SPEAKER_00 0:57

Hello and welcome back to Behind the Paddle Podcast. And we are going to be talking about today the rage before the storm, living with PMDD. Well, what is PMDD? Millions of people assigned female at birth have premenstrual dysphoric disorder. So on this episode, we're going to walk through the biology, the psychology, and the lived experiences of PMDD, a condition that hijacks the menstrual cycle and weaponizes it against the person who bleeds. But this isn't just about hormones, it's about medicine's long, shadowy history of dismissing women's pain. It's about identity and the terrifying question of who am I? when one half of every month feels like someone else entirely is living inside of you. On today's episode, we're gonna unravel the science, the shame, the survival behind PMDD, and why it exposes the cracks in how society understands both biological women and mental health. So I actually came across a TikTok of a woman talking about this and how very new it is. And we'll get into the history, but I was in awe because I was like, what is this? This might explain how I feel. And like I found it very, very interesting that there was a lack of knowledge about this, and not that many people knew about PMDD. So I was like, let's make a podcast episode about this. Like, I have listeners. So I don't know if I did intros, but yeah, Pulse of Victoria, hi. I just get right into this. So, what is PMDD? Premenstrual dysphoric disorder affects roughly five to eight percent of menstruating individuals. Now that might sound small, but globally that's tens of millions of people. The term dysphoric comes from the Greek dysphoros, meaning hard to bear, and that's exactly what PMDD is: a disorder that makes the luteal phase of the menstrual cycle, the two weeks before a period almost unbearable. And you have to remember there are four phases of the menstrual cycle. You've got the menstrual phase, so like the actual period, you've got the follicular phase, and then you've got ovulation, and then you've got the luteal phase. They don't teach you this in schools, which again is another reason why I love him in my podcast, where I can like I can talk to my computer, I can talk to a mic, and say what is on my mind this week, and that I feel like we do need to hear more of. The symptoms aren't just PMS turned off a notch. They're very deliberating and can often include intense mood swings, crushing irritability or rage, severe anxiety, suicidal ideation, physical pain and fatigue, cognitive fog so dense it feels like drowning in your own mind, and for some it feels like having bipolar disorder, but only half the month. And then as soon as bleeding begins, it's gone. A sudden calm after the storm, you could say. The self returns, the guilt sets in, and the cycle resets, and it's it goes over and over and over again. It's a horrible circle. Imagine waking up each morning in the same body, the same home, the same relationship, but half of those days you don't recognize yourself. You lash out at people you love, you question your sanity, and you can't tell if what you feel is real or hormonal treachery. The cruelest part, I think, from reading up PMDD, because I don't know if I've got it, like it's so hard to get a diagnosis for anything these days, never mind when you're a woman, and to get the doctors to actually take you seriously and for them not to just say, Oh, it's your time of the month, or oh go take a bath, you know, like it makes you doubt your own emotions and it makes you doubt yourself and it makes you feel invisible. So what's actually happening inside the body? PMDD is rooted not in abnormal hormone levels, but in abnormal sensitivity to normal hormone changes, particularly to progesterone and its metabolite, alloprenomelone, which act on the GABA receptors in the brain. We are dealing with some big words today. And the GABA are the primary habitatory receptors in the brain binding to the neurotransmitter GABA to reduce neuro excitability. So we're just gonna talk about the receptors just for a little second. So we've got um GABAA receptor, and then you've got B receptors, and then you have C receptors. So the job of A. A receptors are primarily involved in fast synaptic inhibition. When GABA binds to the receptor, an ion channel opens, thereby allowing chloride ions to move across the cell membrane as chloride is negatively charged. This results in ipolarization, making the membrane potentially more negative and less sensitive to depolarization. And so GABAB, their job is they function as slow somnatic inhibitors, exerting inhibitory effects through the second messenger system. And then C, they're unique in what they do. They consist of only P subunits, uh, P1, P2, P3. The role of GABAC receptors is not fully understood and remains under investigation, although they appear to have an important role in retinal signal processing. So, like, there's still so much we don't know about the bodies. Never mind women's bodies. And this was published um February 18th this year. Just what I'm reading off of um the National Library of Medicine. So getting back to the luteal phase, progesterone rises. In most people, this has a calming sedative effect, but for those with PMDD, the same hormone causes a paradoxical reaction, anxiety, irritability, and depression. In simple terms, their brains overreact