxiety began to spread. They weren’t a few days any more, they were a week, and then two weeks.
I was two different people. For half the month, I had energy and ideas. I’d start new projects and try to cram my life into the two weeks when I felt happy and sharp.
For the other two weeks, I’d be exhausted and paranoid, and want to hole myself up at home in Dublin. I struggled with the lack of privacy that comes with sharing a small apartment. Surprises made me freak out. Good news made me sad.
That Christmas, we took the bus down to Kinsale. By this point, I’d added another ailment to the list. For three months, I’d been coughing non-stop, night and day.
Our shared apartment in Rathmines was damp, mouldy, and cold. The building manager had promised to fix the broken windows, put on the heat, and put in a extractor fan in the tiny bathroom. He didn’t do any of it.
So, by Christmas, my husband and I were sleep-deprived and I was hacking up brown gunk. After the first sleepless, coughy night in the hotel, we dropped by the first GP we could find, just off Main Street in Kinsale, down by the harbour.
The doctor, an older man, wrote out a prescription to try to deal with my cough. My husband nudged me to ask about the other thing.
I told the doctor that I felt miserable for a lot of every month, that I found it hard to stop crying, that I got depressed, that we argued because of it, that it had been going on for years, and that it lasted two weeks now.
“That’s half your life,” he said. “You don’t have to live like that.”
He told me that I needed to go and see a doctor when I got back to Dublin, who would probably put me on the pill. The other option might be to have babies, he said. I laughed. When I could barely look after myself, that did not seem like an option.
I was lucky, though, that this kindly, older GP who’d just met me saw I was struggling.
It can be challenging to diagnose severe PMS or PMDD, said Shirley McQuade, Medical Director at Dublin Well Women Centre.
“It isn’t something that patients identify necessarily with their health, when we talk to them about their symptoms and how their moods are. Sometimes, they don’t realise that it is cyclical and so therefore they think that their anxiety and their low moods are more generalised that it actually is,” she said.
GPs today can be rushed too and not have time to ask all the questions that might tease out the issues that would point to a PMDD diagnosis, she said. “Sometimes, I think the diagnosis can be missed simply because the consultation time isn’t long enough.”
When I got back to Dublin, it took me a while to go and see a doctor.
I was worried about spending the money. During my bad weeks, I didn’t feel able to take that step. And then, after I got my period and felt better, I found it hard to remember how bad I’d felt.
Maybe, this time, I’d think, it won’t come back again. How can I have thought that the world was that bad? I was just tired, I’d tell myself.
Eventually, I got there though.
Doctors generally ask patients to track their moods for two months of the cycle in order to confirm a PMDD diagnosis, to make sure that symptoms occur right before menses, and ease off when the period starts.
If a diagnosis is confirmed, then the first step is often to encourage lifestyle changes. Patients might be encouraged to cut down on caffeine and sugar. They’ll be encouraged to exercise, and find time to relax with yoga or meditation.
“All of those things can be enough to make people feel better,” said McQuade.
But for those for whom that doesn’t work, there’s the option of anti-depressants or SSRIs, which have shown good results. Some women might take them daily, others for a week or a few days before they get their periods.
I wasn’t asked to do the two-week tracking. Instead, the doctor put me on Yasminelle, an oral contraceptive. I’m not entirely sure what it does, but it seems to level me out.
Sure, I get glum for a couple of days, but I don’t get the weeks of lows that used to make me crouch in a corner and try to rip out my hair. I get tired, but I can get out of bed. And I’ve worked out how to arrange my life around the tougher days.
Sometimes, I wonder why it took me a long time to realise that something wasn’t right.
A part of the problem was a hectic routine; moving countries, apartments, jobs, it made it hard to see the cycles of moods.
But another issue was that I’d never really seen myself as a girl. It hadn’t been a part of my identity.
When we’d go shopping when I was a kid, my sisters would make adults guess whether I was a boy or a girl. They usually got it wrong. I loved football and maths and hated shopping. So, when I started to get depressed, I didn’t think to look there – at periods, at girly stuff.
Dealing with all this, swinging violently back and forth for years between two versions of myself – one sharp and capable and energetic, one dull and timid and exhausted – was a hard on my confidence. Could I depend on my body, my mind anymore?
There’s been a plus side, though. When you’ve been two people, when you are two people, you believe, that bit more, in how different we all are.