Content warning: This post contains references to suicidal ideation, depression, anxiety, and PTSD
I’ve struggled with severe periods and PMS for as long as I can remember. When I was in high school, I would often have to call my mother to pick me up early because of the severity of my cramps. By the time I went to college, I had gone on birth control pills to help deal with the discomfort and my ever-worsening PMS symptoms (and, eventually, stop my period altogether).
But as my luck would have it, not only am I incredibly sensitive to my own body’s hormones, but hormonal birth control and I have a… tumultuous relationship, to say the least. The pill I was on during college triggered serious migraines, so before I started graduate school in 2016, I tried the Mirena, a hormonal IUD. Well, after two and a half months, I was struggling with depression, panic attacks, and suicidal ideation likely triggered by a cocktail of the extra progesterone and my PTSD from childhood trauma. At the urging of my therapist, I decided to have the Mirena removed and stayed off hormonal birth control while I finished my master’s.
Eventually, I did find an IUD—the Skyla—that was low enough in progesterone where I didn’t notice any severe side effects; in hindsight, I was likely experiencing PMDD symptoms, just at a slightly lower degree. Unfortunately, I had complications with its placement (and determination to move around my uterus!) and ended up removing it and trying out yet another hormonal IUD that, like the Mirena, triggered serious mental health issues within a month. After all of that, I decided that maybe I just wasn’t someone who could handle hormonal birth control. Maybe it was a sign that I should get to know my body off of birth control since I’d spent my later teenage years and most of my twenties on it.
What I didn’t consider was that perhaps my severe reactions could be tied to something else—premenstrual dysphoric disorder, or PMDD. PMDD is diagnosed when a person who menstruates experiences severe symptoms of depression, tension, and irritability in the week before their period. Between 3-8% of people with PMS have symptoms severe enough to be classified as PMDD. Plus, the stigma and pressure many people assigned female at birth (AFAB) face around speaking up about our physical and mental health adds another layer of difficulty to coping with a condition like PMDD.
It wasn’t until I had spent a full year off of birth control that I realized just how affected I had been by my cycle each month, even when I was using an IUD.
It was like clockwork—two weeks before my period started, it would feel like a thick wall of fog had come down in my brain. I felt paranoid, depressed, exhausted, and apathetic all at once. I found myself starting fights with my (extremely understanding and supportive) partner. I couldn’t focus at work. My struggles with body dysmorphia escalated tenfold, making it hard for me to look in the mirror and feel anything but disgust. I was stuck in a brain fog, frequently thinking difficult, terrifying thoughts like, “I wish I didn’t exist.” I truly felt like a different person, like I’d been underwater for two weeks and then had finally come up for air once my period ended. It was scary, and I knew I needed help.
“It was like clockwork—two weeks before my period started, I would feel like a thick wall of fog had come down in my brain. I felt paranoid, depressed, exhausted, and apathetic all at once. For a long time, I thought this was just “normal” PMS, but I had to wonder, “Does everyone feel this way?””
What first clued me into the possibility that I was experiencing PMDD was a friend from college sharing their diagnosis in an Instagram story. Their openness inspired me to post about my own experiences in the summer of 2024, and multiple friends reached out to share that they, too, were dealing with the same thing. As I’m sure anyone with a mental health condition can attest to, that external validation meant the world to me. I also talked to my sister, a gynecologist who approaches all of her work with empathy and kindness, and she affirmed my suspicions that I may have PMDD and encouraged me to speak with my therapist and gynecologist about treatment options.
It took a while to get an appointment, so in the interim, I found myself seeking out help from everyone’s favorite “What’s wrong with me?” platform: Reddit. I read the stories—some of them hopeful, some more horrifying—of other people struggling on r/PMDD, which became a safe space for me, and I felt less alone. I tried out alternative remedies like magnesium, fish oil, and vitamin B12, which made a difference in the severity of my period and evened out some of my more serious PMDD symptoms. I also started exercising more regularly, which has also been shown to help with PMDD and other mental health conditions.
But I knew that I needed something more. As I suffered through a few cycles before my appointment, I tracked everything I was experiencing in a note on my phone—my thoughts, my fears, my physical symptoms—so I would be prepared when I met with my gynecologist.
When I got to my appointment last August, I broke down as I told her what I’d been experiencing. She assured me that I wasn’t alone and that we would work through it together. I ended up being prescribed a low dosage (10mg) of Prozac, an SSRI, to be taken intermittently, a common treatment option for people with PMDD. After a few months, the fog miraculously started to lift, and I was hopeful again.
Now, I’m positive that a combination of the SSRI, continued therapy, introducing more positive movement into my life, and the incredible support system I’ve built quite literally saved my life. I had spent my twenties thinking that what I’d been experiencing was just “normal” PMS, so it was almost jarring to finally feel… normal. With the continued guidance of my gynecologist and support from my partner, I’ve since decided to go back on a newer, progesterone-free hormonal birth control called Slynd that is often prescribed to people with PMDD, and my recovery continues to thrive without the added stress of worrying about an unwanted pregnancy.
If I had to offer any advice or words of comfort to someone who thinks they may be experiencing PMDD, it’s this: It’s OK to ask for help. You don’t need to suffer in silence. PMDD is treatable, and you deserve to feel better.
Visit Mental Health America’s Women’s Mental Health Resource Center to find tools and information to help you manage your mental wellness through every stage of life.
Sarah Heikkinen is a writer and the digital and social media director at Mental Health America.