to hormonal fluctuations that other bodies handle smoothly. It's not about weakness or emotional instability, it's about the neurochemistry's sensibility. A body wired to feel every tremor of its hormonal tide. So there hasn't been many studies on it, but the most recent neuroimaging studies show that people with PMDD have different patterns of activation in areas like the amygdala and the prefrontal cortex, the regions involved in emotion regulation and impulse control. So when someone says it's all in your head, the truth is yes, but not in the way they think. It's not imagined, it's biological. That we can tell, because again, there is not that much research. But here's the thing: PMDD was only officially recognized by the American Cetriatric Association in 2013 when it was added to the DSM V. Now, we have talked about the DMS5 before, so what that stands for is Diagnostic and Statistical Manual of Mental Disorders. So this is a handbook published by the American Psychiatric Association, where the book um has common language and criteria for diagnosing mental health disorders. So, like, this is the book of all books when it comes to like mental health stuff. So this information is less than 15 years old. Which means for decades, millions of women were told they were moody, unstable, dramatic, or just PMSing. PMS stands for premenstrual syndrome. I love that a lot of people these days use like shortened words and they have no idea what the hell they mean. So every now and again doctors misdiagnose PMDD as depression, borderline personality disorder, or generalized anxiety disorder. Many women spend 10 years or more before they receive a correct diagnosis. And it's not just misdiagnosis, it's dismissal. When women describe rage, despair, or suicidal thoughts tied to their cycles, too many doctors minimalise it. They say maybe you're just stressed. Have you tried yoga? Have you tried exercise? This is the legacy of a medical system built by men for men. One that historically treated female hormones as pathology rather than physiology. In the 19th century, doctors called it hysteria. In the 1950s it was nerves. Today it's just PMS. Different wording, same silencing. The impact of PMDD goes far beyond hormones. It dismantles careers, relationships, and self-worth. Research from the International Association of Premenstrual Disorders shows that over 30% of people with PMDD have attempted suicide or experienced suicidal thoughts. Thirty percent. That's not moodiness, that's despair. Many lose jobs because of their productivity drops psychally. Partners leave not understanding why love can coexist with volatility. And the shame that's deep, the unspoken shame, keeps people silent. It's the kind of silence that really does kill. The world really does refuse to want to understand what is happening in women's bodies. So as I said previously, I just stumbled across this on TikTok. A woman talking about her own experiences with PMDD and how she felt whole again, being able to have some answers. Women must constantly perform emotional control in a system designed to punish any deviation from that. PMDD is biological, yes, but it's also political. Because the structures that make it unbearable, the lack of diagnosis, the treatment and compassion are social. When medicine calls a woman's pain hormonal, what it's really saying is it's not my problem. And that is the real sickness. Women are not believed, and we're not researched enough. There is a massive hole in women's research. The PDSM5 defines PDMM as a mood disorder tied specifically to the luteal phase of the menstrual cycle. To qualify for diagnosis, a person must experience at least five symptoms, including one mood-related symptom, like severe depression, anxiety, or irritability, in most cycles over the past year. These symptoms must resolve within a few days of menstruation starting and must cause clinically significant distress or interference with work, school or relationships. See, it doesn't it sounds straightforward? It does. Where it's just like you need to make sure that this is happening with you on a regular basis, but you need to be in so much pain, it is cruel. Sounds straightforward? It's not. There's no like blood tests, there's no brain scans, diagnosis is it depends entirely on tracking systems daily for at least two months. It's a process of self-observation that can feel like auditing your own suffering. And I know especially with having ADHD, it is very difficult to do that in the first place, to self-monitor yourself in the correct and calm way. And like many other things in the world, many people discover PMDD through online support groups, not actually doctors. Imagine needing data to prove that you're in pain. That's what it's like living in a biological female body. Doctors miss PMDD because they're not trained to see it. A 2021 survey of primary care providers found less than 20% had ever received formal education about PMDD. And this was a survey that was in the UK. A significant majority of primary care providers, GPs, had little to no formal education on this. Most confuse it with PMS or depression. And because many women are already prescribed antidepressants, the cycle of misdiagnosis continues. There's also bias. When a woman reports mood swings, it's hormonal. When a man reports them, it's stress. Because these biases shape who gets referred for mental health support, who gets medication, and who gets labelled difficult. Medicine has always had a complicated relationship with biological female emotion. We're told to track it, contain it, and if it leaks, medicate it. But the truth is PMDD doesn't fit neatly into psychiatry's boxes. It sits at the crossroads of endocrinology and mental health, and that's the crossroads medicine still doesn't know how to navigate. So once someone finally gets the diagnosis, what happens next? Well, there are four primary medical approaches. So you've got number one, selective serotonin reuptake inhibitors, SSRI. Then we have number two, hormonal treatments like birth control or GNRH agonists, surgical interventions, and lastly, lifestyle and integrative therapies. So we're gonna go through them one by one. So SSRIs, such as fluxatine, prozac, cetraline, zoloft, or peroxetine, are considered first-line treatments for PMDD. Unlike in depression when SSRIs take weeks to work, in PMDD they can be effective within days because the mechanism targets serotonin sensitively that fluctuates with the menstrual cycle. Some take them continuously, others only during the luteal phase, a method known as intermittent dosing. Of course, for many SSRIs are life-changing. They turn the tidal waves into ripples, but they're not perfect. You know, you've got side effects with everything. You've got loss of libido, fatigue, emotional blunting. It can feel like exchanging one kind of loss for another. And because PMDD's cause is hormonal sensitivity, not a serotonin deficit, SSRIs treat the symptoms, not the root. So then you've got hormonal therapies. Some clinicians prescribe combined oral contraceptives, especially those containing drospirinone, to flatten the hormonal peaks and froths that trigger symptoms. But again, results vary. For some it's a miracle, for others it worsens mood instability. The more extreme option is GNRH. Agonists, drugs that induce temporary menopause by shutting down ovarian hormone production. They can be effective, but they also can cause bone density loss and menopausal symptoms, making them unsustainable long term. So you can also have surgery. When nothing else works, some turn to hysterectomy with overectomy, which is removal of the uterus and ovaries. It can be seen as a last resort, and yeah, it's really to be taken seriously. Imagine being so desperate for peace that you remove your organs. For those who choose it, it means freedom. But it also raises difficult questions about how medicine values women's reproductive health and the fact that too often the only cure offered is sterilization. So lifestyle in integrative therapies. So like obviously we can talk about exercise, nutrition, mindfulness, cognitive behavioral therapy. They're not cures, but they help regulate the nervous system. Some find relief in magnesium, vitamin B6, or calcium supplementation. CBT helps people untangle guilt from biology to see their rage as moral failure, but as data. Because at its core, PMDD is a disorder of miscommunication between body and brain. Healing begins when you learn to speak about it again. So I did a little bit of research of actually speaking to women with PMDD before making this episode. They just what one of them mentioned about how they just wanted to stop feeling crazy, which is like a really sad take on it. And nobody ever wants to feel like that. And I feel like the people who are surviving PMDD, It's not about erasing emotion, it's about building structure around chaos. And sadly, you do have to like map the cycles, track the triggers, and create safety plans for the worst days. And some people use colour-coded calendars. It's horrible because we shouldn't be living like this. And when you have partners, they have to learn like the rhythm too, and they have to offer space and not judgment. And when you're employed, yeah, they it would I should hope that the employers would be okay with it. Because we can't help it. We literally can't. And hopefully things do change for the better in the workplaces where when women do have PMDD or endrometriosis, where it is very, very unbearable. Not even when it's just your time of the month, not even just when you're on your period. So one group who you can actually speak to is the IAPMD, the International Association of Premstrual Disorders. It's a global nonprofit organization. Organization that supports individuals with PMDD by providing resources, educational materials, and directing users to peer support groups and a directory of healthcare providers knowledgeable about PMDD. Main um support in the UK. We have rethink.org and then we have NAPS, which is the National Association for Premenstrual Syndromes. Rethink mental illness, so rethink.org is really, really cool. You can find like a whole page on PMDD, and they even give you a fact sheet and key facts, and is it common? And like you know, you know, you get answers to some of your questions there. The National Association for Premenstrual Syndrome, NAPS, that is a lovely charity that is set up to provide information, advice, and support for PMS sufferers and their families. I would definitely look into those if you do want to reach out to anybody. There's not a lot out there, sadly. But we have some, it seems. It's hard to not notice the pattern. When a condition primarily affects women, it takes decades to believe. Endometriosis, PCOS, fibromyalgia All minimized as women's issues. PMDD joins that lineage. And that demissal isn't neutral, it's systemic. Misogyny coded in scientific language. Funding for PMDD research remains microscopic compared to male pattern disorders. Pharmaceutical interest is low because there's no blockbuster drug to sell. There's nothing to profit off of. And the emotional labour of managing the condition falls, predictability on those who will suffer. Yeah, it might be seen as self-care, but often it's self-rescue. So now we're going to talk about relationships and the politics of emotion. Love under PMDD is not ordinary love. It's a love that learns the phases of the moon, the calendars, betrayals, and the ways hormones can sculpt behaviour. It's the love that must stretch around rupture. Partners often describe life with PMDD as two relationships in one. Half the month, warmth, humour, ease. Then suddenly the ground tilts, patients evaporate, sensitivity spikes, arguments ignite from nothing. Research from the University of Oxford found that over 60% of people with PMDD report significant relationship strain. Nearly one in five experience separation or divorce directly linked to cyclical systems. It isn't that love disappears, it's that perception shifts. Neurochemistry colours reality until even tenderness feels like fret. Partners unprepared internalize the volatility as rejection. Those with PMDD internalize the aftermath as guilt. It's a heartbreaking duet of misunderstanding. The cruel thing about PMDD is that it targets the very thing that could help: closeness. Society has long used hormonal as shorthand for irrational women. From ancient notions of wandering rooms to sitcom punch lines about that time of the month. Female emotion has been meticularized into mockery. When a man shows anger, he's passionate. When a woman shows it, she's hormonal. PMDD lives in that double standards crossfire. Because when a biological condition genuinely does intensify emotion, patriarchy seizes it as proof that women are unstable by nature. That misconception isolates sufferers' fervour. It feeds shame, the sense that one must hide or apologize for biology. But PMDD isn't a caricature of moodiness. It's a measurable neuroendocrine, sensitivity. The rage isn't random, it's patterned. And it is aren't weakness their signal. In BDSM we talk about informed consent, the idea that you can only give or receive what you understand. Living with PMDD demands the same principle in every life. Partners must learn the cycle map. They need to know when words may land harder, when patience matters more than persuasion. Communication isn't about walking on eggshells, it's about transparency. A simple sentence, like saying, I'm in my luteal phase, I need space today, can transform blame into understanding. Some couples share calendars, others develop code, a colour, an emoji, a quiet signal that says, it's here. And you don't want to argue, you don't want to, you want to have your space. It's empathy as strategy. PMDD ripples into every domain. Parents may feel shame when rage or exhaustion makes patients vanish with children. Friends misread isolation as disinterest. Employees mark sick days as unreliability. A 2023 UK survey found that over 40% of those with PMDD had taken unpaid leave or lost jobs because of symptoms. And yet few workplaces offer menstrual health policies. We accommodate broken bones more readily than clinical brain chemistry. Imagine if HR departments tracked hormonal disability the way they do chronic pain, with empathy, not embarrassment. That's the next frontier of inclusion. And let's not forget, in 2013, when the DSM5 finally acknowledged the disorder, it wasn't because pharmaceutical companies demanded it, it was because patients did. Grassroots organizations like the International Association for Premenstrual Disorders started as small online collectives. Today they operate across continents, providing research grants, suicide prevention resources, and clinical training materials. Their mission is simple to make PMDD visible. This is what I mean by like when people are apolitical or when they don't have a stance on the government and they say, Oh, what will my voice do? You will get heard. And we really hope that science does properly catch up. Science is moving very slowly for women, and women's pain has always moved faster. And that's why advocacy and research are so important. So I'm hoping over the next few years there will be more research on this. But that's all the research really we have right now. So this has been Behind the Paddle Podcast. Thank you so much for listening. If you or somebody you love is struggling with PMDD or pre-menstrual related mood symptoms, please go visit the resources which I have named in the show. And remember you're not alone, you're not too much, you're not broken. It's all the brain and the body and biological and you will get through it. It's hard. It is very hard being a biological woman when you have a lot of hurdles to jump through and people don't take you seriously. But if you enjoyed this little wee episode, then please leave a like, please go follow. And yeah, if you have any more topics you want to listen up to and for me to talk about, then yeah, let's do that.

unknown 33:48

Bye.